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