Research Design: This is a 14 centre randomized clinical trial. Patients who fulfill the entry criteria are referred by their oncologist or nephrologist to the apheresis physician at their centre who will explain the nature of the study via a human ethics approved letter of information. An informed consent is requested and if obtained the participants will be randomized centrally by telephone, using a random numbers generator, to either receive or not receive plasma exchange. Recruiting physicians are unaware of the treatment allocation prior to study entry and subsequent randomization, which is stratified by four strata (Vincristine, Adriamycin and Dexamethasone (VAD)/no VAD + on/not on acute hemodialysis with 28 possible allocations per strata for each centre). Following random blinded allocation, participants are treated in an unblinded manner. Patients are followed with standard forms which indicate their serum creatinine, dialysis and survival status at 10 days, 1 month and 6 months. Participants are enrolled from September 1998 to October 2003. The study is conducted after approval from the institutional ethics review boards of the 14 Canadian sites.