Grzasko Norbert, Morawska Marta, Hus Marek
Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, Lublin, Poland.
Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, Lublin, Poland.
Clin Lymphoma Myeloma Leuk. 2015 Apr;15(4):187-98. doi: 10.1016/j.clml.2014.09.012. Epub 2014 Oct 5.
Renal impairment is a common complication of multiple myeloma. It is found in about 20% to 25% of patients at diagnosis and in ≤ 50% at some point during the disease course. The presence of renal insufficiency diminishes patients' quality of life and has been associated with increased mortality, although the outcomes of patients after successful induction therapy have been comparable to those with normal renal function. Therefore, the treatment of patients with multiple myeloma and renal impairment is a major challenge and should aim to achieve remission in a large proportion of patients. New drugs introduced to treat multiple myeloma during the past decade have an established place in the treatment of patients with renal failure. Bortezomib appears to be most beneficial in this setting and, combined with other drugs, provides a chance for rapid remission and related improvement of renal function. Immunomodulatory drugs such as thalidomide and lenalidomide have also been used successfully in patients with renal insufficiency, although for the latter drug appropriate dose adjustments are necessary. The presence of renal failure is not a contraindication to autologous bone marrow transplantation in patients eligible for this procedure. Among the classic cytotoxic agents, bendamustine, in particular, should be considered for patients with renal insufficiency. Appropriate supportive care is also extremely important in the treatment of patients with multiple myeloma and renal failure. It can include plasmapheresis and removal of free light chains with high cut-off hemodialysis, adapted dosages of bisphosphonates, and avoidance of drugs and conditions that can impair renal function.
肾功能损害是多发性骨髓瘤的常见并发症。在诊断时约20%至25%的患者中可发现，在疾病过程中的某个时间点，这一比例≤50%。肾功能不全的存在会降低患者的生活质量，并与死亡率增加相关，尽管成功诱导治疗后的患者预后与肾功能正常者相当。因此，治疗多发性骨髓瘤合并肾功能损害的患者是一项重大挑战，治疗应旨在使大部分患者实现缓解。在过去十年中引入的用于治疗多发性骨髓瘤的新药在治疗肾衰竭患者方面已确立了地位。硼替佐米在这种情况下似乎最有益，与其他药物联合使用可提供快速缓解及肾功能相关改善的机会。免疫调节药物如沙利度胺和来那度胺也已成功用于肾功能不全患者，不过对于后者药物需要进行适当的剂量调整。对于符合条件的患者，肾衰竭并非自体骨髓移植的禁忌证。在经典的细胞毒性药物中，对于肾功能不全患者尤其应考虑使用苯达莫司汀。在治疗多发性骨髓瘤合并肾衰竭患者时，适当的支持治疗也极为重要。这可包括血浆置换和采用高通量血液透析清除游离轻链、调整双膦酸盐的剂量以及避免使用可能损害肾功能的药物和情况。
