Abstract:
Circulating free lambda and kappa free light chains in blood play a role in the pathogenesis of acute renal failure due to myeloma. Coupled plasma filtration and adsorption allows separation of plasma from blood and treatment of the plasma through a cartridge containing a sorbent or resin material, such as hydrophobic divinylbenzene styrenic resins having an average bead diameter of 75 microns, an average pore diameter of 30 nm, and a surface area of 700 m2/g. Lambda and kappa free light chain concentrations progressively decrease during coupled plasma filtration and adsorption treatment resulting in significant reductions by the end of the treatment.

Description:
TECHNICAL FIELD 
     The present invention relates to a kit, system and method for reducing either lambda or kappa free light chains or both in the blood of a patient with myeloma. The present invention provides a method, a system and a kit for treating myeloma. The method generally provides for contacting a patient&#39;s blood with filters and sorbents or resins, which are effective at lowering the amount of free light chains in the patient&#39;s blood. The kit includes filters and sorbents or resins that effectively remove these lambda and/or kappa free light chains from the patient&#39;s blood. The system includes the kit and other equipment which can be used to effect the method of the present invention. 
     BACKGROUND 
     Myeloma is a cancer of the plasma cells in bone marrow. These plasma cells are known to produce antibodies or immunoglobulins that are used to fight infection and disease in patients. In patients suffering from myeloma, increased replication of particular types of plasma cells can lead to an increased production of monoclonal protein or M-protein. This excess production of M-protein in turn leads to an increase of two types of unbound or free proteins, known as lambda and kappa free light chains, in the patient&#39;s blood stream. 
     Although there are a variety of symptoms associated with myeloma, excess levels of lambda and kappa free light chains have been found to lead to impairment of kidney function in patient&#39;s affected with myeloma. For example, in some affected patients, these free light chains have been found to create large accumulations of precipitated free light chains in the kidney. In other affected patients, these free light chains may also be deposited as amyloid in the kidneys as well as other organs. 
     Known treatments to manage or control the levels of lambda and kappa free light chains in the blood may include the use of specific drugs or removal of the free light chains by plasma exchange or high permeability hemofiltration, hemodialysis or hemodiafiltration, but these treatments are not always satisfactory and can lead to undesired complications such as adverse side effects; drug resistance; inefficient removal of the lambda or kappa free light chains using standard hemofilters for hemodialysis or hemofiltration; loss of albumin and the requirement to use exogenous plasma or substitution fluids with associated risks. 
     A need exists for new and effective methods of managing or controlling the levels of lambda and kappa free light chains in myeloma patients, including with or without concomitant drug administration during acute periods of this disease. 
     SUMMARY 
     An embodiment of a kit for treating patients with myeloma includes a high permeability filter and a cartridge to capture elevated levels of either lambda or kappa free light chains or both; and optionally a dialyzer. The filter includes one or more plasma or ultra filtration materials as are well known in the art, and the cartridge includes one or more sorbent or resin materials as are also well known in the art. The physical parameters of the sorbent or resin material are adjusted to maximize the adsorption of the lambda or kappa free light chains. The dialyzer, if used, further removes residual lambda and kappa free light chains and smaller toxins. 
     In an embodiment of a method of treating a patient having myeloma, elevated levels of either lambda or kappa free light chains or both are effectively removed from the plasma and/or the ultrafiltrate, which is then re-infused into the patient. An embodiment of the method further includes the step of simultaneously reducing the levels of inflammatory mediators or uremic toxins to prevent or treat acute renal failure. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  illustrates an embodiment of a kit including components for treating the blood and plasma of a patient having myeloma. 
         FIG. 2  illustrates the effectiveness of a sorbent or resin material in removing lambda free light chains from the blood. 
         FIG. 3  illustrates the effectiveness of a sorbent or resin material in removing lambda free light chains from the plasma. 
         FIG. 4  illustrates the efficacy of in vitro pure resin screens for removing lambda free light chains. 
         FIG. 5  illustrates the efficacy of in vitro mixed resin screens for removing lambda free light chains. 
         FIG. 6A  illustrates the removal rate of kappa free light chains from a first plasma sample by in vitro incubation using different resins. 
         FIG. 6B  illustrates the removal rate of kappa free light chains from a second plasma sample by in vitro incubation using different resins. 
         FIG. 6C  illustrates the removal rate of lambda free light chains from a third plasma sample by in vitro incubation using different resins. 
     
    
    
     DETAILED DESCRIPTION 
     Devices and methods for adsorptive extracorporeal purification of plasma are disclosed in EP 0787500, EP 0958839, and EPO 7425010, all of which are incorporated herein by reference. However, there continues to exist a need for new and effective methods of managing or controlling the levels of lambda and kappa free light chains in myeloma patients. 
     While multiple embodiments of the instant invention are disclosed, still other embodiments may become apparent to those skilled in the art. The following detailed description shows and describes only illustrative embodiments of the invention, and there is no intent to limit the invention in any form or manner. As such, all alternative embodiments of the invention are within the spirit, scope, and intent of the invention as disclosed herein. 
       FIG. 1  illustrates kit  10  for purifying the plasma of a patient having myeloma in accordance with an embodiment of the invention. Kit  10  includes filter  12 , sorbent or resin cartridge  14 , and dialyzer  16 . In an alternate embodiment of kit  10 , dialyzer  16  is an optional component and is therefore not included therein. Another embodiment of kit  10  includes a bypass means for directing blood flow around dialyzer  16  and thereby disrupting the flow of blood through dialyzer  16 . 
     In accordance with an embodiment of the invention, filter  12  includes blood inlet port  18 , plasma outlet port  20 , and blood outlet port  22 . In one embodiment the filtration material is a plasma filter. In another embodiment the filtration material is a high permeability filter. 
     In an embodiment of the invention, sorbent or resin cartridge  14  includes plasma inlet and outlet ports  24  and  26 , respectively, and one or more sorbent or resin materials as are well known in the art. In one embodiment the sorbent or resin material is a hydrophobic resin including but not limited to hydrophobic divinylbenzene styrenic resins. In another embodiment the sorbent or resin material is an ion exchange resin. In yet another embodiment the sorbent or resin material is a silica resin. In an alternate embodiment the sorbent or resin material is a combination of two or more of a hydrophobic resin, an ion exchange resin, or a silica resin. In another embodiment the sorbent or resin material is a hydrophobic polystyrene resin. In yet another embodiment the sorbent or resin material is a bonded silica resin. In an alternate embodiment the sorbent or resin material is a combination of two or more of a hydrophobic polystyrene resin, an ion exchange resin, or a bonded silica resin. In another embodiment the adsorption of either lambda or kappa free light chains or both by the sorbent or resin material is maximizable by providing a linear flow velocity for maximum utilization of the adsorption efficacy and capacity of the sorbent or resin material in cartridge  14 . In one embodiment the flow velocity of the plasma is varied by changing one or more physical characteristics of the sorbent or resin material, such as the diameter, including bead and pore diameters, cartridge height, volume, and area. In yet another embodiment the sorbent or resin volume is in the range of about 50 ml to about 250 ml. 
     In accordance with an embodiment of the invention, dialyzer  16  includes blood inlet port  28 , ultrafiltrate or dialysate containing ultrafiltrate outlet port  30 , blood outlet port  32 , dialysis fluid inlet port  56 , and dialysate fluid outlet port  58 . In one embodiment, dialyzer  16  is a high permeability dialyzer. In another embodiment, dialyzer  16  is a high flux dialyzer. In yet another embodiment, dialyzer  16  is a low flux dialyzer. In an alternate embodiment, dialyzer  16  is a high permeability hemofilter. In another embodiment, dialyzer  16  is a high flux hemofilter. In yet another embodiment, dialyzer  16  is a low flux hemofilter. In one embodiment, dialyzer  16  provides hemodialysis. In another embodiment, dialyzer  16  provides hemodiafiltration. In yet another embodiment, dialyzer  16  provides hemofiltration. In one embodiment, dialyzer  16  provides hemodialysis. In another embodiment, dialyzer  16  provides hemodiafiltration. In yet another embodiment, dialyzer  16  provides hemofiltration. In an alternate embodiment, dialyzer  16  removes small toxins such as those having a molecular weight of less than about 20,000 Daltons. 
     A method, in accordance with an embodiment of the invention, for treating a patient having myeloma utilizes an embodiment of kit  10  for removing either lambda or kappa free light chains or both from the patient&#39;s plasma. The method includes the steps of directing the patient&#39;s blood along path  34  into filter  12  through inlet port  18 . Plasma in the blood entering filter  12  is extracted therefrom and exits filter  12  through outlet port  20 , and the remainder of the blood flows through the filtration material within filter  12 . The filtered blood exits filter  12  through outlet port  22  along path  36 . 
     The plasma exiting filter  12  through outlet port  20  flows along path  38  and into sorbent or resin cartridge  14  through inlet port  24 . The sorbent or resin material within cartridge  14  extracts, by adsorption, one or more of the lambda and kappa free light chains in the plasma flowing therethrough. The purified plasma exits sorbent or resin cartridge  14  through outlet port  26  along path  40 . 
     The filtered blood exiting filter  12  along path  36 , and the purified plasma exiting sorbent or resin cartridge  14  along path  40  are mixed together at junction  42 , and the blood mixture flows along path  44 . As previously discussed, dialyzer  16  is an optional component for further processing the patient&#39;s blood. If dialyzer  16  is not used, then blood flowing along path  44  is further directed along path  46  for re-introduction into the patient. 
     If dialyzer  16  is used, blood flowing along path  44  enters dialyzer  16  through inlet port  28 . Ultrafiltrate, plasmawater, or diffusible toxins in the blood entering dialyzer  16  is extracted therefrom and exits dialyzer  16  through outlet port  30  along path  48 . The remainder of the blood flows through dialyzer  16 . Dialysis fluid flowing along path  60  enters dialyzer  16  through inlet port  56  and the dialysate fluid exits dialyzer  16  through outlet port  58  along flow path  62 . The dialyzed blood exits dialyzer  16  through outlet port  32  along path  50 . 
     At junction  52 , if hemofiltration or hemodiafiltration (a net loss of plasma water) has been used, reinfusion fluid along flow path  54  is mixed with the blood exiting dialyzer  16  along path  50 . The blood mixture is directed along path  46  for re-introduction into the patient. 
       FIG. 2  illustrates the effectiveness of a sorbent or resin material in removing lambda free light chains from the patient&#39;s blood. The illustration of  FIG. 2  is in the form of a bar graph having lambda free light chains, in units of mg/L, along its vertical axis  102 , and time, in units of minutes, along its horizontal axis  104 . Legend  106  is for identifying the vertical rectangles, or bars, extending from horizontal axis  104  such that the height of each vertical bar is indicative of the measured value of the lambda free light chains in mg/L. Vertical bar  108  indicates that just prior to starting the treatment, the patient&#39;s blood included about 500 mg/L of lambda free light chains. At about 30 minutes after starting the treatment, the plasma entering and exiting sorbent or resin cartridge  14 , respectively, included about 275 mg/L and about 125 mg/L of lambda free light chains as illustrated by vertical bars  110  and  112 , respectively. Then, at about 120 minutes after starting the treatment, the patient&#39;s blood, and the plasma entering and exiting sorbent or resin cartridge  14 , respectively, included about 250 mg/L, about 175 mg/L and about 100 mg/L of lambda free light chains as illustrated by vertical bars  114 ,  116  and  118 , respectively. Next, at about 180 minutes after starting the treatment, the plasma entering and exiting sorbent or resin cartridge  14 , respectively, included about 200 mg/L and about 125 mg/L of lambda free light chains as illustrated by vertical bars  120  and  122 , respectively. At about 240 minutes after starting the treatment, the plasma entering and exiting sorbent or resin cartridge  14 , respectively, included about 150 mg/L and about 25 mg/L of lambda free light chains as illustrated by vertical bars  124  and  126 , respectively. As illustrated in  FIG. 2 , the patient&#39;s blood included about 125 mg/L of lambda free light chains at both of about 360 minutes and about 540 minutes after starting the treatment, as respectively indicated by vertical bars  128  and  130 . 
       FIG. 3  illustrates the change in the lambda free light chains in the patient&#39;s plasma as it enters and exits sorbent or resin cartridge  14  as the treatment progresses over time. The illustration is in the form of a line graph having lambda free light chains, in units of mg/L, along its vertical axis  150 , and time, in units of minutes, along its horizontal axis  152 . Solid dark squares, such as that identified by numeral  154 , represent measured values of lambda free light chains, in mg/L, at different times after starting the treatment. A straight line, such as line  156 , is used for connecting two adjacent measurement values taken at different times and therefore may not represent the actual lambda free light chains at a time between two consecutive measurements. As such, line  158  connects the measured lambda free light chains, in mg/L, entering sorbent or resin cartridge  14  as a function of time after starting the treatment. Likewise, line  160  connects the measured lambda free light chains, in mg/L, exiting sorbent or resin cartridge  14  as a function of time after starting the treatment. As illustrated in  FIG. 3 , at about 180 minutes after starting the treatment, the plasma entering and exiting sorbent or resin cartridge  14 , respectively, includes about 200 mg/L and about 125 mg/L of lambda free light chains. 
       FIG. 4  illustrates measured levels of lambda free light chains, in mg/L, at 30 and 120 minutes after in vitro incubation of the patient&#39;s plasma using screens of several different pure resins. The illustration of  FIG. 4  is in the form of a bar graph having lambda free light chains, in units of mg/L, along its vertical axis  170 , and the pure resins used along its horizontal axis  172 . The height of each vertical rectangle, or bar, extending from horizontal axis  172  is indicative of the measured value of the lambda free light chains, in mg/L, in the patient&#39;s plasma. Each vertical bar in the group collectively referenced by numeral  174  corresponds with one of the pure resins in the group collectively referenced by numeral  176 , and as such is indicative of the lambda free light chains, in mg/L, in the patient&#39;s plasma after 30 minutes of in vitro incubation. Likewise, each vertical bar in the group collectively referenced by numeral  178  corresponds to one of the pure resins in the group collectively referenced by numeral  180 , and as such is indicative of the lambda free light chains, in mg/L, in the patient&#39;s plasma after 120 minutes of in vitro incubation. It should be noted that the pure resins in the groups collectively referenced by numerals  176  and  180  are identical. As such,  FIG. 4  indicates that when using pure resin CG71, reference numeral  182 , the patient&#39;s plasma included about 75 mg/L and about 25 mg/L of lambda free light chains, respectively, after 30 minutes and 120 minutes of in vitro incubation. 
       FIG. 4  further illustrates that the pure resins CG71, CG161, and MDR3 (CG300) appear substantially more effective at removing lambda free light chains at both 30 minutes and 120 minutes after in vitro incubation relative to using the other pure resins in group  176  (or 180). Physical measurements provided by the manufacturer of the three pure commercially available resins CG71, CG161, and MDR3 (CG300) indicated a bead diameter in the range of about 35 micron to about 75 micron; a pore diameter in the range of about 150 angstrom to about 300 angstrom; and an area in the range of about 500 square-meter/gram to about 900 square-meter/gram. These pure resins are manufactured by Rohm and Haas, Philadelphia, Pa., U.S.A. 
       FIG. 5  illustrates measured levels of lambda free light chains, in mg/L, at 30 and 120 minutes after in vitro incubation using screens of several different mixed resins. The illustration of  FIG. 5  is also in the form of a bar graph having lambda free light chains, in units of mg/L, along its vertical axis  190 , and the mixed resins used along its horizontal axis  192 . The height of each vertical rectangle, or bar, extending from horizontal axis  192  is indicative of the measured value of the lambda free light chains, in mg/L, in the patient&#39;s plasma. Each vertical bar in the group collectively referenced by numeral  194  corresponds to one of the mixed resins in the group collectively referenced by numeral  196 , and as such is indicative of the lambda free light chains, in mg/L, in the patient&#39;s plasma 30 minutes after in vitro incubation. Likewise, each vertical bar in the group collectively referenced by numeral  198  corresponds to one of the mixed resins in the group collectively referenced by numeral  200 , and as such is indicative of the lambda free light chains, in mg/L, in the patient&#39;s plasma 120 minutes after in vitro incubation. It should be noted that the mixed resins in the groups collectively referenced by numerals  196  and  200  are identical. As such,  FIG. 5  indicates that when using mixed resin MDR3+CG161, reference numeral  202 , the patient&#39;s plasma included about 100 mg/L and about 50 mg/L of lambda free light chains, respectively, after 30 minutes and 120 minutes of in vitro incubation. When compared to the pure resins collectively referenced by numerals  174  and  178  in  FIG. 4 , the mixed resins collectively referenced by numerals  194  and  198  in  FIG. 5  appear to have higher adsorptivity. 
       FIGS. 6A and 6B , respectively, illustrate the change in kappa free light chains over time in a first and a second plasma sample after in vitro incubation using three different pure resins CG71, MDR3, and MEGA CAP. The illustrations are in the form of line graphs having kappa free light chains, in units of mg/L, along respective vertical axes  210  and  220 ; and time, in units of minutes, along horizontal axes  212  and  222 . Solid dark data points in the shape of a circle, a triangle and a square, respectively representing the use of pure resins MDR3, CG71 and MEGA CAP, indicate kappa free light chain measurements after in vitro incubation of each of the first and the second plasma samples. Straight lines are used for connecting two adjacent measurement values taken at different times, and therefore may not represent the actual kappa free light chains at a time between two consecutive measurements. As such, lines  214  and  224  connect the measured kappa free light chains as a function of time after incubation wherein the pure resin MEGA CAP is used when incubating the first and the second plasma samples. Likewise, lines  216  and  226  connect the measured kappa free light chains as a function of time after incubation wherein the pure resin CG71 is used when incubating the first and the second plasma samples. And, lines  218  and  228  connect the measured kappa free light chains as a function of time after incubation wherein the pure resin MDR3 is used when incubating the first and the second plasma samples. 
     As illustrated in  FIG. 6A , the efficacy of pure resins MDR3 and CG71 on kappa free light chains, when used with the first plasma sample, appears to be substantially the same and also appears significantly better than the efficacy of pure resin MEGA CAP on kappa free light chains. Both pure resins MDR3 and CG71 appear to be most effective at about 30 minutes after in vitro incubation. 
       FIG. 6B  illustrates that the efficacy of pure resin MDR3 on kappa free light chains, when used with the second plasma sample, appears to be better than that of pure resin CG71 on kappa free light chains, which in turn appears to have an efficacy better than of pure resin MEGA CAP on kappa free light chains. 
       FIG. 6C  illustrates the change in lambda free light chains over time in a third plasma sample after in vitro incubation using three different pure resins CG71, MDR3, and MEGA CAP. The illustration is in the form of line graphs having lambda free light chains, in units of mg/L, along vertical axis  230 ; and time, in units of minutes, along horizontal axis  232 . Solid dark data points in the shape of a circle, a triangle and a square, respectively representing the use of pure resins MDR3, CG71 and MEGA CAP, indicate lambda free light chain measurements after in vitro incubation of the third plasma sample. Straight lines are used for connecting two adjacent measurement values taken at different times, and therefore may not represent the actual lambda free light chains at a time between two consecutive measurements. As such, line  234  connects the measured lambda free light chains as a function of time after incubation wherein the pure resin MEGA CAP is used when incubating the third plasma sample. Likewise, line  236  connects the measured lambda free light chains as a function of time after incubation wherein the pure resin CG71 is used when incubating the third plasma sample. And, line  238  connects the measured lambda free light chains as a function of time after incubation wherein the pure resin MDR3 is used when incubating the third plasma sample. 
     As illustrated in  FIG. 6C , the efficacy of pure resins MDR3 and CG71 on lambda free light chains, when used with the third plasma sample, appears to be substantially the same and also appears significantly better than the efficacy of pure resin MEGA CAP on lambda free light chains. Both pure resins MDR3 and CG71 appear to be most effective at about 30 minutes after in vitro incubation 
     In accordance with an embodiment of the invention, the method described in the foregoing for removing either lambda or kappa free light chains or both from the patient&#39;s plasma is also useable for preventing acute renal failure in such patients by removing one or more of uremic toxins and inflammatory mediators such as one or more of interleukin 6 (IL6), vascular endothelial growth factor (VEGF), or tumor necrosis factor. 
     An alternate embodiment of the invention comprises a system for executing an embodiment of a method for treating myeloma patients, wherein the system includes an embodiment of the kit in combination with other equipment such as, but not limited to, mechanical components, software, hardware, firmware, or some combination thereof. 
     Various modifications and additions may be made to the exemplary embodiments presented hereinabove without departing from the scope, intent and spirit of the foregoing disclosure. For example, while the disclosed embodiments refer to particular features, the scope of the instant invention is considered to also include embodiments having different combinations of features that do not include all of the features described herein. Accordingly, the scope of the present invention is intended to embrace all such alternatives, modifications, and variations as falling within the scope and intent of the appended claims, including all equivalents thereof.