Noushad Thekke Puthiyottil1, Sreelatha Melemadathil2, Jayakumar Edathedathe Krishnan3
AIM
To assess the efficacy and safety of bortezomib based regimen and plasma exchange in patients with cast nephropathy, the clinical profile of patients with Multiple Myeloma and renal involvement, to assess the factors affecting the renal outcome.
MATERIALS AND METHODS
This prospective observational study done in Department of Nephrology, Medical College, Kozhikode enrolled patients who satisfied Inclusion criteria from October 2013 to September 2015. Clinical, demographic and biochemical profile was studied. Serum free light chain levels were estimated. Renal biopsy and bone marrow biopsy were done. Study patients were managed with plasmapheresis and bortezomib based induction for a period of 16 weeks. Renal and haematologic response was noted.
RESULTS
18 patients satisfied the inclusion criteria and included for analysis. Mean Hb was 7.31 ± 1.25 g/dL. Mean eGFR at presentation was 6.19±2.61 mL/min/1.73 m2. 6 patients kappa myeloma, 12 had lambda (66.67%). Renal biopsy showed cast nephropathy in all patients (100%) with varying degrees of tubular atrophy. 15 patients had dialysis requiring renal failure (83.33%). Following treatment, 8 patients had complete renal response (44.44%), 7 patients had partial renal response (38.88%). All patients achieved haematologic remission. Mean eGFR at end of therapy was 56.79 mL/min/1.73 m2, which was statistically significant. The FLC reduction at the end of 16 weeks was statistically significant. (p <0.01). 5 patients developed peripheral neuropathy, 2 patients had cytopenia, 5 patients had non-life threatening infection episodes.
DISCUSSION
Bortezomib based regimen combined with plasma exchange sessions upfront demonstrated a high haematologic response and renal response in the study population. Our study group had a predominant lambda subtype myeloma in contrast to other studies. There is emerging data regarding the use of renal biopsy as a prognostic tool in cast nephropathy. In our study group, tubular atrophy predicted renal response.
