Is plasmapheresis indicated in multiple myeloma and cast nephropathy

Is plasmapheresis indicated as treatment in patients with multiple myeloma and cast nephropathy?

The role of plasmapheresis in myeloma cast nephropathy is debated. Although early studies demonstrated improvement in kidney function and patient survival, the largest study to date of 104 patients with multiple myeloma and acute kidney failure randomly assigned to conventional therapy plus plasma exchanges or conventional therapy alone did not show differences in the composite outcome of death, dialysis dependence, or severely reduced kidney function.

The findings of this study do not support the routine use of plasmapheresis in myeloma patients, but it can be considered in patients with unusually high paraprotein burdens or Waldenstrom macroglobulinemia and hyperviscosity syndromes.


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