Table 2.

Therapeutic options for monoclonal gammopathies of renal significance

Agent (Dosage Form)	Clone Sensitivity		Dose Adjustment for eGFR?	Described Kidney-Associated Toxicities	Common Adverse Events
	B Cell	Plasma Cell
Proteasome inhibitors
Bortezomib (IV, SC)	X	X	No	None	Thrombocytopenia
					Peripheral neuropathy
					Varicella zoster reactivation
Carfilzomib (IV)	X	X	Yes	AKI, thrombotic microangiopathy	Thrombocytopenia
					Dyspnea
					Hypersensitivity reaction
					Varicella zoster reactivation
Monoclonal antibodies
Rituximab (anti-CD20) (IV)	X		No	None	Infusion reactions
					Hepatitis B reactivation
Daratumumab (anti-CD38) (IV)		X	No	None	Infusion reactions
Cytotoxic agents
Cyclophosphamide (IV, PO)	X	X	No	None	Nausea
					Cytopenias
Melphalan (IV, PO)	X	X	Yes	None	Nausea
					Cytopenias
Bendamustine (IV)	X	X	Yes	None	Cytopenias
Immunomodulatory agents
Thalidomide (IV, PO)	X	X	No	Hyperkalemia observed in renal insufficiency	Constipation
					Fatigue, somnolence
					Peripheral neuropathy
					Venous thrombosis
					Rash
					Teratogenicity
Lenalidomide (IV)	X	X	Yes	Increased myelosuppression in renal insufficiency, AKI observed in AL amyloidosis	Cytopenias
					Venous thrombosis
					Diarrhea
					Constipation
					Rash
					Teratogenicity
Pomalidomide (IV)		X	Unknown	No	Cytopenias
					Venous thrombosis
					Diarrhea; Constipation
					Teratogenicity
Other agents
Fludarabine (IV)	X		Yes	None	Cytopenias
					Opportunistic infections
					Hemolytic anemia
					Secondary myeloid neoplasms
Pentostatin (IV)	X		Yes	Increased creatinine	Cytopenias
					Opportunistic infections
					Hemolytic anemia
Ibrutinib (PO)	X		Unknown	Increased creatinine	Bleeding
					Tachyarrhythmias

IV, intravenous; SC, subcutaneous; PO, oral; AL, amyloid light chain amyloidosis.