Scientific publications

International Myeloma Working Group Recommendations for the Diagnosis and Management of Myeloma-Related Renal Impairment

Dimopoulos MA (1), Sonneveld P (2), Leung N (2), Merlini G (2), Ludwig H (2), Kastritis E (2), Goldschmidt H (2), Joshua D (2), Orlowski RZ (2), Powles R (2), Vesole DH (2), Garderet L (2), Einsele H (2), Palumbo A (2), Cavo M (2), Richardson PG (2), Moreau P (2), San Miguel J (2), Rajkumar SV (2), Durie BG (2), Terpos E (2).
(1) Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA; Brian G.M. Durie, Samuel Oschin Cancer Center, Los Angeles, CA; Giampaolo Merlini, Scientific Institute Policlinico San Matteo and University of Pavia, Pavia; Antonio Palumbo, University of Torino, Azienda Ospedaliero-Universitaria Citta della Salute e della Scienza di Torino, Torino; Michele Cavo, Bologna University School of Medicine, S.Orsola's University Hospital, Bologna, Italy; Heinz Ludwig, Wilhelminenspital, Vienna, Austria; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg; Hermann Einsele, Wuerzburg University Medical Center, Wuerzburg, Germany; Douglas Joshua, Royal Prince Alfred Hospital, Sydney University Medical School, Sydney, New South Wales, Australia; Raymond Powles, Cancer Centre London, London, United Kingdom; Laurent Garderet, Saint Antoine Hospital & University of "Pierre et Marie Curie" Paris-6, Paris; Philippe Moreau, University Hospital Hôtel-Dieu, Nantes, France; and Jesús San Miguel, Clínica Universidad de Navarra/CIMA, Navarra, Spain.
(2) Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA; Brian G.M. Durie, Samuel Oschin Cancer Center, Los Angeles, CA; Giampaolo Merlini, Scientific Institute Policlinico San Matteo and University of Pavia, Pavia; Antonio Palumbo, University of Torino, Azienda Ospedaliero-Universitaria Citta della Salute e della Scienza di Torino, Torino; Michele Cavo, Bologna University School of Medicine, S.Orsola's University Hospital, Bologna, Italy; Heinz Ludwig, Wilhelminenspital, Vienna, Austria; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg; Hermann Einsele, Wuerzburg University Medical Center, Wuerzburg, Germany; Douglas Joshua, Royal Prince Alfred Hospital, Sydney University Medical School, Sydney, New South Wales, Australia; Raymond Powles, Cancer Centre London, London, United Kingdom; Laurent Garderet, Saint Antoine Hospital & University of "Pierre et Marie Curie" Paris-6, Paris; Philippe Moreau, University Hospital Hôtel-Dieu, Nantes, France; and Jesús San Miguel, Clínica Universidad de Navarra/CIMA, Navarra, Spain. 

Magazine: Journal of Clinical Oncology

Date: Mar 14, 2016

Haematology and Hameotherapy

PURPOSE

The aim of the International Myeloma Working Group was to develop practical recommendations for the diagnosis and management of multiple myeloma-related renal impairment (RI).

METHODS

Recommendations were based on published data through December 2015, and were developed using the system developed by the Grading of Recommendation, Assessment, Development, and Evaluation Working Group.

RECOMMENDATIONS

All patients with myeloma at diagnosis and at disease assessment should have serum creatinine, estimated glomerular filtration rate, and electrolytes measurements as well as free light chain, if available, and urine electrophoresis of a sample from a 24-hour urine collection (grade A).

The Chronic Kidney Disease Epidemiology Collaboration, preferably, or the Modification of Diet in Renal Disease formula should be used for the evaluation of estimated glomerular filtration rate in patients with stabilized serum creatinine (grade A).

International Myeloma Working Group criteria for renal reversibility should be used (grade B). For the management of RI in patients with multiple myeloma, high fluid intake is indicated along with antimyeloma therapy (grade B).

The use of high-cutoff hemodialysis membranes in combination with antimyeloma therapy can be considered (grade B). Bortezomib-based regimens remain the cornerstone of the management of myeloma-related RI (grade A). High-dose dexamethasone should be administered at least for the first month of therapy (grade B). Thalidomide is effective in patients with myeloma with RI, and no dose modifications are needed (grade B).

Lenalidomide is effective and safe, mainly in patients with mild to moderate RI (grade B); for patients with severe RI or on dialysis, lenalidomide should be given with close monitoring for hematologic toxicity (grade B) with dose reduction as needed. High-dose therapy with autologous stem cell transplantation (with melphalan 100 mg/m2 to 140 mg/m2) is feasible in patients with RI (grade C).

Carfilzomib can be safely administered to patients with creatinine clearance > 15 mL/min, whereas ixazomib in combination with lenalidomide and dexamethasone can be safely administered to patients with creatinine clearance > 30 mL/min (grade A). 

CITATION  J Clin Oncol. 2016 Mar 14. pii: JCO650044

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