Contrast Administration in Patients with Multiple Myeloma

There is a widespread perception that iodinated contrast media are contra-indicated in patients with multiple myeloma but this is unsupported by the available evidence. In a comprehensive review of this topic [1], it was noted that the primary risk factors for acute renal failure in patients with multiple myeloma are hypercalcemia, dehydration, infection, and Bence Jones proteinuria (rather than contrast media). This review identified seven retrospective studies reporting iodinated contrast administration in 476 myeloma patients for a total of 568 imaging studies. The frequency of acute renal failure was 0.6%-1.25%, as against a comparable frequency of 0.15% in the general population receiving iodinated contrast. Although the administration of contrast media to myeloma patients is not totally risk free, it may be performed if the clinical need arises and the patient is well hydrated.

Key Point
The administration of contrast media to myeloma patients is not totally risk free, but the widespread perception of high risk is unfounded and contrast may be administered if the clinical indication is appropriate and the patient is well hydrated.