Immunomodulatory drugs and proteasome inhibitors in the treatment of multiple myeloma patients with renal failure

Abstract

while renal impairment is present in 50% of multiple myeloma patients at some point in their disease course, it is associated with higher tumor burden, more aggressive disease, diminished quality of life, development of complications and increased mortality. Patients presenting severe renal impairment represent a greater therapeutic challenge and generally have poorer outcome. Bortezomib, thalidomide, and lenalidomide have substantially improved survival of MM patients including patients with renal insufficiency. we review efficacy and safety of these agents in patients with renal impairment. Bortezomib can be administered at the full approved dose and schedule in renally impaired patients; similarly, no dose reductions are required with thalidomide. Lenalidomide pharmacokinetics is affected due to its renal route of excretion; dose adjustments are recommended for moderate/severe impairment. Substantial evidence has emerged demonstrating these novel agents improve outcomes of patients with renal impairment, including impairment reversal.