A critical and emergent clinical scenario in myeloma management is a patient presenting with the disease in acute renal failure. The 2 most common initial therapies used are CyBorD (the choice of both faculty) and bortezomib/dexamethasone. Dr Vij notes that data from nonrandomized studies suggest that reversal of renal dysfunction within the first few months allows patients to live nearly as long as those who started out with normal renal function, and for this reason he approaches these cases aggressively with a 3-drug regimen.

Kapoor P et al. Bortezomib combination therapy in multiple myeloma. Semin Hematol 2012;49(3):228-42. Abstract

Kumar SK et al. Management of newly diagnosed symptomatic multiple myeloma: Updated Mayo Stratification of Myeloma and Risk-Adapted Therapy (mSMART) consensus guidelines. Mayo Clin Proc 2013;88(4):360-76. Abstract

Dimopoulos MA et al. Renal impairment in patients with multiple myeloma: A consensus statement on behalf of the International Myeloma Working Group. J Clin Oncol 2010;28(33):4976-84. Abstract