Plasma Exchange for Myeloma?

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A question which comes up not infrequently during nephrology fellowship is whether or not to perform pheresis on patients with multiple myeloma. Once very much in vogue, the results of a fairly recent (Annals of Internal Medicine, 2005) randomized control trial cast doubt on the efficacy of plasma exchange in this group of patients, and it is not used with as much enthusaism (though I have certainly seen it done).

The trial was done on over 100 patients with newly-diagnosed myeloma and acute kidney injury who were randomly assigned to conventional therapy alone versus conventional therapy plus pheresis (5-7 treatments over 10 days). The end-point was a combination of death, dialysis-dependence, or GFR

2 comments

  1. Sudeendra- thanks for the comment. Interesting read.

  2. May be this extended high cut-off dialysis may be more benificial than Plasma exchange.
    ref:1.Hutchison, C. A. et al. Treatment of acute renal failure secondary to multiple myeloma with chemotherapy and extended high cut-off hemodialysis. Clin. J. Am. Soc. Nephrol. 4, 745–754 (2009).
    2.http://www.ndt-educational.org/hutchisonslide2009txt.asp

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