以硼替佐米为基础的方案治疗多发性骨髓瘤患者肾脏损害的可逆性:预测因素的确定

Meletios A. Dimopoulos, Maria Roussou, Maria Gavriatopoulou, Flora Zagouri, Magdalini Migkou, Charis Matsouka, Despina Barbarousi, Dimitrios Christoulas, Erasmia Primenou, Irini Grapsa, Evangelos Terpos, Efstathios Kastritis
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引用次数: 108

摘要

目的:肾脏损伤是多发性骨髓瘤(MM)的常见并发症,与显著的发病率和早期死亡率增加有关。硼替佐米对存在或发生肾脏损害的MM患者有效且耐受性良好。患者和方法我们分析了46例连续出现肾功能损害的患者,以评估硼替佐米对肾功能改善的影响,并确定与肾反应相关的预测因素。所有患者均接受硼替佐米与地塞米松联合或不联合其他药物治疗。结果59%的患者在中位11天(8-41天)内出现肾脏反应。需要透析的9名患者中有2名不再需要透析。30%的患者有完全的肾反应(CRrenal)。毒性与使用硼替佐米为基础的方案治疗的无肾衰竭骨髓瘤患者相似。纯轻链骨髓瘤患者实现肾脏反应的可能性更高,先前未接受治疗的患者完全解决肾脏损害的可能性更高,而纯轻链骨髓瘤与较短的肾脏反应时间独立相关。肾脏损害程度不能预测肾反应或CRrenal的概率;然而,在可获得胱抑素C的一部分患者中,基线胱抑素C >2 mg/L或胱抑素C计算估计肾小球滤过率<30ml /min与CRrenal的可能性较低相关。结论:以硼替佐米为基础的方案可以改善大多数骨髓瘤肾损害患者的肾功能。
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Reversibility of Renal Impairment in Patients With Multiple Myeloma Treated With Bortezomib-Based Regimens: Identification of Predictive Factors

Purpose

Renal impairment is a frequent complication of multiple myeloma (MM) and is associated with significant morbidity and increased early death rate. Bortezomib is active and well tolerated in patients with MM who present or develop renal impairment.

Patients and Methods

We analyzed 46 consecutive patients who presented with renal impairment in order to evaluate the impact of bortezomib on the improvement of renal function and to identify predictive factors associated with renal response. All patients received bortezomib with dexamethasone with or without other agents.

Results

Renal response was documented in 59% of patients within a median of 11 days (range, 8-41 days). Two of 9 patients who required dialysis became dialysis independent. A complete renal response (CRrenal) was documented in 30% of patients. Toxicities were similar to those seen in myeloma patients without renal failure who were treated with bortezomib-based regimens. Patients with light chain—only myeloma had a higher probability of achieving a renal response, and previously untreated patients had a higher probability for complete resolution of renal impairment, while light chain—only myeloma was independently associated with a shorter time to renal response. The degree of renal impairment was not predictive of the probability for renal response or CRrenal; however, in a subset of patients for whom cystatin C was available, a baseline cystatin C > 2 mg/L or cystatin C calculated estimated glomerular filtration rate < 30 mL/min were associated with a lower probability of CRrenal.

Conclusion

We conclude that bortezomib-based regimens may improve renal function in the majority of myeloma patients with renal impairment.

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