Please for heavens sake DON’T put your patients at risk. I recommend both Daratumumab based therapy and plasma exchange for acute light chain cast nephropathy specially in newly diagnosed myeloma. These papers which mix up patients cause me more problems. Dara VCd plus plasma exchange is the best therapy for acute light chain cast nephropathy. If you treat patients with some other cause for renal failure with this approach it won’t help. If you have a doubt on the diagnosis of acute light chain cast nephropathy, renal biopsy will be needed. If you start therapy late when the renal failure has been there for over a month therapy won’t work. If you give suboptimal therapy (Dara alone etc) you cannot hope for the plasma exchange to work. If you give Dara based therapy without plasma exchange you can’t hope for renal recovery quickly because it takes 2-4 weeks for the therapy to work and in that time the kidney is getting damaged. You need BOTH in a timely manner.

Profound sorry that my mentor, friend, and colleague, the legend Bob Kyle passed away. His contributions to patients, medicine, myeloma, @IMFmyeloma @MayoClinic myeloma group, and the institution are monumental. A role model who will be remembered for his integrity and commitment to patients. I owe my career to him. He leaves behind a legacy of experts at Mayo Clinic as well as world over who were influenced greatly by him. See thread for links to a video an article on him that I wrote for @MayoProceedings Post your memories below.