Plasmapheresis (Plasma exchange) for Myeloma

Overview
In some cases of myeloma, cancer cells secrete abnormal proteins, leading to the development of complications known as hyperviscosity syndrome, amyloidosis, and light chain deposition disease. In hyperviscosity syndrome, the blood becomes so thick with abnormal proteins that the body cannot maintain normal blood flow. In amyloidosis and light chain deposition disease, the abnormal proteins cause damage and symptoms when they are deposited into the body’s tissues. About 50 percent of people diagnosed with multiple myeloma develop kidney problems or chronic kidney disease as a consequence of abnormal proteins damaging the kidneys.

Plasmapheresis, also known as plasma exchange, is a short-term treatment for acute kidney damage or hyperviscosity syndrome in people with myeloma. Plasmapheresis does not treat the underlying problem – it does not kill the cancer cells making the abnormal proteins – but it limits the amount of abnormal proteins in the blood and helps to limit the damage and symptoms caused by the proteins. Chemotherapy and other medications are needed to kill the cancer cells.

There is some controversy among doctors about whether plasmapheresis is an effective treatment for complications of myeloma. Some doctors may recommend plasmapheresis, while others may not.

What does it involve?
Plasma exchange involves replacing the plasma, or liquid part of your blood, with either saline solution (a salt and water mixture) or plasma from a donor. The plasma and abnormal antibodies are removed; your red and white blood cells are combined with the replacement plasma and returned to your body. It is thought that plasma exchange works to combat hyperviscosity syndrome, amyloidosis, and light chain deposition disease by reducing the amount of abnormal proteins in the blood.

Plasma exchange must be received in a dedicated clinical setting. A medical professional will insert a needle and tubing into a large vein in the neck, near the groin, or under the collarbone. The tubing will be attached to a special machine that performs the exchange. Each treatment requires two to four hours. Typically, people receiving plasma exchange for myeloma undergo between five and seven treatments within a span of seven to 10 days.

Intended outcomes
The goal of plasmapheresis is to reduce levels of abnormal proteins in the blood by at least 50 percent, preventing damage and symptoms caused by acute complications of myeloma.

Results
In a review of several clinical studies, 147 people with myeloma cast nephropathy (the most common type of kidney disease in those with multiple myeloma) were either treated with plasma exchange or other methods. Those treated with plasma exchange showed a significantly lower risk of becoming dependent on dialysis than those who did not receive plasma exchange. It is noteworthy that the studies were completed before the introduction of newer medications for myeloma.

Another review pooled results from clinical studies that involved more than 80 people with kidney failure caused by multiple myeloma. The results of this review found no significant difference in survival or dialysis dependence among those who underwent plasmapheresis versus those who were not treated with the procedure. These studies were also completed before the introduction of newer medications for myeloma.

Constraints
Plasma exchange can be a time-consuming and expensive procedure. Your insurance may or may not cover plasma exchange.

A very small number of people experience infections or bleeding due to the procedure of plasma exchange. Some people may have allergic reactions to albumin, which may be used as the replacement liquid for plasma, or to the chemicals used to sterilize the tubing. Some people may experience dizziness, fainting or nausea during plasma exchange; drinking extra water beginning three days before the treatment can help combat these side effects.

Plasma exchange may cause a drop in levels of calcium in the blood due to the use of the blood thinner citrate. Ask your doctor about taking a calcium supplement when receiving plasma exchange.

Seek medical help immediately if you experience symptoms of an allergic reaction such as trouble breathing, severe dizziness, a rash, or itching or swelling of the face, tongue and throat.

For more details about this treatment, visit:

Disease Complications – Leukemia & Lymphoma Society
https://www.lls.org/disease-information/myeloma...

Supportive Treatments for Patients With Multiple Myeloma – American Cancer Society
https://www.cancer.org/cancer/multiple-myeloma/...

Myeloma (PDF) – Leukemia & Lymphoma Society
https://www.lls.org/sites/default/files/file_as...

Plasmapheresis and Myeloma Cast Nephropathy: A Meta-Analysis and Review of Evidence – Blood
http://www.bloodjournal.org/content/130/Suppl_1...

Plasmapheresis in the Treatment of Renal Failure Associated with Multiple Myeloma. – Blood
http://www.bloodjournal.org/content/108/11/3585...

Treatment and prognosis of kidney disease in multiple myeloma and other monoclonal gammopathies – UpToDate
https://www.uptodate.com/contents/treatment-and...