Xu Yan, An Gang, Deng Shu-hui, Sui Wei-wei, Feng Xiao-yan, Li Fei, Hao Mu, Wang Ya-fei, Qiu Lu-gui
Institute of Hematology & Blood Diseases Hospital, CAMS & PUMC, Tianjin, China.
Zhonghua Xue Ye Xue Za Zhi. 2013 Apr;34(4):304-8. doi: 10.3760/cma.j.issn.0253-2727.2013.04.012.
To explore the efficacy and safety of bortezomib (btz) based chemotherapy in multiple myeloma (MM) patients with renal-function impairment (RI).
Fifty-six MM patients with impaired renal function treated with bortazomib based regimens in our single center were retrospectively analyzed.
The median age was 59 (ranged 30-77) years. 39.3% were κ-restricted MM, while 57.1% were λ-restricted MM. Nine patients were IgD-MM, and 14 were light chain MM. Median creatinine clearance (CrCl) was 25.33 (7.23-59.55) ml/min. The number of patients with mild, moderate and severe RI was 6, 35 and 15, respectively. Overall response rate of MM was 82.4% (≥MR), including 32.4% complete response (CR), 17.6% very good partial response (VGPR) and 26.5% partial response (PR). The rate of renal response was 89.3%, including 62.5% CR, 14.3% PR and 12.5% minor response (MR). A median time of optimal response was 25.5 (ranged 5-240) days. There was no significant difference in the median overall survival and the time to progress in different RI groups. Adverse events observed were similar to those patients with normal renal function previously reported. Most adverse events were manageable, 55.6% patients developed peripheral neuropathy and 10 patients discontinued bortezomib.
The incidence of RI is higher in patients with IgD-MM and λ restricted MM. Bortezomib based treatment is a highly effective and safe option in MM patients with impaired renal function. In this analysis, renal function was improved in a substantial proportion of patients. Peripheral neuropathy is the major adverse events which limit its use in MM patients.
探讨以硼替佐米（btz）为基础的化疗方案在肾功能损害（RI）的多发性骨髓瘤（MM）患者中的疗效和安全性。
回顾性分析了在我们单中心接受以硼替佐米为基础方案治疗的56例肾功能受损的MM患者。
中位年龄为59岁（范围30 - 77岁）。39.3%为κ型限制型MM，而57.1%为λ型限制型MM。9例为IgD-MM，14例为轻链MM。中位肌酐清除率（CrCl）为25.33（7.23 - 59.55）ml/min。轻度、中度和重度RI患者的数量分别为6例、35例和15例。MM的总缓解率为82.4%（≥MR），包括32.4%的完全缓解（CR）、17.6%的非常好的部分缓解（VGPR）和26.5%的部分缓解（PR）。肾脏缓解率为89.3%，包括62.5%的CR、14.3%的PR和12.5%的微小缓解（MR）。最佳缓解的中位时间为25.5天（范围5 - 240天）。不同RI组的中位总生存期和疾病进展时间无显著差异。观察到的不良事件与先前报道的肾功能正常患者相似。大多数不良事件是可控的，55.6%的患者发生周围神经病变，10例患者停用硼替佐米。
IgD-MM和λ型限制型MM患者的RI发生率较高。以硼替佐米为基础的治疗在肾功能受损的MM患者中是一种高效且安全的选择。在本分析中，相当一部分患者的肾功能得到改善。周围神经病变是限制其在MM患者中使用的主要不良事件。
