Plasma Exchange Treatment Is Not Effective in Treating Acute Kidney Failure Caused by Multiple Myeloma. Ann Intern Med. 2005;143:I-20. doi: 10.7326/0003-4819-143-11-200512060-00001
Download citation file:
Published: Ann Intern Med. 2005;143(11):I-20.
Multiple myeloma is a type of cancer that causes overgrowth of abnormal (malignant) cells in the bone marrow. These malignant cells release a large amount of abnormal protein (myeloma protein) into the bloodstream. Myeloma protein can be removed by the kidney and can be excreted in the urine. Unfortunately, the kidney often becomes blocked by large amounts of myeloma protein, and kidney function often deteriorates by the time that multiple myeloma is first diagnosed. Doctors have tried to prevent further deterioration of kidney function by performing a procedure called plasma exchange. Plasma exchange is done by removing blood from a vein and then separating the liquid portion of the blood (the plasma) from the red blood cells. The patient's plasma (which contains myeloma protein) is then discarded and is replaced with plasma from healthy donors before returning it to the patient's bloodstream. Plasma exchange is now recommended by 2 large medical organizations.
To find out whether plasma exchange could help patients with multiple myeloma whose kidneys had already been damaged by myeloma protein and, specifically, whether plasma exchange could reduce the incidence of progressive kidney failure, the need for long-term kidney dialysis, or death in these patients.
97 patients with newly diagnosed multiple myeloma and worsening acute kidney function.
The researchers treated all patients for multiple myeloma but also divided them randomly (by chance alone) into 2 groups: One group received plasma exchange therapy, and the other group did not. The researchers evaluated both groups over the next 6 months to see whether they developed severe kidney failure, required long-term dialysis, or died.
After 6 months, one third of patients in each group had died. Seventy percent of patients in the group that did not receive plasma exchange and 58% of the patients who received plasma exchange had a bad outcome (developed severe kidney failure, required long-term dialysis, or died). However, the researchers found that even this difference could have happened by chance alone. In other words, treating these patients with plasma exchange had no clinically significant advantage.
The number of patients in the study was relatively small. Although this study did not show any advantage to treatment with plasma exchange, the researchers could not be sure whether certain types of patients within the treatment group might have been either helped or harmed by plasma exchange.
The previous recommendations to treat patients with multiple myeloma who have acute worsening of kidney function with plasma exchange must be questioned since this treatment does not seem to have any beneficial effect.
The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.
Hematology/Oncology, Nephrology, Acute Kidney Injury, Multiple Myeloma.
Results provided by:
Copyright © 2016 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use
This PDF is available to Subscribers Only