Background: Renal failure is a common and severe complication of multiple myeloma. About 20% of the population with myeloma present with renal insufficiency and is associated with increased risk of early mortality. Plasmapheresis has been proposed as a method to reduce rate of permanent renal failure by removing the light chains from the plasma in myeloma patients. However, evidence related to the addition of plasmapheresis to chemotherapy for renal recovery in myeloma patients in existing literature is conflicting. The objective of this study is to present the totality of evidence by conducting a systematic review to assess the efficacy of plasmapheresis in preventing irreversible renal failure in patients with multiple myeloma.
Methods: A systematic and comprehensive search of the literature was performed using MEDLINE, and Cochrane library databases from 1966–2006 for all phase III randomized controlled trials comparing the use of chemotherapy with forced diuresis plus plasmapheresis versus chemotherapy plus forced diuresis in myeloma patients. Additionally, we searched ASCO and ASH meeting abstracts for the last two years. Data were extracted and pooled on overall survival and renal outcome (discontinuation of dialysis, improvement in renal function/creatinine clearence) as per the methods recommended by the Cochrane Collaboration.
Results: Altogether we identified 25 trials out of which 3 studies met the inclusion criteria. Overall, the methodological quality of the trials was good and there was no statistically significant heterogeneity between trials [outcome: overall survival (p=0.2), renal outcome (p=0.6)]. Overall survival and renal outcome were similar for the plasma exchange group and the control. Hazard ratio for the outcome overall survival was 0.76 (95% CI 0.47, 1.25, p=0.3) and for the requirement of dialysis was 0.71 (95%CI 0.35, 1.42, p=0.3) indicating no benefit for plasmapheresis in the treatment of renal failure associated with myeloma (see figure 1).
Conclusion: In multiple myeloma patients with acute renal failure there is no conclusive evidence that plasmapheresis has any effect on overall survival or on the requirement of dialysis.
Disclosure: No relevant conflicts of interest to declare.