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Plasmapheresis, Hemodialysis, and Chemotherapy

William J. Johnson, MD; Robert A. Kyle, MD; Alvaro A. Pineda, MD; Peter C. O'Brien, PhD; Keith E. Holley, MD

Arch Intern Med. 1990;150(4):863-869.

Abstract
• The aims of this study were to examine in a prospective, randomized trial the efficacy of plasmapheresis in preventing irreversible renal failure in patients with multiple myeloma and to study the renal biopsy tissues from such patients. Twenty-one patients with active myeloma and progressive renal failure were randomized to one of two groups: group 1, forced diuresis and chemotherapy (10 patients), and group 2, forced diuresis, chemotherapy, and plasmapheresis (11 patients). Plasmapheresis and chemotherapy lowered the serum myeloma protein value much more rapidly than chemotherapy alone. Of 5 patients who were oliguric and undergoing dialysis at presentation, only 3 who were treated by plasmapheresis recovered. Of 16 polyuric patients, 5 in group 1 and 7 in group 2 showed improvement in renal function. The main factor that determined irreversibility of renal failure was the severity of myeloma cast formation.

(Arch Intern Med. 1990;150:863-869

Author Affiliations
From the Divisions of Nephrology and Internal Medicine (Dr Johnson), Hematology and Internal Medicine (Dr Kyle), and Laboratory Medicine (Drs Pineda and Holley) and the Section of Biostatistics (Dr O'Brien), Mayo Clinic and Mayo Foundation, Rochester, Minn.

Footnotes
Accepted for publication November 7,1989.

Reprint requests to Mayo Clinic, 200 First St SW, Rochester, MN 55905 (Dr Johnson).

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