The Gambro HCO ("high cut-off") 1100 dialyzer is distinct for its 15-60 nm pore size, permitting passage of molecules with a MW of up to 45 Daltons (the size of a dimeric lambda light chain).
|The Gambro HCO 1100 Dialyzer (*sigh*)|
The figure above models clearance of light chains from the serum with plasma exchange and HCO hemodialysis.
Randomized studies - EuLITE and MYRE - have been ongoing (and ongoing, and ongoing...) in Europe. In both studies, myeloma patients with renal injury who are being treated with bortezomib-based therapy will be randomized to either HCO dialysis with the Gambro filter, or to conventional high flux hemodialysis. The EuLITE trial was initiated 5 years ago, and results are expected this year.
The technology may have relevance for patients with AL amyloidosis, as well. The mechanism of renal failure in AL is different, but disease outcome is clearly linked to prompt, deep, sustained reduction in serum light chain levels:
|cited in http://www.readcube.com/articles/10.1186/1756-8722-4-47|
|Professor Giampaolo Merlini, Amyloid Guru|
At this point, as a sufferer of chronic TE, my prognosis remains guarded: it feels like we have waited an eternity for the results of large and small European trials examining whether use of the Gambro HCO 1100 dialyzer will have real utility in patients with plasma cell diseases. News may come this year. Negative results would probably relieve me of my longstanding TE, but would also certainly be a disappointment for the myeloma/amyloidosis medical and patient community. The needed prescription then for both patients suffering from light chain mediated kidney and organ disease, as well as clinicians and researchers suffering from TE? Positive results leading to accelerated availability of the filter on this side of the Atlantic. Fingers crossed.
[AUTHOR NOTE: There is no financial relationship of any sort between myself and Gambro, the maker of the product discussed above. As far as I know, I have never even met anyone associated with Gambro. Admitting this, as readers might imagine, is actually aggravating my TE a little bit]
Have the results of these studies been published? Is your TE alleviated?
Cyd Szymanski, Caregiver of newly diagnesed AL patient
No randomized results published as yet. There was a recent interesting publication in which the authors examined whether HCO filtration affects levels of commonly used (and, alas, protein-bound) anti-myeloma drugs, and the answer is YES. This has relevance for AL patients, since the same drugs are typically used. Link to this article: http://www.ncbi.nlm.nih.gov/pubmed/24392952Delete