Chemotherapy in myeloma with AKI

What chemotherapy is used in patients with myeloma and AKI?

Although myeloma and AKI are incurable, chemotherapy and the use of autologous stem cell transplantation (ASCT) have improved patient survival significantly. ASCT is now the procedure of choice for eligible patients and the avoidance of alkylating agents, such as melphalan, that impair stem cell harvest is preferred. Chemotherapy targeting rapid plasma cell killing and LC lowering should include the reversible proteasome inhibitor bortezomib (which does not need dose adjustment in kidney failure) alone or in conjunction with other agents. Lenalidomide, a derivative of thalidomide, has also shown great benefit for rapid lowering of LC, but it requires dose adjustment in kidney failure because of myelosuppression. Determining the optimal chemotherapy requires close collaboration between nephrologists and hematologists to individualize management decisions according to age and comorbidity, suitability for ASCT, eligibility for trials, and consideration of HCO dialysis.

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