International myeloma working group recommendations for the diagnosis and management of myeloma-related renal impairment

Meletios A. Dimopoulos, Pieter Sonneveld, Nelson Leung, Giampaolo Merlini, Heinz Ludwig, Efstathios Kastritis, Hartmut Goldschmidt, Douglas Joshua, Robert Z. Orlowski, Raymond Powles, David H. Vesole, Laurent Garderet, Hermann Einsele, Antonio Palumbo, Michele Cavo, Paul G. Richardson, Philippe Moreau, Jesús San Miguel, S. Vincent Rajkumar, Brian G.M. DurieEvangelos Terpos, Niels Abildgaard, Rafat Abonour, Melissa Alsina, Kenneth C. Anderson, Michel Attal, Hervé Avet-Loiseau, Ashraf Badros, Nizar Jacques Bahlis, Bart Barlogie, Régis Bataille, Meral Beksaç, Andrew Belch, Dina Ben-Yehuda, Bill Bensinger, P. Leif Bergsagel, Manisha Bhutani, Jenny Bird, Joan Bladé, Annemiek Broijl, Mario Boccadoro, Jo Caers, Asher Chanan-Khan, Ajai Chari, Wen Ming Chen, Marta Chesi, J. Anthony Child, Chor Sang Chim, Wee Joo Chng, Ray Comenzo, Gordon Cook, John Crowley, Edvan Crusoe, William Dalton, H. Lee Moffitt, Faith Davies, Javier de la Rubia, Cármino de Souza, Michel Delforge, Madhav Dhodapkar, Angela Dispenzieri, Johannes Drach, Matthew Drake, Juan Du, Dominik Dytfeld, Theirry Facon, Dorotea Fantl, Jean Paul Fermand, Carlos Fernández de Larrea, Rafael Fonseca, Gösta Gahrton, Ramón Garćia-Sanz, Christina Gasparetto, Morie Gertz, Irene Ghobrial, John Gibson, Peter Gimsing, Sergio Giralt, Jingli Gu, Roman Hajek, Izhar Hardan, Parameswaran Hari, Hiroyuki Hata, Yutaka Hattori, Tom Heffner, Jens Hillengass, Joy Ho, Antje Hoering, James Edward Hoffman, Jian Hou, Jeffrey Huang, Vania Hungria, Shinsuke Ida, Sundar Jagannath, Andrzej J. Jakubowiak, Hans Erik Johnsen, Artur Jurczyszyn, Martin Kaiser, Jonathan Kaufman, Michio Kawano, Neha Korde, Eva Kovacs, Amrita Krishnan, Sigurdur Kristinsson, Nicolaus Kröger, Shaji Kumar, Robert A. Kyle, Chara Kyriacou, Martha Lacy, Juan José Lahuerta, Ola Landgren, Alessandra Larocca, Jacob Laubach, Fernando Leal da Costa, Jae Hoon Lee, Merav Leiba, Xavier Leleu, Suzanne Lentzsch, Henk Lokhorst, Sagar Lonial, Jin Lu, Anuj Mahindra, Angelo Maiolino, Elisabet E. Manasanch, Tomer Mark, María Victoria Mateos, Amitabha Mazumder, Philip McCarthy, Jayesh Mehta, Ulf Henrik Mellqvist, Joseph Mikhael, Gareth Morgan, Nikhil Munshi, Hareth Nahi, Weerasak Nawarawong, Ruben Niesvizky, Amara Nouel, Yana Novis, Enrique Ocio, Michael O'Dwyer, Peter O'Gorman, Alberto Orfao, Paula Rodriguez Otero, Bruno Paiva, Santiago Pavlovsky, Linda Pilarski, Guy Pratt, Lugui Qui, Noopur Raje, Donna Reece, Anthony Reiman, Guillermina Remaggi, Joshua Richter, Eloísa Riva Serra, Angelina Rodríguez Morales, Kenneth R. Romeril, David Roodman, Laura Rosiñol, Adriana Rossi, Murielle Roussel, Stephen Russell, Fredrik Schjesvold, Rik Schots, Sabina Sevcikova, Orhan Sezer, Jatin J. Shah, Kazuyuki Shimizu, Chaim Shustik, David Siegel, Seema Singhal, Andrew Spencer, Edward Stadtmauer, Keith Stewart, Daryl Tan, Carolina Terragna, Patrizia Tosi, Guido Tricot, Ingemar Turesson, Saad Usmani, Ben Van Camp, Niels Van de Donk, Brian Van Ness, Ivan Van Riet, Isabelle Vande Broek, Karin Vanderkerken, Robert Vescio, Ravi Vij, Peter Voorhees, Anders Waage, Michael Wang, Donna Weber, Brendan M. Weiss, Jan Westin, Keith Wheatley, Elena Zamagni, Jeffrey Zonder, Sonja Zweegman

Research output: Contribution to journalArticlepeer-review

169 Scopus citations

Abstract

Purpose: The aim of the International Myeloma Working Group was to develop practical recommendations for the diagnosis and management of multiple myeloma–related renal impairment (RI). Methods: Recommendations were based on published data through December 2015, and were developed using the system developed by the Grading of Recommendation, Assessment, Development, and Evaluation Working Group. Recommendations: All patients with myeloma at diagnosis and at disease assessment should have serum creatinine, estimated glomerular filtration rate, and electrolytes measurements as well as free light chain, if available, and urine electrophoresis of a sample from a 24-hour urine collection (grade A). The Chronic Kidney Disease Epidemiology Collaboration, preferably, or the Modification of Diet in Renal Disease formula should be used for the evaluation of estimated glomerular filtration rate in patients with stabilized serum creatinine (grade A). International Myeloma Working Group criteria for renal reversibility should be used (grade B). For the management of RI in patients with multiple myeloma, high fluid intake is indicated along with antimyeloma therapy (grade B). The use of high-cutoff hemodialysis membranes in combination with antimyeloma therapy can be considered (grade B). Bortezomib-based regimens remain the cornerstone of the management of myeloma-related RI (grade A). High-dose dexamethasone should be administered at least for the first month of therapy (grade B). Thalidomide is effective in patients with myeloma with RI, and no dose modifications are needed (grade B). Lenalidomide is effective and safe, mainly in patients with mild to moderate RI (grade B); for patients with severe RI or on dialysis, lena-lidomide should be given with close monitoring for hematologic toxicity (grade B) with dose reduction as needed. High-dose therapy with autologous stem cell transplantation (with melphalan 100 mg/m2 to 140 mg/m2) is feasible in patients with RI (grade C). Carfilzomib can be safely administered to patients with creatinine clearance > 15 mL/min, whereas ixazomib in combination with lenalidomide and dex-amethasone can be safely administered to patients with creatinine clearance > 30 mL/min (grade A).

Original languageEnglish (US)
Pages (from-to)1544-1557
Number of pages14
JournalJournal of Clinical Oncology
Volume34
Issue number13
DOIs
StatePublished - May 1 2016
Externally publishedYes

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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