N.E. Zuderman, N.D. Ushakova, I.B. Lysenko, N.V. Nikolaeva, E.A. Kapuza
Rostov research institute of oncology, Rostov-on-Don
For correspondence: Natalia Е. Zuderman, doctor anesthesiologist-resuscitator of the Block of extracorporeal methods of treatment of anesthesiology and resuscitation department of the Rostov Research Oncology Institute of the Ministry of Health of the Russian Federation, Rostov-on-Don; e-mail: email@example.com
For citation: Zuderman NE, Ushakova ND, Lysenko IB, Nikolaeva NV, Kapuza EA. Experience with the use of selective plasma exchange in patients with newly detected secreting multiple myeloma. Alexander Saltanov Intensive Care Herald. 2019;2:98–104.
The prospects of using the selective plasma exchange in the treatment of first identified multiple myeloma (secretory) is substantiated (MM). Twenty-four patients (16 men and 8 women) were examined with stage II−III of the disease. Patients were divided into two groups: the main group (n = 13) with inclusion in therapy selective plasma exchange were included in the treatment and a control group (n = 11) — were treated according to standard protocol. The patients received specific treatment according to the VCD scheme. The concentrations of paraprotein, free light chains Ig (FLC), glomerular filtration rate (GFR), blood toxicity and the functional characteristics of albumin were studied. The studies were conducted before and after the completion of chemotherapy. Additionally, the concentration of paraprotein, FLC and MSM (molecules with average mass) in the blood serum were determined before and 30 min after the end of selective plasma exchange, as well as in the plasma filtrate. The results of the study showed that the inclusion of selective plasma exchange in the treatment ensured the excretion of more than 50 % of the paraprotein and FLC in the blood, a decrease in their concentration after the completion of the procedure: paraprotein 32 %, κ — FLC 43 %, λ — FLC 68 %. There was a greater regression of monoclonal protein levels and FLC production with a marked decrease in the indices of endogenous intoxication and an improvement in the functional properties of the albumin in the main group as compared with the control after completing the chemotherapy course. In the group of patients a more best to the therapy was obtained: a good response — in 69.2 % of the patients (in the control group — in 45.5 %); a negative response — in 30.8 % of cases against 54.5 % in the control group. The obtained results suggested that including selective plasma exchange in the specific complex therapy of patients with first identified multiple myeloma allows to reduce the volume of paraprotein, increase the degree and rate of reduction of LC, without affecting the toxicity of the therapy, which contributes to the strengthening of hematological and renal response to ongoing treatment.
Keywords: First identified multiple myeloma, selective plasma exchange
- Рыжко В.В., Бирюкова Л.С., Чавынчак Р.Б., Клодзинский А.А. Почечная недостаточность при множественной миеломе. Обзор литературы и собственные данные. Клиническая онкогематология. 2009; 2(4): 316–325. [Ryzhko V.V., Biryukova L.S., Chavynchak R.B., Klodzinskiy A.A. Efficacy of extracorporeal methods in the elimination of light chains in patients with multiple myeloma on programmed hemodialysis. Klinicheskaya onkogematologiya. 2009; 2(4): 316–325. (In Russ)]
- San-Miguel J.F., Mateos M.-V. How to treat a newly diagnosed young patient with multiple myeloma. Hematology (American Society of Hematology Education Program Book, New Orleans, Louisiana, December 508, 2009); 2009: 555–565.
- Рехтина И.Г., Менделеева Л.П., Варламова Е.Ю., Бирюкова Л.С. Сравнение эффективности бортезомибсодержащих программ в достижении раннего гематологического и почечного ответа у больных миеломной нефропатией с диализзависимой почечной недостаточностью. Гематология и трансфузиология. 2015; 60(4): 4–7. [Rekhtina I.G., Mendeleeva L.P., Varlamova E.Yu., Biryukova L.S. Comparison of the effectiveness of bortezomibsoderzhaschih programs in achieving early hematological and renal response in patients with myeloma nephropathy with dialysis-dependent renal failure. Gematologiya i transfuziologiya. 2015; 60(4): 4–7. (In Russ)]
- Dimopoulos M.A., Terpos E., Chanan-Khan A., et al. Renal impairment in patients with multiple myeloma: a consensus statement on behalf of the international myeloma working group. J. Clin. Oncology. 2010; 28(33): 4976–4984.
- Бессмельцев С.С., Абдулкадыров К.М., Замотина Т.Б. Лечебный плазмаферез в лечении больных с множественной миеломой. Эфферентная терапия. 2001; 3: 34–43. [Bessmelʼtsev S.S., Abdulkadyrov K.M., Zamotina T.B. Therapeutic plasmapheresis in the treatment of patients with multiple myeloma. Efferentnaya terapiya. 2001; 3: 34–43. (In Russ)]
- Диагностика и лечение множественной миеломы Рекомендации Британского форума по множественной миеломе и Скандинавской исследовательской группы по множественной миеломе. 2005. [Diagnosis and treatment of multiple myeloma Recommendations of the British Forum on Multiple Myeloma and the Scandinavian Multiple Myeloma Research Group. 2005. (In Russ)]
- Рехтина И.Г., Марьина С.А., Тангиева Л.М. и др. Эффективность экстракорпоральных методов в элиминации легких цепей у больных множественной миеломой на программном гемодиализе. Гематология и трансфузиология. 2013; 58(2). [Rekhtina I.G., Marʼina S.A., Tangieva L.M., et al. Efficacy of extracorporeal methods in the elimination of light chains in patients with multiple myeloma on programmed hemodialysis. Gematologiya i transfuziologiya. 2013; 58(2). (In Russ)]