Trends in the use of therapeutic plasma exchange in multiple myeloma

Abstract

Introduction Therapeutic plasma exchange (TPE) is traditionally performed for hyperviscosity, neuropathy and to mitigate renal injury in the setting of high clonal free light chain burden in patients with multiple myeloma (MM) with unknown clinical benefit. Materials and Methods Retrospective study of adults ≥18 years with MM who received TPE in the in‐patient setting in the United States from 1993 to 2015. We examined the temporal trends of TPE utilization in MM hospitalizations, hospital charges, in‐hospital mortality, and length of hospitalization and the predictors of in‐hospital mortality and length of hospitalizations. Results The number of MM‐hospitalizations for TPE in adults increased significantly from 1993 to 2015 (1% in 1993‐1999 to 2.1% in 2008‐2015 of all MM discharges, P for trend <.0001). About 70% of TPE recipients had acute kidney injury (AKI). The median hospital charges increased 5‐fold during the time period ($ 24 407 to $ 113 496; P for trend <.0001). In‐hospital mortality decreased (17.5% (SE 2.66) in 1993‐1997 to 8.7% (1.39) in 2007 to 2013) P for trend <.005) while the length of stay remained unchanged (11.2 days vs 11.9 days, P for trend 0.17). On adjusted analysis, significant predictors of in‐hospital mortality among MM TPE recipients include, Charlson Comorbidity Index (CCI) (3 vs 2 adjusted odds ratio, aOR 2.16, 95% CI 1.26‐3.71; P = .005), year (continuous) (aOR 0.93, 95% CI 0.90‐0.96; P < .001) and race (other vs white; aOR 0.44, 95% CI 0.25‐0.78; P = 0.004). Conclusions There has been a substantial increase in the use and associated cost of TPE in hospitalized MM patients.

Chemotherapy plus therapeutic plasmapheresis with 4% human albumin solution in multiple myeloma patients with acute kidney injury: a prospective, open-label, proof-of-concept study

“…The first day of hospitalization was related to the remission of the patient’s condition and the economic expenses of hospitalization. The median FLOS in most patients was 10 days (IQR 6.8–17.6 days), which is consistent with Dhakal et al.’s reported hospital stay of 11.9 days (IQR 7.2–17.6 days) under TPE treatment [ 50 ]. The median FLOS of patients with severe infection, rheumatic immune disease, severe organ failure, etc., was significantly prolonged (22.0 days).…”

Global disparities in patients with multiple myeloma: a rapid evidence assessment

“…Nineteen US and 14 non-US studies reported on sex and survival (Supplementary Table 10 ), and six US and 10 non-US studies on sex and mortality (Supplementary Table 11 ). Most studies reported no effect of sex on survival or mortality [ 16 , 25 , 27 , 32 , 34 , 38 , 45 , 56 , 59 , 63 , 66 , 68 , 69 , 74 , 75 , 80 , 84 , 90 , 92 , 97 ]. However, a subset of studies reported more favorable survival in women [ 14 , 22 , 29 , 40 , 41 , 43 , 48 , 55 , 61 ], and mortality rates were generally higher in men [ 29 , 44 , 46 , 67 , 70 , 77 , 82 , 89 , 92 , 94 , 98 , 99 ].…”

High-Cutoff Hemodialysis Therapy for Patients with Light Chain Cast Nephropathy and AKI Requiring Dialysis: CON

“…Despite the lack of solid supportive data supporting its role in MC-AKI, its use reportedly increased over the past two decades. 12 A disadvantage of TPE is the indiscriminate removal of most plasma proteins, which renders it less efficient and can contribute to complications because of the loss of essential proteins (e.g., clotting factors). Thus, a strategy that more selectively removes proteins in the FLC size range (22.5-45 kD) was devised by performing hemodialysis (HD) using HCO-HD filters, which have molecular mass cutoffs of 45-60 kD.…”

“…Despite the lack of solid supportive data supporting its role in MC-AKI, its use reportedly increased over the past two decades. 12 …”