Light chain cast nephropathy (LCCN) is a leading cause of acute kidney injury (AKI) in patients with multiple myeloma (MM) and is now defined as a myeloma defining event. While the long-term prognosis has improved with novel agents, short-term mortality remains significantly higher in patients with LCCN especially if the renal failure is not reversed. Recovery of renal function requires a rapid and significant reduction of the involved serum free light chain. Therefore, proper treatment of these patients is of the utmost importance. In this paper, we provide an algorithm for treatment of MM patients who present with biopsy-proven LCCN or in those where other causes of AKI have been ruled out. The algorithm is based on data from randomized trial whenever possible. When trial data is not available, our recommendations is based on non-randomized data and expert opinions on best practices. We recommend that all patients should enroll in a clinical trial if available prior to resorting to the treatment algorithm we outlined.
轻链管型肾病（LCCN）是多发性骨髓瘤（MM）患者发生急性肾损伤（AKI）的主要原因，现已被定义为骨髓瘤定义事件。尽管新型药物改善了长期预后，但LCCN患者的短期死亡率仍显著更高，尤其是在肾功能未能逆转的情况下。肾功能恢复需要快速且显著降低受累血清游离轻链水平。因此，对这些患者进行恰当治疗至关重要。本文提出了一套针对经活检证实为LCCN或已排除其他AKI病因的MM患者的治疗流程。该流程尽可能基于随机试验数据制定；若缺乏试验数据，则依据非随机研究数据及专家最佳实践意见形成推荐建议。我们建议所有患者在采用本流程治疗前，如条件允许应先加入相关临床试验。
肿瘤(癌症)患者之家