Department of Hematology and Oncology, Charité--Universitätsmedizin Berlin, Germany.
Eur J Med Res. 2009;14(2):47-54. doi: 10.1186/2047-783x-14-2-47.
Multiple myeloma (MM) is a malignancy with excessive production of monoclonal proteins. At disease presentation 30% of MM patients have significant renal impairment which may progress to renal failure requiring dialysis. Besides chemotherapy extracorporeal elimination procedures such as plasma exchange have been applied as adjuvant strategies to eliminate free light chains from circulating blood, however the efficacy was poor with older techniques. We report about a highly efficient method to eliminate serum free light chain (sFLC) using a newly designed protein leaking membrane in patients suffering from sFLC induced acute renal failure. The protein leaking membrane (HCO 1100) is characterized by increased pore size facilitating elimination of middle molecules such as sFLC kappa (22.5 kD). The HCO 1100 membrane was applied in a hemodialysis and hemodiafiltration mode and compared to standard procedures (high flux hemodialysis, hemodiafiltration and plasma exchange). Hemodiafiltration with the protein leaking membrane HCO 1100 was superior to all other extracorporeal replacement strategies in eliminating sFLC-kappa from circulating blood. A median blood reduction rate of 40.8% (range 13.9%-66.4%) was achieved during hemodiafiltration. The corresponding peak clearance rate was 25 ml/min. Importantly, the poorest elimination rate was achieved by plasma exchange followed by standard high flux hemodialysis. Extracorporeal elimination strategies with the protein leaking membrane HCO 1100 may be a promising adjuvant treatment strategy for patients with sFLC nephropathy requiring dialysis. Hemodiafiltration and to lesser extend also hemodialysis with the HCO 1100 hemofilter are able to eliminate substantial amounts of sFLC kappa in MM patients.
多发性骨髓瘤（MM）是一种单克隆蛋白过度产生的恶性肿瘤。在疾病发作时，30%的 MM 患者有明显的肾功能损害，可能进展为需要透析的肾衰竭。除了化疗，体外清除程序如血浆置换已被应用作为辅助策略，以从循环血液中消除游离轻链，但在旧技术下效果较差。我们报告了一种在游离轻链（sFLC）诱导的急性肾衰竭患者中使用新设计的蛋白渗漏膜高效消除血清游离轻链（sFLC）的方法。蛋白渗漏膜（HCO 1100）的特点是孔径增大，有利于消除中分子物质，如 sFLC kappa（22.5 kD）。HCO 1100 膜应用于血液透析和血液透析滤过模式，并与标准程序（高通量血液透析、血液透析滤过和血浆置换）进行比较。与其他所有体外替代策略相比，血液透析滤过与蛋白渗漏膜 HCO 1100 联合应用在消除循环血液中的 sFLC-kappa 方面更具优势。血液透析滤过过程中平均血液减少率为 40.8%（范围 13.9%-66.4%）。相应的峰值清除率为 25 ml/min。重要的是，血浆置换的消除率最差，其次是标准高通量血液透析。蛋白渗漏膜 HCO 1100 的体外清除策略可能是需要透析的 sFLC 肾病患者的一种有前途的辅助治疗策略。血液透析滤过和较小程度的血液透析滤过与 HCO 1100 血液滤过器联合应用，能够在 MM 患者中消除大量的 sFLC kappa。
