Table 1.

Inclusion and exclusion criteria

Inclusion criteria
∘ Age greater than 18 years
∘ Dialysis dependent acute renal failure (defined by: an estimated GFR of < 15 ml/min/1.73 m2)
∘ Fulfils criteria for the diagnosis of symptomatic de novo multiple myeloma
∘ Abnormal serum FLC ratio and a serum FLC concentration > 500 mg/L
∘ Myeloma kidney demonstrated on a renal biopsy (cast nephropathy)
∘ Commencement of study within 10 days of presenting to enrolling unit
Exclusion criteria
∘ Known advanced chronic renal failure (eGFR < 30 mls/min/1.73 m2) or evidence of significant chronic damage on renal biopsy
∘ Amyloidosis or light chain deposition disease on renal biopsy
∘ Previous treatment of multiple myeloma with chemotherapy
∘ Haemodynamic instability that precludes unsupported renal replacement therapy
∘ Significant cardiac disease
∘ Advanced disease or significant co-morbidity: with poor short term prognosis, necessitating palliation and no active or disease specific treatment.
∘ History of allergic reaction attributable to compounds containing boron or mannitol
∘ Peripheral neuropathy or neuropathic pain Grade 2 or higher
∘ Clinically significant liver dysfunction (bilirubin > 1.8 mg/dl (30 umol/L))
∘ Active uncontrolled infection or known HIV infection
∘ Inability to give informed consent
∘ Pregnant and lactating women