European Trial of Free Light Chain Removal by Extended Haemodialysis in Cast Nephropathy

Inclusion Criteria:

* Age \>= 18 years
* Dialysis dependent acute renal failure (eGFR \<15ml/min/1.73m2)
* Fulfils diagnostic criteria for the diagnosis of symptomatic de novo multiple myeloma1
* Abnormal serum FLC ratio and a sFLC concentration \> 500 mg/L
* Myeloma kidney demonstrated on a renal biopsy (cast nephropathy)
* Ability to give informed consent to partake in study
* Commencement of study within 10 days of presenting to enrolling unit

Exclusion Criteria:

* Age \< 18 years
* Known advanced chronic renal failure (CKD stage IV 4-5; eGFR \<30mls/min/1.73m2) or evidence of significant chronic damage on renal biopsy
* Amyloidosis or light chain deposition disease on renal biopsy
* Previous treatment of multiple myeloma with chemotherapy
* Haemodynamic instability that precludes unsupported dialysis renal replacement therapy
* Significant cardiac disease (myocardial infarction with in the last 6 months; unstable angina; NYHA class III or IV heart failure; clinically significant pericardial disease; cardiac amyloidosis)
* Advanced disease or significant co-morbidity: with poor short term prognosis, necessitating palliation and no active or disease specific treatment.
* Inability to give informed consent
* History of allergic reaction attributable to compounds containing boron or mannitol
* History of Peripheral neuropathy or neuropathic pain (grade 2 or higher as defined by NCI CTCAE version 3)
* Clinically significant liver dysfunction (bilirubin \>1.8mg/dl (30µmol/L))
* Known HIV infection
* Active uncontrolled infection
* Pregnant and lactating women
* Inability to give informed consent
* Pre-menopausal female patients of childbearing potential: positive pregnancy test or unwilling to use effective contraception during the study
* Lactation