Madore François
Department of Nephrology, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada.
Curr Opin Nephrol Hypertens. 2015 Mar;24(2):177-82. doi: 10.1097/MNH.0000000000000101.
Renal failure is a frequent complication of multiple myeloma and portends a poor prognosis. Plasmapheresis has been suggested as an adjunct to chemotherapy to halt or reverse renal injury associated with multiple myeloma. The purpose of this article is to review the rationale for using plasmapheresis for this indication and then provide a discussion of the evidence regarding its use.
The outcome of patients with multiple myeloma has improved considerably in recent years, mostly owing to the introduction of new highly effective chemotherapeutic agents. However, patients with renal failure who do not recover independent renal function continue to have very poor prognosis. Recent evidence now indicates that an early and sustained reduction in circulating free light chains (FLCs) is associated with improved renal recovery in patients with myeloma kidney. Extracorporeal removal of FLCs with plasmapheresis, or other techniques, can achieve rapid and sustained reduction in serum FLC concentration in patients with acute myeloma kidney. Unfortunately, there is currently no convincing evidence in the literature that the addition of mechanical removal of FLC to standard chemotherapy translates into clinical benefits for patients.
Plasmapheresis is theoretically attractive as a means of rapidly lowering serum FLC burden in the hope of reducing nephrotoxicity in patients with multiple myeloma. However, the role of plasmapheresis in improving renal prognosis and patient survival remains to be demonstrated.
肾衰竭是多发性骨髓瘤常见的并发症，预示着预后不良。血浆置换已被提议作为化疗的辅助手段，以阻止或逆转与多发性骨髓瘤相关的肾损伤。本文旨在回顾将血浆置换用于该适应症的理论依据，然后讨论其使用证据。
近年来，多发性骨髓瘤患者的预后有了显著改善，这主要归功于新型高效化疗药物的引入。然而，肾功能未能恢复独立肾功能的肾衰竭患者预后仍然很差。最近的证据表明，循环游离轻链（FLC）的早期和持续降低与骨髓瘤肾病患者的肾功能改善相关。通过血浆置换或其他技术体外清除FLC，可以使急性骨髓瘤肾病患者的血清FLC浓度迅速且持续降低。不幸的是，目前文献中没有令人信服的证据表明，在标准化疗基础上增加机械性清除FLC能给患者带来临床益处。
血浆置换理论上是一种有吸引力的方法，可迅速降低血清FLC负荷，有望减轻多发性骨髓瘤患者的肾毒性。然而，血浆置换在改善肾脏预后和患者生存方面的作用仍有待证实。
