Table 1 Inclusion and exclusion criteria

   ∘ Age greater than 18 years

   ∘ Dialysis dependent acute renal failure (defined by: an estimated GFR of < 15 ml/min/1.73 m²)

   ∘ Fulfils criteria for the diagnosis of symptomatic de novo multiple myeloma

   ∘ Abnormal serum FLC ratio and a serum FLC concentration > 500 mg/L

   ∘ Myeloma kidney demonstrated on a renal biopsy (cast nephropathy)

   ∘ Commencement of study within 10 days of presenting to enrolling unit

Exclusion criteria

   ∘ Known advanced chronic renal failure (eGFR < 30 mls/min/1.73 m²) 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 renal replacement therapy

   ∘ Significant cardiac disease

   ∘ Advanced disease or significant co-morbidity: with poor short term prognosis, necessitating palliation and no active or disease specific treatment.

   ∘ History of allergic reaction attributable to compounds containing boron or mannitol

   ∘ Peripheral neuropathy or neuropathic pain Grade 2 or higher

   ∘ Clinically significant liver dysfunction (bilirubin > 1.8 mg/dl (30 umol/L))

   ∘ Active uncontrolled infection or known HIV infection

   ∘ Inability to give informed consent

   ∘ Pregnant and lactating women