Treatment of Renal Failure Due to Multiple Myeloma by Plasmapheresis Adjunctive to Chemotherapy: A Systematic Review

Abstract

Context: Up to half of multiple myeloma (MM) patients develop renal impairment from elevated free light chains (FLCs). Plasmapheresis can rapidly reduce FLCs, but its clinical benefit remains unclear. This systematic review therefore evaluated the efficacy of plasmapheresis as an adjunct to chemotherapy in treating multiple myeloma-related renal failure (MM-RF). Evidence Acquisition: A comprehensive literature search was performed covering PubMed, Web of Science, Cochrane Library, Embase, and Google Scholar databases from inception to October 2025. All steps were performed by two independent reviewers and any discrepancies between reviewers were resolved through discussion or adjudication by a third reviewer. Results: Eight studies were included, three randomized clinical trials (RCTs) (n = 147) and five observational studies (n = 157). Evidence for survival benefit was inconsistent. One small RCT reported a significant improvement in survival in the plasmapheresis group (66 vs 28) over the reported study follow-up period, whereas the largest RCT and all observational studies with variable follow-up durations found no difference in survival between plasmapheresis plus chemotherapy and chemotherapy alone. Two RCTs showed greater reductions in serum creatinine and dialysis dependence with plasmapheresis, but these findings were not replicated in the largest RCT or in the observational studies, which showed no clear renal benefit. Conclusions: In conclusion, although plasmapheresis may offer some renal recovery benefits in select patients, the current evidence does not demonstrate a meaningful improvement in either renal outcomes or survival in MM-RF. More well-designed, large-scale randomized trials and observational prospective studies are needed to evaluate plasmapheresis in combination with modern anti-myeloma therapies. © 2026, Moeinzadeh et al.