Time is nephron: Daratumumab plus CyBorD in newly-diagnosed multiple myeloma with cast nephropathy: A report of five cases

Background: Renal failure is a common complication of multiple myeloma, often due to overproduction of light chains. Case presentation: Light chain cast nephropathy in newly-diagnosed multiple myeloma is associated with inferior outcomes. Proteasome inhibitors and immunomodulatory drugs with therapeutic plasma exchange can rapidly reduce light chain levels and confer remission; however, optimal delivery of these agents is limited by decreased renal function, and plasma exchange is often limited to tertiary centers. Conclusion: These cases highlight the utility of daratumumab with cyclophosphamide, bortezomib, and dexamethasone for acute renal failure in newly-diagnosed multiple myeloma and a clinical diagnosis of cast nephropathy.