20.500.12556/DiRROS-29614 Use of high- and medium-cut-off membrane hemodialysis for removal of free light chains in patients with multiple myeloma-a single-center experience Background/Objectives: Light-chain cast nephropathy remains a major cause of morbidity in newly diagnosed multiple myeloma (MM), and rapidly reducing circulating free light chains (FLCs) is considered essential for renal recovery and survival. Methods: We conducted a single-center retrospective study evaluating high- and medium-cut-off hemodialysis (HCO/MCO HD) in newly diagnosed MM patients presenting with acute kidney injury (AKI). Consecutive patients treated at the University Medical Center Ljubljana between 1 January 2020 and 31 December 2023 were included. As per institutional protocols, HCO/MCO HD- and myeloma-directed therapy were initiated on the day of diagnosis. Primary endpoints were the magnitude of FLC reduction, renal and hematologic responses at three months, and overall survival. Results: The median FLC concentration at presentation was 9630 mg/L. FLC levels declined rapidly after HCO/MCO HD initiation, reaching 2400 mg/L by day 7, 1083 mg/L by day 14, and 370 mg/L by day 30. MCO HD achieved kapa FLC clearance comparable to HCO HD for the lambda isotype. Despite a median of only four HCO/MCO-HD sessions, the reduction in FLC was rapid, with an additional decline observed over time, while the median FLC concentration fell below 500 mg/L. At three months, the overall hematologic response was 87%, including very good partial response or better in 35% of patients, and renal response in 79% of patients. Achieving a ≥70% FLC reduction by day 7 was associated with superior outcomes, including markedly longer median overall survival (82.5 vs. 23.2 months). Conclusions: Our data show that HCO/MCO-HD treatment alongside anti-myeloma therapy achieves sustained FLC reduction in newly diagnosed MM with AKI and early FLC reduction is highlighted as a key determinant of survival. acute kidney injury free light chains high-cut-off dialysis light chain cast nephropathy medium-cut-off dialysis myeloma akutna ledvična okvarna prosti lahki verigi (imunoglobulinov) dializa s filtrom z visoko propustnostjo nefropatija z valji iz lahkih verig mielomska ledvica dializa s filtrom s srednjo prepustnostjo mielom true false true Angleški jezik Slovenski jezik Neznano 2026-06-01 13:45:34 2026-06-01 13:45:35 2026-06-02 03:48:26 0000-00-00 00:00:00 2026 0 0 Nasl. z nasl. zaslona; Opis vira z dne 21. 5. 2026; str. 1-12 iss. 8, [article no.] 2917 Vol. 15 Apr. 2026 0000-00-00 Zaloznikova Objavljeno NiDoloceno 0000-00-00 0000-00-00 0000-00-00 616.1/.4 2077-0383 10.3390/jcm15082917 278979843 RAZ_Skerget_Matevz_2026.pdf RAZ_Skerget_Matevz_2026.pdf 1 6F6BA6E622B9F8A0186E1853BAE914CC 146d63f22201367e910d6ffbd4a93be68356ca2ca2ece511d1085817a78c8b66 98b8ed02-5daf-11f1-8e51-001a4af901a5 https://dirros.openscience.si/Dokument.php?lang=slv&id=44454 https://www.mdpi.com/2077-0383/15/8/2917 1 6c675a49-5daf-11f1-8e51-001a4af901a5 https://dirros.openscience.si/Dokument.php?lang=slv&id=44453 Univerzitetni klinični center Ljubljana 0 0 0