Is there still a role for plasma exchange/PLEX for confirmed or suspected cast nephropathy in multiple myeloma to rapidly reduce light chain burden?

This is a good question that comes up from time to time. The most important thing is time-to-bortezomib, which should be as short as possible.

For light chain only disease, I do not do plasma exchange. My reasons are:

1. It only marginally reduces free light chains (see: Hutchison et al., PMID 17229909)...