eligibility_summary
Adults ≥18 with new/relapsed MM (BM plasma cells >10%), light chain cast nephropathy (involved LC >500 mg/L), and AKI (≥1.5× baseline SCr or RRT). PLEX group: ≥1 session within 30 days of CN diagnosis, treated in 2010+. Controls met same criteria without PLEX. Exclude ESKD, amyloidosis/MIDD, CLL/plasma cell leukemia/Waldenström, moribund, urinary obstruction, significant albuminuria, other AKI causes, no clone-directed therapy, PLEX >30 days.
trial_source
clinical_trials.gov from Dec 2, 2025
annotation_status
ai
ai_summary
NCT06483139 (observational) compares three approaches in MM with light chain cast nephropathy/AKI: 1) Plasma exchange (procedure): extracorporeal removal of circulating free light chains to lower intratubular cast formation with uromodulin (Tamm-Horsfall protein), reduce tubular toxicity/inflammation, and improve renal recovery. Targets: circulating κ/λ light chains and downstream tubular cast pathway. 2) Daratumumab-based therapy (drug): daratumumab is a human IgG1κ anti-CD38 monoclonal antibody that depletes CD38+ myeloma plasma cells via CDC, ADCC, ADCP, and apoptosis, reducing light-chain production, also modulates CD38+ immunosuppressive cells. Targets: CD38-expressing malignant plasma cells/immune cells. 3) Non-daratumumab regimens (e.g., CyBorD): bortezomib (proteasome inhibitor, blocks 26S proteasome/NF-κB, induces plasma-cell apoptosis), cyclophosphamide (alkylating agent, DNA crosslinking), dexamethasone (corticosteroid, pro-apoptotic/anti-inflammatory). Targets: malignant plasma cells (proteasome pathway, DNA) and resultant light-chain load.