Management of multiple myeloma-related renal impairment: recommendations from the International Myeloma Working Group - 04/07/23

Doi : 10.1016/S1470-2045(23)00223-1

Meletios A Dimopoulos, ProfMD ^a, Giampaolo Merlini, ProfMD ^b, Frank Bridoux, ProfMD ^c, Nelson Leung, ProfMD ^d, Joseph Mikhael, ProfMD ^f, Simon J Harrison, ProfPhD ^g,^h, Efstathios Kastritis, ProfMD ^a, Laurent Garderet, MD ⁱ, Alessandro Gozzetti, MD ^j, Niels W C J van de Donk, ProfMD ^k, Katja C Weisel, ProfMD ^l, Ashraf Z Badros, ProfMD ^m, Meral Beksac, ProfMD ⁿ, Jens Hillengass, ProfMD ^o, Mohamad Mohty, ProfMD ^p, P Joy Ho, ProfMD ^q, Ioannis Ntanasis-Stathopoulos, MD ^a, Maria-Victoria Mateos, MD ^r, Paul Richardson, ProfMD ^s, Joan Blade, MD ^t, Philippe Moreau, ProfMD ^u, Jesus San-Miguel, ProfMD ^v, Nikhil Munshi, ProfMD ^s, S Vincent Rajkumar, ProfMD ^e, Brian G M Durie, ProfMD ^w, Heinz Ludwig, ProfMD ^x, Evangelos Terpos, ProfMD ^a,⁎
on behalf of the
International Myeloma Working Group^*
Members listed in the Supplementary Material

^a Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece

^b Amyloidosis Research and Treatment Center, IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy

^c Department of Nephrology, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France

^d Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA

^e Division of Hematology, Mayo Clinic, Rochester, MN, USA

^f Translational Genomics Research Institute, City of Hope Cancer Center, Phoenix, AZ, USA

^g Peter MacCallum Cancer Centre, Royal Melbourne Hospital, Melbourne, VIC, Australia

^h Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia

ⁱ Service d’Hématologie, Hopital Pitié Salpetriere, Paris, France

^j Department of Hematology, University of Siena, Policlinico S Maria alle Scotte, Siena, Italy

^k Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands

^l University Medical Center Hamburg-Eppendorf, Hamburg, Germany

^m Department of Medicine, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA

ⁿ Department of Hematology, Ankara University School of Medicine, Ankara, Turkey

^o Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA

^p Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM UMRs 938, Paris, France

^q Institute of Haematology, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia

^r Hospital Universitario de Salamanca, Salamanca, Spain

^s Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA

^t Department of Hematology, Hospital Clinic, IDIBAPS, Barcelona, Spain

^u Department of Hematology, University Hospital of Nantes, Nantes, France

^v Cancer Center Clinica Universidad de Navarra, CCUN, Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra, Centro de Investigación Biomédica en Red Cáncer, Pamplona, Spain

^w Department of Hematology/Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA

^x Wilhelminen Cancer Research Institute, First Department of Medicine, Clinic Ottakring, Vienna, Austria

^* Correspondence to: Prof Evangelos Terpos, Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens 11528, Greece Department of Clinical Therapeutics School of Medicine National and Kapodistrian University of Athens Alexandra General Hospital Athens 11528 Greece

Summary

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.

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Vol 24 - N° 7

P. e293-e311 - juillet 2023 Retour au numéro

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Management of multiple myeloma-related renal impairment: recommendations from the International Myeloma Working Group - 04/07/23

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