Cast Nephropathy, Kidney Failure, Multiple Myeloma
Conditions
Keywords
Hemodialysis, Multiple myeloma, Cast nephropathy, Kidney failure
Brief summary
Hypothesis: Free light chain removal haemodialysis will increase the rate of renal recovery in patients with cast nephropathy, severe renal failure and de novo multiple myeloma. This study will randomise patients with multiple myeloma and severe renal failure to treatment to remove free light chains by haemodialysis or not.
Detailed description
The EUropean trial of free LIght chain removal by exTEnded haemodialysis in cast nephropathy (EuLITE) trial is a prospective, randomised, multicentre, open label clinical trial to investigate the clinical benefit of FLC removal haemodialysis in patients with cast nephropathy, dialysis dependent renal failure and de novo multiple myeloma. Recruitment commenced in May 2008, in total 90 patients will be recruited. Participants will be randomised, centrally, upon enrolment, to either trial chemotherapy and FLC removal haemodialysis or trial chemotherapy and standard high flux haemodialysis. Trial chemotherapy is a modified PAD regime, consisting of bortezomib, doxorubicin and dexamethasone. FLC removal haemodialysis is undertaken using two Gambro HCO 1100 dialysers in series, over an intensive treatment schedule. The primary outcome for the study is independence of dialysis at 3 months. Secondary outcomes are: duration of dialysis, reduction in serum FLC concentrations; myeloma response and survival.
Interventions
DEVICEFLC removal HD (Gambro HCO 1100)
FLC removal HD using a extended dialysis schedule on the Gambro HCO 1100
PROCEDUREStandard dialysis on a high flux ployflux dialyser
Standard dialysis on a high flux ployflux dialyser at a frequency determined by the duty nephrologist
Sponsors
Gambro Renal Products, Inc.
Ortho Biotech, Inc.
University Hospital Birmingham
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age \>= 18 years * Dialysis dependent acute renal failure (eGFR \<15ml/min/1.73m2) * Fulfils diagnostic criteria for the diagnosis of symptomatic de novo multiple myeloma1 * Abnormal serum FLC ratio and a sFLC concentration \> 500 mg/L * Myeloma kidney demonstrated on a renal biopsy (cast nephropathy) * Ability to give informed consent to partake in study * Commencement of study within 10 days of presenting to enrolling unit
Exclusion criteria
* Age \< 18 years * Known advanced chronic renal failure (CKD stage IV 4-5; eGFR \<30mls/min/1.73m2) or evidence of significant chronic damage on renal biopsy * Amyloidosis or light chain deposition disease on renal biopsy * Previous treatment of multiple myeloma with chemotherapy * Haemodynamic instability that precludes unsupported dialysis renal replacement therapy * Significant cardiac disease (myocardial infarction with in the last 6 months; unstable angina; NYHA class III or IV heart failure; clinically significant pericardial disease; cardiac amyloidosis) * Advanced disease or significant co-morbidity: with poor short term prognosis, necessitating palliation and no active or disease specific treatment. * Inability to give informed consent * History of allergic reaction attributable to compounds containing boron or mannitol * History of Peripheral neuropathy or neuropathic pain (grade 2 or higher as defined by NCI CTCAE version 3) * Clinically significant liver dysfunction (bilirubin \>1.8mg/dl (30µmol/L)) * Known HIV infection * Active uncontrolled infection * Pregnant and lactating women * Inability to give informed consent * Pre-menopausal female patients of childbearing potential: positive pregnancy test or unwilling to use effective contraception during the study * Lactation
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Independence of haemodialysis at 3 months from enrollment (eGFR > 15mls/min/1.73m2 at 2 weeks after last dialysis session) | 3 months from enrollment |
Secondary
| Measure | Time frame |
|---|---|
| Efficiency of extended HD with respect to reduced sFLC concentrations; duration of HD before renal recovery; multiple myeloma response to chemotherapy and suitability for stem cell transplantation; mortality over 24 months observation period | 24 months |
Countries
United Kingdom
Outcome results
None listed