The role of extracorporeal therapy in light chain cast nephropathy

Recent advances in treating multiple myeloma have increased overall survival and brings a cure closer to reality. Kidney failure remains one of the most significant factors impacting survival, and the recovery of kidney function is crucial in this aspect. Light chain cast nephropathy is the most common subtype of kidney injury caused by toxic monoclonal proteins in myeloma patients and is closely related to the concentration of the involved serum-free light chain (sFLC). A fast decline in sFLC is associated with improved kidney recovery rates. Negative results in randomized controlled trials of extracorporeal therapies have not yet distracted clinicians from applying these options in light chain cast nephropathy due to the demonstrated efficiency of these modalities in sFLC removal compared to conventional dialytic therapies. This review summarizes the efficiency of sFLC reduction with available extracorporeal methods in patients with multiple myeloma and severe kidney failure when combined with anti-myeloma therapy.