A novel option for reducing free light chains in myeloma kidney: supra-hemodiafiltration with endogenous reinfusion (HFR)

Pasquali, Sonia; Iannuzzella, Francesco; Corradini, Mattia; Mattei, Silvia; Bovino, Achiropita; Stefani, Alfredo; Palladino, Giuseppe; Caiazzo, Marialuisa

doi:10.1007/s40620-014-0130-8

Cited by 34 publications

(27 citation statements)

References 9 publications

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“…In a recent report de Pascalli published in 2015 [15] suprahemodiafiltration in combination with chemotherapy effectively reduced serum free light chains without need for albumin replacement, As in previous studies only 4 patients were treated, allowing us to draw few conclusions.…”

Section: Discussionmentioning

confidence: 91%

Cost/Effectiveness Treatment of Acute Renal Failure Secondary to Multiple Myeloma with Filters High Cut off

Lipe¹,

Wennekers²

2016

J Nephrol Ther

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Section: Discussionmentioning

confidence: 91%

Cost/Effectiveness Treatment of Acute Renal Failure Secondary to Multiple Myeloma with Filters High Cut off

Lipe¹,

Wennekers²

2016

J Nephrol Ther

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“…The removal of FLC reported in other recent studies is around 84% for kappa [24] and 32.2-49.5% [25] or 69.3% [24] for lambda chains. Although other groups have shown a reduction of serum FLC with hemodiafiltration with ultrafiltrate regeneration [24][25][26], our study is the first that analyzes the concentration of FLC and albumin in both, blood and ultrafiltrate. The FLC reduction ratio obtained in the ultrafiltrate was greater than in blood.…”

Section: Discussionmentioning

confidence: 94%

Hemodiafiltration with ultrafiltrate regeneration reduces free light chains without albumin loss in multiple myeloma patients.

Mier

Ojeda

Alvarez‐Lara

et al. 2020

Preprint

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Background Acute kidney injury (AKI) occurs in 12-20% of multiple myeloma (MM) patients. Several studies have shown a reduction of free light chains (FLC) using hemodialysis with High-Cut-Off membranes. However, this technique entails albumin loss. Hemodiafiltration with ultrafiltrate regeneration is a technique that includes a process of adsorption. The aim of this study was to evaluate the effectiveness of hemodiafiltration with ultrafiltrate regeneration in reducing FLC levels without causing albumin loss.Methods This is an observational study (2012 to 2018) including eleven patients with MM (6 kappa, 5 lambda) and AKI. All patients were treated with chemotherapy and hemodiafiltration with ultrafiltrate regeneration. Blood Samples (pre and post-dialysis) and ultrafiltrate were collected pre and post-resin at 5 minutes after initiation of the session and 5 minutes before the end of the procedure. ResultsThe serum levels of kappa and lambda were reduced by a 53±14% and 33±22% respectively.Serum albumin concentration remained unchanged after the procedure. In the ultrafiltrate, the mean FLC reduction ratio shortly after initiation of the dialysis procedure was: 99.2% and 97.06% for kappa and lambda respectively, and only 0.7% for albumin; and at the end of the session the percent reduction was: 63.7% and 33.62% for kappa and lambda respectively, and 0.015% for albumin.Patients clinical outcome was: 36.4% recovered renal function, 18.2% died during the first year and 45.45% required maintenance dialysis.Conclusions Hemodiafiltration with ultrafiltrate regeneration reduces FLC levels without producing a significant loss of albumin; and, FLC removal is maintained throughout the session. Therefore, hemodiafiltration with ultrafiltrate regeneration may be considered an effective adjunctive therapy in patients with MM.

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“…This ultrafiltrate is then reinfused in a second dialyzer where the diffusive process and water removal take place (iii) [32,33,34,37,38].…”

Section: Discussionmentioning

confidence: 99%

Serum Free Light Chains Removal by HFR Hemodiafiltration in Patients with Multiple Myeloma and Acute Kidney Injury: a Case Series

Menè¹,

Giammarioli²,

Fofi³

et al. 2018

Kidney Blood Press Res

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Background/Aims: Multiple myeloma (MM) represents 10% of all haematologic malignancies. Renal involvement occurs in 50% of MM patients; of them, 12-20% have acute kidney injury (AKI), with 10% needing dialysis at presentation. While hemodialysis (HD) has no effect upon circulating and tissue levels of monoclonal proteins, novel apheretic techniques aim at removing the paraproteins responsible for glomerular/tubular deposition disease. High cut-off HD (HCO-HD) combined with chemotherapy affords a sustained reduction of serum free light chains (FLC) levels. One alternative technology is haemodiafiltration with ultrafiltrate regeneration by adsorption on resin (HFR–SUPRA), employing a “super high-flux” membrane (polyphenylene S-HF, with a nominal cut-off of 42 kD). Aim of our pilot study was to analyze the effectiveness of HFR-SUPRA in reducing the burden of FLC, while minimizing albumin loss and hastening recovery of renal function in 6 subjects with MM complicated by AKI. Methods: Six HD-dependent patients with MM were treated with 5 consecutive sessions of HFR-SUPRA on a Bellco® monitor, while simultaneously initiating chemotherapy. Levels of albumin and FLC were assessed, calculating the rates of reduction. Renal outcome, HD withdrawal and clinical follow-up or death were recorded. Results: All patients showed a significant reduction of FLC, whereas serum albumin concentration remained unchanged. In three, HD was withdrawn, switching to a chemotherapy alone regimen. The other patients remained HD-dependent and died shortly thereafter for cardiovascular complications. Conclusion: Our study suggests that HFR-SUPRA provides a rapid and effective reduction in serum FLC in patients with MM and AKI, while minimizing the loss of albumin. When started early in combination with chemotherapy, blood purification by HFR-SUPRA was followed by the recovery of renal function in half of the patients treated.

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A novel option for reducing free light chains in myeloma kidney: supra-hemodiafiltration with endogenous reinfusion (HFR)

Abstract: FLC removal with adsorbent resins represents an effective therapeutic strategy that does not require replacement with albumin .

Cited by 34 publications

References 9 publications

Cost/Effectiveness Treatment of Acute Renal Failure Secondary to Multiple Myeloma with Filters High Cut off

Cost/Effectiveness Treatment of Acute Renal Failure Secondary to Multiple Myeloma with Filters High Cut off

Hemodiafiltration with ultrafiltrate regeneration reduces free light chains without albumin loss in multiple myeloma patients.

Serum Free Light Chains Removal by HFR Hemodiafiltration in Patients with Multiple Myeloma and Acute Kidney Injury: a Case Series

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