A trial looking at plasma exchange in patients with newly diagnosed myeloma and kidney failure (MERIT)

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Cancer type:

Blood cancers

Myeloma

Status:

Results

Phase:

Phase 3

This trial looked at plasma exchange to help treat kidney damage in people with myeloma.

More about this trial

People with myeloma often have high levels of proteins called immunoglobulins in their blood. These extra proteins can damage the kidneys, as they pass through from the blood into the urine.

Some myeloma patients have serious kidney failure when they are first diagnosed. When this trial was done, these patients often needed to have kidney dialysis for life.

Doctors wanted to find out whether a process called plasma exchange may help damaged kidneys to work again. Plasma exchange is a way of removing some of the extra proteins in the blood.

They hoped that lowering the levels of these proteins would stop damage to the kidneys, which would then be able to recover. So patients would be less likely to need dialysis.

The aim of this trial was to find out if plasma exchange, along with steroid and chemotherapy treatment, can help damaged kidneys to recover.

Summary of results

The research team found that plasma exchange didn’t affect whether people with myeloma needed dialysis or not.

The recruited people between 2004 and 2009, and presented the results at a conference in 2012.

Results

The research team had hoped to recruit nearly 300 people. But treatment for people with myeloma and kidney failure changed while this trial was being done, so they found it hard to recruit people. They eventually decided to close the trial even though they hadn’t reached their target.

They recruited 78 people with myeloma and poor kidney function (renal failure).

The people taking part were put into one of two groups at random:

40 people had 2 four day courses of steroid (dexamethasone) tablets in the first 2 weeks, and then chemotherapy
38 people had 2 four day courses of dexamethasone tablets and plasma exchange 7 times in first 2 weeks, and then chemotherapy

The research team took blood samples to measure the levels of a particular protein. They did this before people started treatment and then again on days 5, 10 and 17.

They were able analyse the results of 72 people, 100 days after joining the trial. They found that there was little difference between the two groups.

Of those who hadn’t had plasma exchange:

11 were living and didn’t need dialysis
21 were living but did need dialysis
5 had died

And of those who did have plasma exchange:

11 were living and didn’t need dialysis
17 were living but did need dialysis
7 had died

The research team looked at the levels of protein in blood samples in more detail. They found that people who were less likely to need dialysis had a lower level to start with, or had a greater reduction during the trial.

Conclusion

The research team found that plasma exchange didn’t reduce the need for dialysis. And that people with lower overall levels of protein were less likely to need dialysis.

We have based this summary on information from the research team. The information they sent us has been reviewed by independent specialists (peer reviewed Open a glossary item

) but may not have been published in a medical journal. The figures we quote above were provided by the research team. We have not analysed the data ourselves.