Abstract
Abstract Background and Aims Acute kidney injury is a frequent complication of multiple myeloma with unfavorable prognostic significance. The aim of the present study is to evaluate the effectiveness of hemadsorption to reducing free light chains (FLCs) in patients with multiple myeloma without replacement kidney therapy. Method The research was conducted for 6 patients ages 65- 74 with multiple myeloma. All patients were already suffering from a mild degree of renal insufficiency and elevated free light chains (4 kappa, 2 lambda). All patients didn’t have renal replacement therapy. Patients received VMP induction chemotherapy after two sessions of hemadsorption. The level of creatinine was from 198 µmol/l to 289 µmol/l. The glomerular filtration rate (eGFR) was from 34,8 to 21,3 mL/min/1,73 m2. The level of kappa FLC was 1714 – 5600 mg/L. The level of lambda FLC was 1575 – 3220 mg/L. In CytoSorb therapy, the blood is purified by adsorption in a procedure similar to hemoperfusion. The hemadsorption procedures were carried out on the AK10 device (Gambro, Sweden) with use of CytoSorb adsorbent cartridge. The content of the CytoSorb cartridge consists of a highly porous high-tech polymer. The patients were treated with 2 CytoSorb hemoadsorption treatments for 10 hours each separated and from one another by a pause interval of 12-14 hours. The blood flow rate was 130-160 ml/min. Anticoagulation was ensured by washing the bloodlines and a cartridge with a sorbent with normal saline with heparin – 4,000 units of activity per 1 L. 5,000 units of activity of heparin were injected intravenously at the beginning of the procedure. The FLCs, the level of creatinine and coagulogram test results of patients were studied prior to procedure and upon termination of procedure. Results An extracorporeal blood purification methods reduce elevated levels of FLCs. The cartridge with a total surface of>40,000 square meters, an adsorber is able to effectively and over time lower hydrophobic (water-insoluble) molecules that can be removed up to a size of 55kDa. FLC have high molecular weight (monomeric kappa of 22.5 kDa, dimeric lambda of 45 kDa). FLC removal, combined with chemotherapy may be associated with renal function recovery. As a result of hemadsorption after carrying out two procedures, there was a significant decrease in level kappa FLCs by 78.3 %, lambda FLCs by 64,0 %. All patients were dialysis independent. The level of creatinine decreased and the glomerular filtration rate increased. Other blood chemistry parameters did not show any changes. Throughout the treatment, the study did not show a decrease in dynamics of hemoglobin or platelets. There were not negative dynamics in change of INR (international normalized ratio), APTT (activated partial thromboplastin time), level of fibrinogen, prothrombin, or anti-thrombin III. No bleeding complication occurred in any patient during the procedure of hemadsorption. Other biochemical values did not change significantly. Conclusion The research showed that an extracorporeal blood purification method by CytoSorb therapy reduce elevated levels of FLCs in patients with multiple myeloma. The benefits of this modality need confirmation with a randomized controlled trial.
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