Evaluating the role of plasmapheresis in the treatment of light chain cast nephropathy-induced acute kidney injury in patients with multiple myeloma
OA Version
Citation
Abstract
Multiple myeloma is a complex, cytogenetically heterogenous disease that has significant deleterious effects on patient quality of life and overall survival. Though recent advancements in chemotherapeutic technology have improved progression-free survival, light chain cast nephropathy (LCCN) remains the most pervasive etiology of renal injury in myeloma patients, significantly negatively impacting patient outcomes. The treatment of LCCN with plasmapheresis (PLEX) is the subject of much scholarly controversy, however, with some studies showing improvement in renal recovery and others failing to confirm the same results. This work sought to investigate whether patients treated with plasmapheresis experienced improvement in renal recovery at 90 days post-diagnosis with LCCN. This multicenter study employed a target trial emulation framework. Data were analyzed using IPTW to adjust for confounders and mediation analysis was performed. Our primary exposure was treatment with plasmapheresis, and the primary outcome was renal recovery, defined as being alive, not on renal replacement therapy (RRT), and a decline in at least one stage of AKI. Our results showed no statistically significant difference in renal recovery between PLEX-treated and non-PLEX treated patients in aggregate and within one subgroup analysis of newly diagnosed patients. Further randomized controlled trials are needed to confirm these results.
Description
2025
License
Attribution-NonCommercial 4.0 International