Lee C-K, Zangari M, Barlogie B, Fassas A, van Rhee F, Thertulien R, Talamo G, Muwalla F, Anaissie E, Hollmig K, Tricot G
The Myeloma Institute for Research and Therapy, The University of Arkansas for Medical Sciences, Little Rock, 72205, USA.
Bone Marrow Transplant. 2004 Apr;33(8):823-8. doi: 10.1038/sj.bmt.1704440.
To evaluate the role of high-dose melphalan and autologous transplant (AT) in reversing dialysis-dependent renal failure, 59 patients still on dialysis at the time of AT were analyzed. A total of 37 patients had been on dialysis < or =6 months. A 5-year event-free and overall survival rate of all patients after AT was 24 and 36%, respectively. Of 54 patients evaluable for renal function improvement, 13 (24%) became dialysis independent at a median of 4 months after AT (range: 1-16). Dialysis duration < or =6 months prior to first AT and pre-transplant creatinine clearance >10 ml/min were significant for renal function recovery: 12 of 36 (33%) < or =6 months vs one of 18 patients (6%) >6 months on dialysis recovered renal function; 10 of 26 (38%) with >10 ml/min vs three of 28 (11%) with < or =10 ml/min of creatinine clearance (both P<0.05). Quality of response after autotransplant was also significant: 12 of 31 (39%) being greater than partial remission after AT vs one of 21 patients (5%) attaining partial remission or less became independent of dialysis (P<0.05). Our data suggest that significant renal failure can be reversible and AT should be considered early in the disease course.
为评估大剂量美法仑和自体移植（AT）在逆转依赖透析的肾衰竭中的作用，对59例在进行AT时仍在透析的患者进行了分析。共有37例患者透析时间≤6个月。所有患者AT后的5年无事件生存率和总生存率分别为24%和36%。在可评估肾功能改善的54例患者中，13例（24%）在AT后中位时间4个月（范围：1 - 16个月）时不再依赖透析。首次AT前透析时间≤6个月和移植前肌酐清除率>10 ml/min对肾功能恢复有显著意义：透析时间≤6个月的36例患者中有12例（33%）恢复肾功能，而透析时间>6个月的18例患者中只有1例（6%）恢复肾功能；肌酐清除率>10 ml/min的26例患者中有10例（38%）恢复肾功能，而肌酐清除率≤10 ml/min的28例患者中有3例（11%）恢复肾功能（均P<0.05）。自体移植后的反应质量也有显著差异：AT后大于部分缓解的31例患者中有12例（39%）不再依赖透析，而达到部分缓解或更低程度的21例患者中只有1例（5%）不再依赖透析（P<0.05）。我们的数据表明，严重肾衰竭可能是可逆的，应在疾病进程早期考虑AT。
