Reversal of dialysis-dependent renal failure in patients with advanced multiple myeloma: single institutional experiences over 8 years

Acute renal failure in patients with multiple myeloma (MM) requiring dialysis is a serious complication and is associated with extremely poor survival. In addition, its treatment included high-dose dexamethasone and/or thalidomide-containing regimens on the reversibility of renal function, which has not been adequately evaluated previously. We studied the impact on the reversibility of high-dose dexamethasone and/or thalidomide-containing regimen in 12 newly diagnosed MM patients (median 74 years, range; 63–85 years) who required dialysis at Kameda General Hospital from 2001 to 2008. There were seven light chain only myelomas, three IgD myelomas, and two IgG myelomas. Ten patients initially received high-dose dexamethasone-based treatment and two received thalidomide-based treatment, with modifications. Complete (CR) and partial responses (PR) were obtained in three and five patients, respectively. Dialysis independency was achieved in all eight patients (67%) who achieved better than PR, with a median duration of 2.0 months. Six of the ten patients who received high-dose dexamethasone-containing regimen and all of the two patients received thalidomide-containing regimen became dialysis-independent. A high concentration of serum-free light chain was detected in all patients examined, before the start of anti-myeloma treatment, and this was associated with the presence of advanced renal failure. Improved renal function was preceded by a significant decrease in serum-free light chain in patients who achieved dialysis independence. These results suggest that dialysis-dependent renal failure is reversible by dexamethasone- or thalidomide-based treatments in most patients with MM, even if the patient is in advanced age, and that serum-free light chain monitoring might be useful for predicting improvements in renal function.