Multiple myeloma with renal insufficiency as a therapeutic challenge

Abstract

One of the first symptoms of multiple myeloma (MM) can be renal insufficiency (RI). Elevated concentration of serum creatinine states is already present at the time of diagnosis in 20–50% of patients with MM. The prognosis for patients with a serum creatinine >2.0mg/dL is very bad and is found for only approximately 6 months. Improvement of renal function in MM can only be achieved through a comprehensive therapeutic treatment, but mainly by the quick start of modern chemotherapy. Bortezomib in combination with dexamethasone is recommended in MM patients with RI. Currently, it is advisable to give bortesomib subcutaneously, as to avoid significant neurotoxicity and establish treatment program execution and consequently have a greater chance of a reversal of the RI and a significant improvement in prognosis. Metabolism of lenalidomide is associated with the kidneys, which greatly limits its use in the treatment of MM in particular with a high degree of RI. Regarding the introduction into clinical practice of new drugs suggests that renal failure should no longer be regarded as a significant factor for worsening the prognosis of patients with MM.