This protocol applies to patients with multiple myeloma and myeloma bone disease whose creatinine clearance is below 60 ml/min. Renal impairment is frequently encountered in multiple myeloma and directly determines which bone-protective therapy is appropriate.
Key consideration: In multiple myeloma with reduced kidney function (CrCl <60 ml/min), the renal safety profile of the bone-modifying agent is the primary selection criterion — not all standard options carry equal renal risk.
Management centers on a specific bone-modifying agent preferred in this setting for its favourable renal safety profile. The complete regimen, schedule, and monitoring guidance are available in the full structured protocol.
DOI: 10.1016/j.annonc.2020.07.019
Denosumab is the agent of choice in MM patients with renal impairment (creatinine clearance <60 ml/min).
Because denosumab is not cleared through the kidneys, it has a better renal safety profile, especially in patients with creatinine clearance of 30–60 ml/min.
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