Table 2.

Summary of known renal toxicities of Food and Drug Administration approved antimyeloma agents

Class/Drug Name	Published Toxicities in the Literature	CKD Dosing	ESRD Dosing
Traditional chemotherapy
Cisplatin	ATN, TMA, hypomagnesemia, fanconi syndrome, renal salt wasting	Reduce dose by 25% (46–60 ml/min CrCl)	HD: Reduce dose by 50% and administer after HD; CAPD: reduce dose by 50%; CRRT: reduce dose by 25%
		Reduce dose by 50% (10–45 ml/min CrCl)
Melphalan	AKI, hyponatremia	Reduce dose by 15% (46–60 ml/min CrCl)	Limited data
		Reduce dose by 25% (10–45 ml/min CrCl)
Cyclophosphamide	Hemorrhagic cystitis, hyponatremia	No dosing adjustment needed	HD: reduce dose by 50% and administer after HD;
			CAPD: reduce dose by 25%; CRRT: no adjustment needed
Anthracyclines	Collapsing glomerulopathy, FSGS, minimal change disease, TMA	No dosing adjustment needed	No dosing adjustment needed
Immunomodulators
Lenalidomide	AKI, AIN, fanconi syndrome, minimal change disease	10 mg daily (30–60 ml/min CrCl)	HD: 5 mg daily after HD
		15 mg every 48 h (10–29 ml/min CrCl)
Pomalidomide	AKI, crystal nephropathy	CrCl<45ml/min avoid use	Insufficient data
Proteasome inhibitors
Bortezomib	TMA	Reduce dose if GFR<20 cc/min	Dose after dialysis and consider dose reduction (but insufficient data)
Carfilzomib	TMA, prerenal, tumor lysis like syndrome, ATN	No dose adjustment	Dose after dialysis
Ixazomib	None reported	Insufficient data	Insufficient data
HDAC inhibitors
Panobinostat	None reported	No dose adjustment	Insufficient data
SLAMF7 inhibitors
Elotuzumab	AKI	No dose adjustment	No dose adjustment
Anti-CD38 agents
Daratumumab	None reported	No dose adjustment	No dose adjustment

ATN, acute tubular necrosis; TMA, thrombotic microangiopathy; CrCl, creatinine clearance; HD, hemodialysis; CAPD, continuous automated peritoneal dialysis; CRRT, continuous RRT; AIN, acute interstitial nephritis; HDAC, histone deactylase; SLAMF7, signaling lymphocytic activation molecule F7.