Publicaciones científicas
Management of multiple myeloma-related renal impairment: recommendations from the International MyelomaWorking Group
Meletios A Dimopoulos 1, Giampaolo Merlini 2, Frank Bridoux 3, Nelson Leung 4, Joseph Mikhael 5, Simon J Harrison 6, Efstathios Kastritis 1, Laurent Garderet 7, Alessandro Gozzetti 8, Niels W C J van de Donk 9, Katja C Weisel 10, Ashraf Z Badros 11, Meral Beksac 12, Jens Hillengass 13, Mohamad Mohty 14, P Joy Ho 15, Ioannis Ntanasis-Stathopoulos 1, Maria-Victoria Mateos 16, Paul Richardson 17, Joan Blade 18, Philippe Moreau 19, Jesus San-Miguel 20, Nikhil Munshi 17, S Vincent Rajkumar 21, Brian G M Durie 22, Heinz Ludwig 23, Evangelos Terpos 24; International Myeloma Working Group
Abstract
Here, the International Myeloma Working Group (IMWG) updates its clinical practice recommendations for the management of multiple myeloma-related renal impairment on the basis of data published until Dec 31, 2022. All patients with multiple myeloma and renal impairment should have serum creatinine, estimated glomerular filtration rate, and free light chains (FLCs) measurements together with 24-h urine total protein, electrophoresis, and immunofixation. If non-selective proteinuria (mainly albuminuria) or involved serum FLCs value less than 500 mg/L is detected, then a renal biopsy is needed. The IMWG criteria for the definition of renal response should be used. Supportive care and high-dose dexamethasone are required for all patients with myeloma-induced renal impairment. Mechanical approaches do not increase overall survival. Bortezomib-based regimens are the cornerstone of the management of patients with multiple myeloma and renal impairment at diagnosis. New quadruplet and triplet combinations, including proteasome inhibitors, immunomodulatory drugs, and anti-CD38 monoclonal antibodies, improve renal and survival outcomes in both newly diagnosed patients and those with relapsed or refractory disease. Conjugated antibodies, chimeric antigen receptor T-cells, and T-cell engagers are well tolerated and effective in patients with moderate renal impairment.
CITA DEL ARTÍCULO Lancet Oncol. 2023 Jul;24(7):e293-e311. doi: 10.1016/S1470-2045(23)00223-1.
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