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

Abstract

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 In three, HD was withdrawn, switching to a chemotherapy alone regimen.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.

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

“…There were eleven patients analyzed, which may be sufficient to estimate the percentage reduction of FLC. 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.…”

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

“…Testa et al showed that this technique removes FLC, particularly kappa, in patients with both monoclonal and polyclonal gammopathies [15]. The removal of FLC reported in other recent studies has been around 84% for kappa [22] and 32.2 -49.5% [23] or 69.3% [22] for lambda chains. Although other groups have shown a reduction of serum FLC with hemodia ltration with ultra ltrate regeneration [22][23][24], our study is the rst that analyzes the concentration of FLC and albumin in both, blood and ultra ltrate.…”

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

“…Moreover, no complications associated with the technique were observed. [20][21][22], 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.…”

“…Testa et al showed that this technique removes FLC,particularly kappa, in patients with both monoclonal and polyclonal gammopathies[15]. The removal of FLC reported in other recent studies has been around 84% for kappa[20] and 32.2 -49.5%[21] or 69.3%[20] for lambda chains. Although other groups have shown a reduction of serum FLC with…”