Nelson Leung, MD
Potential Financial Conflicts of Interest: None disclosed.
Leung N.; Plasma Exchange in Multiple Myeloma. Ann Intern Med. 2006;144:455. doi: 10.7326/0003-4819-144-6-200603210-00021
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Published: Ann Intern Med. 2006;144(6):455.
TO THE EDITOR:
The long-awaited randomized, controlled trial of plasma exchange by Clark and colleagues (1) has finally been published. As the largest trial on the subject, it was supposed to help define the role of plasma exchange in multiple myeloma. However, on closer evaluation of the data, I found more questions than answers.
First, what disease was actually treated with plasma exchange in this study? Autopsy data from Ivanyi (2) found light-chain deposition disease, amyloidosis, and cast nephropathy in 5%, 11%, and 32%, respectively, of the patients who died with myeloma (2). Others have shown acute tubular necrosis, tubulointerstitial nephritis, and plasma-cell infiltration as additional causes of acute renal failure in this population (3). Considering that most of Clark and colleagues' patients did not have renal biopsy, how did the authors ensure that only cast nephropathy was being studied? It is equivalent to treating patients with monoclonal gammopathy without a bone marrow biopsy. Since plasma exchange is only intended to treat cast nephropathy, it is therefore not unexpected that this study found no benefit.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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