Blog entry by Arif Khwaja

Anyone in the world

Interesting data is presented in this months JASN from Colin Hutchinson in Birmingham, UK presents data ( from Birmingham and Rochester) suggesting that early and aggressive reduction of serum free light chains (FLCs) associates with renal recovery in myeloma kidney. 39 patients with biopsy-proven myeloma kidney, the majority of whom had severe renal failure at presentation (median estimated GFR 9 ml/min per 1.73 m2) were analysed to see which variables associated with renal recovery. In a multivariable analysis FLC reduction significantly predicted renal recovery (P = 0.003). The relationship between renal recovery and FLC reduction was linear with a 60% reduction in FLCs by day 21 associated with recovery of renal function for 80% of the population. Unsurprsingly patient survival strongly associated with renal recovery: the median survival was 42.7 months (range 0 to 80) among those who recovered function compared with 7.8 months (range 0 to 54) among those who did not (P < 0.02). Patients had variable treatment but treatment broadly consisted of a combination  direct removal of FLCs and  aggressive chemotherapy often using bortezomib. In Birmingham FLC removal was achieved using extended hemodialysis using a protein permeable dialyser whilst plasma exchange was used in Rochester. This data suggests that early reduction of FLC aids renal recovery but also that the FLC immunoassay is an essential quantitative tool in monitoring response to therapy in multiple myeloma. For further details see


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