---
title: "Bortezomib/dexamethasone vs thalidomide/dexamethasone for monoclonal immunoglobulin deposition dis"
id: "pubmed-42634194"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42634194"
content_type: "clinical_feed_article"
specialty: "Nephrology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42634194/"
doi: "10.1093/joneph/aajag144"
published_at: "2026-10-22T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Bortezomib/dexamethasone vs thalidomide/dexamethasone for monoclonal immunoglobulin deposition dis
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42634194
- **Specialty:** [Nephrology](https://medichelpline.com/clinical-feed/nephrology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42634194/)
- **DOI:** [10.1093/joneph/aajag144](https://doi.org/10.1093%2Fjoneph%2Faajag144)
- **Published At:** 2026-10-22T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Retrospective cohort of 72 biopsy-confirmed patients with **monoclonal immunoglobulin deposition disease**, enrolled from 2005–2025 and divided by first-line regimen: bortezomib/dexamethasone (BD, n = 37) and thalidomide/dexamethasone (TD, n = 35). - Investigators evaluated hematological and renal responses in evaluable patients and assessed renal survival, time to next treatment, and overall survival across the entire cohort. - The BD group achieved higher hematological complete response/very good partial response rates (63% vs. 46%) and higher renal complete response/very good partial response rates (57% vs. 32%) than TD. - Five-year renal survival favored BD (73% vs. 51%); five-year overall survival trended higher with BD (85% vs. 64%) per the study team. - Subgroup analysis: BD-only (no ASCT) showed higher complete response than TD (52% vs. 25%) and favorable trends in 5‑year renal and overall survival; details on statistical significance beyond stated comparisons were not provided in the abstract. - In eight patients who received autologous stem cell transplantation (ASCT) after BD induction, hematological complete response rose from 25% post-induction to 75% post-transplant, as reported by the authors. - Multivariate analysis identified three independent protective factors for renal survival: CKD stage ≤3, achieving hematological CR/VGPR, and receiving the **bortezomib/dexamethasone** regimen. - Safety signals: neurotoxicity occurred in 19% of BD patients versus 29% of TD patients; anemia and peripheral edema were more frequent with TD; no treatment-related deaths were reported. - The authors recommend **bortezomib/dexamethasone** as first-line therapy for eligible patients, with BD followed by ASCT for transplant-eligible patients and BD alone for those ineligible. - The source is a retrospective study; the abstract did not report detailed dosing schedules, exact follow-up duration for all patients, or full statistical measures in the abstract text.
## Clinical Analysis & Structured Key Points
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Affiliations Expand ### Affiliations * 1 Southeast University School of Medicine, Nanjing 210009, China. * 2 National Clinical Research Center of Kidney Diseases, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210016, China. * PMID: **42634194** * DOI: [ 10.1093/joneph/aajag144 ](https://doi.org/10.1093/joneph/aajag144) Item in Clipboard Comparative Study # Comparison of bortezomib with dexamethasone and thalidomide with dexamethasone in the treatment of patients with monoclonal immunoglobulin deposition disease Jianan Jiang et al. J Nephrol. 2026. Show details Display options Display options Format Abstract PubMed PMID J Nephrol Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22J+Nephrol%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22J+Nephrol%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42634194/) . 2026 Oct 22;39(7):1495-1503. doi: 10.1093/joneph/aajag144. ### Authors [Jianan Jiang](https://pubmed.ncbi.nlm.nih.gov/?term=Jiang+J&cauthor_id=42634194)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42634194/#short-view-affiliation-1 "Southeast University School of Medicine, Nanjing 210009, China."), [Wencui Chen](https://pubmed.ncbi.nlm.nih.gov/?term=Chen+W&cauthor_id=42634194)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42634194/#short-view-affiliation-2 "National Clinical Research Center of Kidney Diseases, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210016, China."), [Xiaomei Wu](https://pubmed.ncbi.nlm.nih.gov/?term=Wu+X&cauthor_id=42634194)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42634194/#short-view-affiliation-2 "National Clinical Research Center of Kidney Diseases, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210016, China."), [Jinzhou Guo](https://pubmed.ncbi.nlm.nih.gov/?term=Guo+J&cauthor_id=42634194)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42634194/#short-view-affiliation-2 "National Clinical Research Center of Kidney Diseases, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210016, China."), [Weiwei Xu](https://pubmed.ncbi.nlm.nih.gov/?term=Xu+W&cauthor_id=42634194)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42634194/#short-view-affiliation-2 "National Clinical Research Center of Kidney Diseases, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210016, China."), [Xianghua Huang](https://pubmed.ncbi.nlm.nih.gov/?term=Huang+X&cauthor_id=42634194)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42634194/#short-view-affiliation-1 "Southeast University School of Medicine, Nanjing 210009, China.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42634194/#short-view-affiliation-2 "National Clinical Research Center of Kidney Diseases, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210016, China.") ### Affiliations * 1 Southeast University School of Medicine, Nanjing 210009, China. * 2 National Clinical Research Center of Kidney Diseases, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210016, China. * PMID: **42634194** * DOI: [ 10.1093/joneph/aajag144 ](https://doi.org/10.1093/joneph/aajag144) Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID Linked Discoveries ## Abstract **Background:** There is currently no standardized treatment strategy for monoclonal immunoglobulin deposition disease, and anti-plasma cell therapy is considered an effective method for treating patients with this pathology. **Methods:** This retrospective study included 72 patients with biopsy-confirmed monoclonal immunoglobulin deposition -disease from 2005 to 2025, divided by first-line therapy into bortezomib/dexamethasone (BD, n = 37) and thalidomide/-dexamethasone (TD, n = 35) groups. The bortezomib/dexamethasone group was further divided into those who received autologous stem cell transplantation (bortezomib/dexamethasone with autologous stem cell transplantation, n = 8) and those who did not (bortezomib/dexamethasone-only, n = 29). Efficacy was analyzed in evaluable patients, and risk factors for renal survival, time to next treatment, and overall survival were assessed in the entire cohort. **Results:** The two groups had comparable baseline characteristics. The entire bortezomib/dexamethasone cohort showed superior rates of hematological complete response/very good partial response (63% vs. 46%), and renal complete response/very good partial response (57% vs. 32%) than the thalidomide/dexamethasone group, with superior 5-year renal survival (73% vs. 51%) and a favorable trend in 5-year overall survival (85% vs. 64%). The bortezomib/dexamethasone-only subgroup showed a significantly higher complete response rate (52% vs. 25%) and favorable trends in 5-year renal survival (74% vs. 51%) and overall survival (79% vs. 64%) compared with thalidomide/dexamethasone. In the 8 autologous stem cell transplantation patients, the hematological complete response rate increased from 25% post-induction to 75% post-transplant. Multivariate analysis identified chronic kidney disease (CKD) stage ≤3, hematological complete response/very good partial response, and the bortezomib/dexamethasone regimen as independent protective factors for renal survival. Regarding safety, neurotoxicity occurred in 19% of bortezomib/dexamethasone patients and in 29% of thalidomide/dexamethasone patients, while anemia and peripheral edema were more frequent in the thalidomide/dexamethasone group; no treatment-related deaths occurred. **Conclusions:** The bortezomib/dexamethasone regimen yields deeper hematological response and improved renal survival in monoclonal immunoglobulin deposition disease patients. Bortezomib/dexamethasone followed by autologous stem cell transplantation is recommended for transplant-eligible patients, while bortezomib/dexamethasone alone remains effective for those who are ineligible, which supports bortezomib/dexamethasone as first-line therapy. **Keywords:** monoclonal immunoglobulin deposition disease; prognostic factors; renal insufficiency; treatment response. © The Author(s) 2026. Published by Oxford University Press on behalf of Societa Italiana Nefrologia/Italian Society of Nephrology; Society ownership. 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