Abstract
We report the case of a 56-year-old man who had been monitored in the Hematology Department since 2009 with a diagnosis of asymptomatic IgG λ multiple myeloma and cytogenic findings of poor prognosis (a P53 gene deletion).After several months under observation and without treatment, disease progression occurred with anemia (hemoglobin 9.8g/dL), renal failure (creatinine 2mg/dL) and increased urinary excretion of lambda light chains (10.8g/24h). Treatment with bortezomib/thalidomide/dexamethasone was initiated with no response. Subsequently, the kidney failure showed abrupt worsening (creatinine 8.8mg/dl) and consequently dialysis with a high cut-off filter (Theralite) was started. The Hematology Department decided to switch the treatment to lenalidomide.Treatment was started with daily hemodialysis for 6 days, followed by alternate days. After 53 days of treatment and 27 dialysis sessions, the level of free light chains decreased to 1,000mg/dl, and glomerular function was 26 cc/min. Dialysis with the HCO filter was then withdrawn. ConclusionThe HCO filter was effective in removing plasma free light chains and in treating the acute renal failure.
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