Lay Summary: Renal failure is common in newly diagnosed myeloma. Recent literature shows that ASCT is an attractive alternative for MM patients with renal insufficiency, and it should not constitute a criterion for exclusion from transplant unless patients display poor performance status and very high creatinine levels (>5 mg/dl).
Renal failure is present in about 20% of patients with multiple myeloma (MM) at diagnosis. Approximately 10% of patients diagnosed with MM in a general hospital have renal failure severe enough to require dialysis. This along with treatmetn for myeloma often allows recovery of renal function. For patients who do not recover, combined kidney and bone marrow transplantation is being studied. Many reports show that if renal functions recovers sufficiently as to not require dialysis, autologous transplantation can restore normal kidney funcion.
San Miguel JF, Lahuerta JJ, García-Sanz R, Alegre A, Bladé J, Martinez R, García-Laraña J, De La Rubia J, Sureda A, Vidal MJ, Escudero A, Pérez-Esquiza E, Conde E, García-Ruiz JC, Cabrera R, Caballero D, Moraleda JM, Leon A, Besalduch J, Hernandez MT, Rifon J, Hernandez F, Solano C, Palomera L, Parody R, Gonzalez JD, Mataix R, Maldonado J, Constela J, Carrera D, Bello JL, De Pablos JM, Pérez-Simón JA, Torres JP, Olanguren J, Prieto E, Acebede G, Peñarrubia MJ, Torres P, Díez-Martín JL, Rivas A, Sánchez JM, Díaz-Mediavilla J.Are myeloma patients with renal failure candidates for autologous stem cell transplantation? Hematol J. 2000;1(1):28-36.
Bladé, J, Fernandez-Llama P, Bosch F, et al. Renal failure in multiple myeloma. Presenting features and predictors of outcome in 94 patients from a single institution. Arch Intern Med 1998; 158: 1889-1893
Torra R, Bladé J, Cases A, et al. Patients with multiple myeloma requiring long-term dialysis: presenting features, response to therapy, and outcome in a series of 20 cases. Br J Haematol 1995; 91: 854-859.