{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T15:54:41Z","timestamp":1791906881757,"version":"4.3.4"},"reference-count":29,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2024,6,14]],"date-time":"2024-06-14T00:00:00Z","timestamp":1718323200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Hematological Oncology"],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Current treatment guidelines of myeloma cast nephropathy (MCN) recommend the institution of plasma cell\u2010directed therapy and consideration of therapeutic plasma exchange (TPE), with the goal of rapid reduction of the serum free light chain (sFLC). However, the role of TPE continues to remain a subject of debate. The goal of this retrospective bi\u2010institutional study was to evaluate the clinical outcomes of TPE in combination with systemic therapy. Eighty patients were included in this analysis, of whom 72.5% had \u226550% drop in their initial involved sFLC. At 3\u00a0months from TPE initiation, the overall hematologic response rate (ORR) was 67.5% with a very good partial response or better (\u2265VGPR) rate of 40%. At 6\u00a0months, ORR was 57.5%, with \u2265VGPR rate of 49%. The renal response rate at 3 and 6\u00a0months was 47.5% and 43.75%, respectively; the overall renal response rate was 48.75%. On multivariable analysis, every one unit increase in baseline creatinine (odds ratio [OR] 0.76, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.006), and achievement of \u2265VGPR (OR 21.7 <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.0001) were significantly associated with renal response. Also, a \u226550% drop in sFLC was favorably associated with renal response (OR 3.39, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.09). With a median follow\u2010up of 36.4\u00a0months, the median overall survival (OS) was 11\u00a0months. On multivariable analysis, achievement of renal response (hazard ratio [HR]\u00a00.3, <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.0001) and newly diagnosed disease (NDMM; HR 0.43, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.0055) were associated with improved OS. Among NDMM patients, those treated with daratumumab\u2010based regimens had a trend for better OS (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.15), compared to other regimens, but the difference was not significant. At the end of follow\u2010up, an estimated 40.4% of patients who were on dialysis were able to become dialysis independent. In conclusion, our study highlights the poor survival of patients with MCN. Achievement of early renal response is crucial for prolonged OS, with daratumumab\u2010based therapies showing promise.<\/jats:p>","DOI":"10.1002\/hon.3293","type":"journal-article","created":{"date-parts":[[2024,6,14]],"date-time":"2024-06-14T03:39:19Z","timestamp":1718336359000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Outcomes of therapeutic plasma exchange for the treatment of patients with multiple myeloma cast nephropathy"],"prefix":"10.1002","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3587-7975","authenticated-orcid":false,"given":"Danai","family":"Dima","sequence":"first","affiliation":[{"name":"Multiple Myeloma Program Department of Hematology and Medical Oncology Cleveland Clinic Taussig Cancer Institute  Cleveland Ohio USA"},{"name":"University of Washington, Fred Hutchinson Cancer Center  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1663-0325","authenticated-orcid":false,"given":"Utkarsh","family":"Goel","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4779-6905","authenticated-orcid":false,"given":"Aishwarya","family":"Sannareddy","sequence":"additional","affiliation":[{"name":"Myeloma, Waldenstrom's, and Amyloidosis Program Hematologic Malignancies and Cellular Therapy Program Harold C. 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