Since 2005, treatment strategy for multiple myeloma has significantly changed due to the successive introduction of novel agents. The three drugs including a proteasome inhibitor bortezomib, and two immunomodulatory drugs (IMiDs), lenalidomide and thalidomide, are referred to as novel agents, and each drug has characteristic profiles of efficacy and safety. While all those agents can be expected to PLX3397 research buy restore renal function due to improvement PF-6463922 datasheet of the primary disease, bortezomib, with strong antitumor effect, is reported to rapidly improve renal function

(Fig. 9). Roussou et al. retrospectively compared improvement of renal function among traditional chemotherapy group, IMiDs (lenalidomide or thalidomide)-based treatment group, and bortezomib-based treatment Wortmannin group with 96 cases of newly diagnosed multiple myeloma. It showed that the best and the most rapid improvement of renal function were observed in the bortezomib-based treatment group. Renal response rate (minor response and better) based on creatine clearance improvement and time to response as 59 % and 1.8 months in chemotherapy group, 79 % and 1.6 months in IMiDs-based group, and 94 % and 0.69 month in bortezomib-based group, respectively [36]. In addition, some cases with withdrawal

from dialysis are also reported. Thus, administration of bortezomib should be considered in patients with acute or severe renal dysfunction if it is possible. Fig. 9 Complete response (CR) renal. CR may be attained by bortezomib-based regimen not only the high levels percentage but also time to response. 5-stage is divided as the figure Lenalidomide Lenalidomide is an anti-myeloma drug possessing dual functions of antitumor effect and immunomodulating activity. Because lenalidomide is urinary excreted, its blood concentration

increases in patients with renal dysfunction which leads to high incidence risk of adverse reactions [37]. However, lenalidomide itself has no renal toxicity and clinical studies showed improvement of renal function in the patients else treated with lenalidomide. Lenalidomide can be administrated by proper adjustment of its dose corresponding to renal function according to the package description [38]. In fact, it is reported that adjusted dosing of lenalidomide to patients with renal dysfunction resulted with similar anti-myeloma efficacy to those with normal renal function [39, 40], and recovery of renal function was also observed [41]. Similar to bortezomib, cases that withdrew from dialysis are reported [42]. Stratified analysis of lenalidomide/dexamethasone therapy by age showed similar efficacy and tolerability in elderly (over 65 years of age) to those of youth [43].