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Unformatted text preview: 57% req dialysis), 76% biopsied, all given melphalan, prednisone, & forced diuresis, 11 plasmapheresed, subgroup analysis of dialysis dependent patients – renal recovery in 47% pheresed v. 0% control Plasmapheresis? Plasmapheresis? • Clark 2005: 97 patients (26 v. 36% initially on dialysis in plasmapheresis v. control group), few biopsied, treated w/ vincristine, adriamycin, dexamethasone or melphalan & prednisone, +/­ plasmapheresis, no statistically significant difference in composite endpoint of death, dialysis dependence, gfr < 30 ml/min @ 6 months Plasmapheresis? Plasmapheresis? • Leung 2007: retrospective study in 40 patients, cast nephropathy in 18/28 patients (64.3%) that were biopsied, w/ these patients having renal response associated w/ >/= 50% reduction in sFLC levels (77.8% v. 0%, p = 0.001), & w/ sFLC reduction not affecting renal recovery in the other 10 patients, post­treatment sFLC level predicted renal response (p = 0.01) & renal response predicted long­term survival (p = 0.04) – median survival 31.8 v. 11 months References References • • • • • • • Clark, WF et al. Plasma exchange when myeloma presents as acute renal failure: a randomized, controlled trial. Ann Intern Med 2005; 143:777. Huang, ZQ et al. Localization of a single binding site for immunog...
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This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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