How do you monitor multiple myeloma in patients receiving dialysis?

In brief, it depends. I’ve had some patients on dialysis whose light chains completely normalize with treatment and continue to remain normal - and others where the light chains never drop below 100 mg/L even in the setting of MRD negativity. This probably has something to do with the fact that not all light chains are created equally in terms of their clearance by kidneys or a dialysis circuit.

We unfortunately don’t have much trial data to guide us, and IMWG does have renal response criteria based on the eGFR but that wouldn’t be relevant to patients with irreversible cast nephropathy who remain on dialysis.

SO - I typically use standard response criteria, but my threshold to assess for MRD negativity (or at least check a bone marrow biop...