Cancer Conference Update: A Multimedia Review of Key Presentations from the 2016 American Society of Hematology Annual MeetingAbstract 978: MYRE randomized study of intensive hemodialysis with high cutoff or standard high-flux dialyzer for myeloma cast nephropathy in patients receiving a bortezomib-based regimen
3:20 minutes.
TRANSCRIPTION:
DR MIKHAEL: I think this was very encouraging to us, especially — there’s still 20% of patients who are diagnosed with myeloma who have significant renal insufficiency and maybe a smaller amount of them that come in with true acute renal failure. There have been some studies in the past that have tried to even look whether or not some kind of plasma exchange is helpful or not, with conflicting results. But I think most of us now recognize that if you do the 2 things of giving a bortezomib-based regimen to rapidly reduce the production of those light chains and then try and clear them as quickly as possible, often with a plasma exchange-like approach — dialysis almost-like approach — that the patient has a better chance for renal recovery. But now, in addition to just those 2 modalities, more effectively dialyzing the patient with this high-cutoff filter in this study was really quite significant. The rate of individuals who had renal recovery was statistically significantly higher. And so I think it’s going to herald to us in, granted, a smaller group of patients who present with this kind of dramatic renal insufficiency. But for those patients, going onto dialysis versus not going to dialysis is a life changer. We all know that on dialysis treatments are more difficult. Quality of life and quantity of life is affected. So if we can up front rescue more patients from having to go down the dialysis path, long-term dialysis path, with this kind of a filter, then I think we’re serving our patients well. DR LOVE: Now, my understanding is that this is really not available in the United States right now. DR MIKHAEL: That’s correct. I mean, obviously that’s being pursued, but it’s not currently available to us. But I think this trial will clearly help its hopefully ultimate path of making it here. DR LOVE: If it were made available, do you think you’d want to have it at your center? Do you think it’s a real big deal to get it? DR MIKHAEL: Absolutely. I think it’s an important thing, because we’re doing this approach anyway. But to have a more sophisticated dialyzer, I suspect, will contribute somewhat to cost. But it’s hard to put a cost on the ability to rescue someone from long-term dialysis. So this really can have an impact on people’s quality of life long term. DR LOVE: So I have heard about, I don't know, issues in actually doing it, that it takes a long time, that you lose albumin or something. Do you know anything about that? DR MIKHAEL: I wasn’t involved in the details of it, but yes, we’ve been discussing this for a while. It’s not just a question of switching out a modern filter for an older filter. There are some logistical challenges. And I think that’s one of the reasons why you indicated. We’ve been talking about these filters for several years. Why haven’t we seen them incorporated into clinical practice right away is, it’s not that easy a step. So I still think it’ll take some time. And you’re right. My understanding is that it does take a little bit more challenge in how we reinfuse their plasma, whether or not we need to supplement it with additional albumin. So there are some hoops, literally, to jump through. But at least this study demonstrated that it was feasible. And perhaps it’ll make its way to prime time to us before too long. |