2015 Volume 6 Issue 1 Pages 78-81
【Case】 A 58-year-old man who was diagnosed as having IgM κ-type Waldenström macroglobulinemia (WM) has treated with maintenance hemodialysis due to rapidly progressive kidney failure and peripheral neuropathy secondary to paraproteinemia. Chemotherapy according to the R-CHOP schema was initiated for WM, but interstitial pneumonia occurred as an adverse effect. Chemotherapy was stopped, but the hemodialysis was continued to eliminate free light chains (FLCs. 【Methods】 To determine the most effective FLC elimination method, hemodialysis was performed for this patient under several conditions by changing the kinds of dialyzers and dialysis methods. The removal rate, removal amount, and clear space of FLCs were then evaluated. 【Results】 The condition that showed the highest FLC removal rate was hemodiafiltration with a V-type membrane. Significant correlations were found between removal rates of κ light chain and β2-MG, and between removal rates of λ light chain and α1-MG (r=0.943 [p=0.035] and r=0.943 [p=0.035], respectively). Meanwhile, hemodialysis with the PMMA membrane showed the highest removal amount and clear space of FLCs. However, a large amount of albumin was also eliminated. 【Summary】 In conclusion, PMMA and V-type membranes, which have excellent propensities for molecular elimination were considered to be better than other membranes for FLC removal. However, a large amount of albumin tended to be eliminated using these membranes. When choosing the dialysis conditions for patients with WM, it seems important to consider their general condition, including their nutritional status. Further studies are necessary to identify the best method for FLC elimination in patients with WM.
