Chemotherapy plus therapeutic plasmapheresis with 4% human albumin solution in multiple myeloma patients with acute kidney injury: a prospective, open-label, proof-of-concept study
As no unified treatment protocol or evidence yet exists for plasmapheresis without plasma, this study explored the outcomes of using 4% human albumin (ALB) solution as a replacement solution in patients undergoing plasma exchange for multiple myeloma (MM) patients with acute kidney injury (AKI). Thi...
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2024-12-01
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| Series: | Renal Failure |
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| Online Access: | https://www.tandfonline.com/doi/10.1080/0886022X.2024.2356708 |
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| author | Tianzhi Wu Dandan Liu Shangqin Liu Hui Xiao Bei Xiong Yi Zhou Yafen Xiong Qin Cui Jiang Wu Minghui Liu Hongli Liu Yiming Li Meixin Wang Xueqin Bao Ye Li Fuling Zhou |
| author_facet | Tianzhi Wu Dandan Liu Shangqin Liu Hui Xiao Bei Xiong Yi Zhou Yafen Xiong Qin Cui Jiang Wu Minghui Liu Hongli Liu Yiming Li Meixin Wang Xueqin Bao Ye Li Fuling Zhou |
| author_sort | Tianzhi Wu |
| collection | DOAJ |
| description | As no unified treatment protocol or evidence yet exists for plasmapheresis without plasma, this study explored the outcomes of using 4% human albumin (ALB) solution as a replacement solution in patients undergoing plasma exchange for multiple myeloma (MM) patients with acute kidney injury (AKI). This study was prospectively registered (ChiCTR2000030640 and NCT05251896). Bortezomib-based chemotherapy plus therapeutic plasmapheresis (TPP) with 4% human ALB solution was assessed for three years in patients with MM aged >18 years, with AKI according to the Kidney Disease Improving Global Outcomes criteria, and without previous renal impairment from other causes. The primary endpoints were changes in renal function over 18 weeks and survival outcomes at 36 months. The secondary endpoints were the incidence of adverse reactions and symptom improvement. Among the 119 patients included in the analysis, 108 experienced renal reactions. The M protein (absolute changes: median −12.12%, interquartile ranges (IQRs) −18.62 to −5.626) and creatine (median −46.91 μmol/L, IQR −64.70 to −29.12) levels decreased, whereas the estimated glomerular filtration rate (eGFR) increased (median 20.66 mL/(min·1.73 m2), IQR 16.03–25.29). Regarding patient survival, 68.1% and 35.3% of patients survived for >12 and >36 months, respectively. The three symptoms with the greatest relief were urine foam, poor appetite, and blurred vision. All 11 patients (7.6%) who experienced mild adverse reactions achieved remission. In conclusion, in MM patients with AKI, plasma-free plasmapheresis with 4% human ALB solution and bortezomib-based chemotherapy effectively alleviated light chain damage to kidney function while improving patient quality of life. |
| format | Article |
| id | doaj-art-6b328c2974e344179d4a6cfeb5f527cc |
| institution | Kabale University |
| issn | 0886-022X 1525-6049 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Renal Failure |
| spelling | doaj-art-6b328c2974e344179d4a6cfeb5f527cc2025-01-23T04:17:47ZengTaylor & Francis GroupRenal Failure0886-022X1525-60492024-12-0146110.1080/0886022X.2024.2356708Chemotherapy plus therapeutic plasmapheresis with 4% human albumin solution in multiple myeloma patients with acute kidney injury: a prospective, open-label, proof-of-concept studyTianzhi Wu0Dandan Liu1Shangqin Liu2Hui Xiao3Bei Xiong4Yi Zhou5Yafen Xiong6Qin Cui7Jiang Wu8Minghui Liu9Hongli Liu10Yiming Li11Meixin Wang12Xueqin Bao13Ye Li14Fuling Zhou15Department of Haematology, Zhongnan Hospital, Wuhan University, Wuhan, ChinaDepartment of Haematology, Zhongnan Hospital, Wuhan University, Wuhan, ChinaDepartment of Haematology, Zhongnan Hospital, Wuhan University, Wuhan, ChinaDepartment of Haematology, Zhongnan Hospital, Wuhan University, Wuhan, ChinaDepartment of Haematology, Zhongnan Hospital, Wuhan University, Wuhan, ChinaDepartment of Haematology, Zhongnan Hospital, Wuhan University, Wuhan, ChinaDepartment of Haematology, Zhongnan Hospital, Wuhan University, Wuhan, ChinaDepartment of Haematology, Zhongnan Hospital, Wuhan University, Wuhan, ChinaDepartment of Haematology, Zhongnan Hospital, Wuhan University, Wuhan, ChinaDepartment of Haematology, Zhongnan Hospital, Wuhan University, Wuhan, ChinaDepartment of Haematology, Zhongnan Hospital, Wuhan University, Wuhan, ChinaDepartment of Haematology, Zhongnan Hospital, Wuhan University, Wuhan, ChinaDepartment of Haematology, Zhongnan Hospital, Wuhan University, Wuhan, ChinaDepartment of Haematology, Zhongnan Hospital, Wuhan University, Wuhan, ChinaDepartment of Haematology, Zhongnan Hospital, Wuhan University, Wuhan, ChinaDepartment of Haematology, Zhongnan Hospital, Wuhan University, Wuhan, ChinaAs no unified treatment protocol or evidence yet exists for plasmapheresis without plasma, this study explored the outcomes of using 4% human albumin (ALB) solution as a replacement solution in patients undergoing plasma exchange for multiple myeloma (MM) patients with acute kidney injury (AKI). This study was prospectively registered (ChiCTR2000030640 and NCT05251896). Bortezomib-based chemotherapy plus therapeutic plasmapheresis (TPP) with 4% human ALB solution was assessed for three years in patients with MM aged >18 years, with AKI according to the Kidney Disease Improving Global Outcomes criteria, and without previous renal impairment from other causes. The primary endpoints were changes in renal function over 18 weeks and survival outcomes at 36 months. The secondary endpoints were the incidence of adverse reactions and symptom improvement. Among the 119 patients included in the analysis, 108 experienced renal reactions. The M protein (absolute changes: median −12.12%, interquartile ranges (IQRs) −18.62 to −5.626) and creatine (median −46.91 μmol/L, IQR −64.70 to −29.12) levels decreased, whereas the estimated glomerular filtration rate (eGFR) increased (median 20.66 mL/(min·1.73 m2), IQR 16.03–25.29). Regarding patient survival, 68.1% and 35.3% of patients survived for >12 and >36 months, respectively. The three symptoms with the greatest relief were urine foam, poor appetite, and blurred vision. All 11 patients (7.6%) who experienced mild adverse reactions achieved remission. In conclusion, in MM patients with AKI, plasma-free plasmapheresis with 4% human ALB solution and bortezomib-based chemotherapy effectively alleviated light chain damage to kidney function while improving patient quality of life.https://www.tandfonline.com/doi/10.1080/0886022X.2024.2356708Multiple myelomaacute kidney injurychemotherapyplasmapheresis |
| spellingShingle | Tianzhi Wu Dandan Liu Shangqin Liu Hui Xiao Bei Xiong Yi Zhou Yafen Xiong Qin Cui Jiang Wu Minghui Liu Hongli Liu Yiming Li Meixin Wang Xueqin Bao Ye Li Fuling Zhou Chemotherapy plus therapeutic plasmapheresis with 4% human albumin solution in multiple myeloma patients with acute kidney injury: a prospective, open-label, proof-of-concept study Renal Failure Multiple myeloma acute kidney injury chemotherapy plasmapheresis |
| title | Chemotherapy plus therapeutic plasmapheresis with 4% human albumin solution in multiple myeloma patients with acute kidney injury: a prospective, open-label, proof-of-concept study |
| title_full | Chemotherapy plus therapeutic plasmapheresis with 4% human albumin solution in multiple myeloma patients with acute kidney injury: a prospective, open-label, proof-of-concept study |
| title_fullStr | Chemotherapy plus therapeutic plasmapheresis with 4% human albumin solution in multiple myeloma patients with acute kidney injury: a prospective, open-label, proof-of-concept study |
| title_full_unstemmed | Chemotherapy plus therapeutic plasmapheresis with 4% human albumin solution in multiple myeloma patients with acute kidney injury: a prospective, open-label, proof-of-concept study |
| title_short | Chemotherapy plus therapeutic plasmapheresis with 4% human albumin solution in multiple myeloma patients with acute kidney injury: a prospective, open-label, proof-of-concept study |
| title_sort | chemotherapy plus therapeutic plasmapheresis with 4 human albumin solution in multiple myeloma patients with acute kidney injury a prospective open label proof of concept study |
| topic | Multiple myeloma acute kidney injury chemotherapy plasmapheresis |
| url | https://www.tandfonline.com/doi/10.1080/0886022X.2024.2356708 |
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