University of California San Francisco Medical Center, San Francisco, CA, USA.
CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
Bone Marrow Transplant. 2017 Dec;52(12):1616-1622. doi: 10.1038/bmt.2017.198. Epub 2017 Sep 18.
Autologous hematopoietic cell transplantation (AHCT) in multiple myeloma (MM) patients with renal insufficiency (RI) is controversial. Patients who underwent AHCT for MM between 2008 and 2013 were identified (N=1492) and grouped as normal/mild (⩾60 mL/min), N=1240, moderate (30-59), N=185 and severe RI (<30), N=67 based on Modification of Diet in Renal Disease. Multivariate analyses of non-relapse mortality (NRM), relapse, PFS and overall survival (OS) were performed. Of the 67 patients with severe RI, 35 were on dialysis prior to AHCT. Patients received melphalan 200 mg/m (Mel 200) in 92% (normal/mild), 75% (moderate) and 33% (severe) RI; remainder received 140 mg/m (Mel 140). Thirty four of 35 patients with severe RI achieved post-AHCT dialysis independence. The 5-year PFS for normal, moderate and severe RI was 35 (95% CI, 31-38)%, 40 (31-49)% and 27 (15-40)%, respectively, (P=0.42); 5-year OS for normal, moderate and severe RI was 68 (65-71)%, 68 (60-76)% and 60 (46-74)%, respectively, (P=0.69). With moderate RI, 5-year PFS for high-dose melphalan 140 mg/m was 18 (6-35)% and for Mel 200 was 46 (36-57)% (P=0.009). With severe RI, 5-year PFS Mel 140 was 25 (11-41) % and for Mel 200 was 32 (11-58)% (P=0.37). We conclude that AHCT is safe and effective in patients with MM with RI.
自体造血细胞移植 (AHCT) 在肾功能不全 (RI) 的多发性骨髓瘤 (MM) 患者中存在争议。本研究共纳入了 2008 年至 2013 年间接受 AHCT 治疗的 MM 患者 1492 例，并根据改良肾脏病膳食研究 (Modification of Diet in Renal Disease) 将患者分为正常/轻度 RI (⩾60mL/min，N=1240)、中度 RI (30-59，N=185)、重度 RI (<30，N=67)。多变量分析非复发死亡率 (NRM)、复发、无进展生存期 (PFS) 和总生存期 (OS)。在 67 例重度 RI 患者中，有 35 例在 AHCT 前接受透析治疗。92%（正常/轻度）、75%（中度）和 33%（重度）RI 患者接受了 200mg/m2 美法仑 (Mel 200)，其余患者接受了 140mg/m2 美法仑 (Mel 140)。35 例重度 RI 患者中有 34 例在 AHCT 后实现了透析独立。正常、中度和重度 RI 的 5 年 PFS 分别为 35(95%CI，31-38)%、40(31-49)%和 27(15-40)%，P=0.42；5 年 OS 分别为 68(65-71)%、68(60-76)%和 60(46-74)%，P=0.69)。在中度 RI 患者中，高剂量美法仑 140mg/m2 的 5 年 PFS 为 18(6-35)%，美法仑 200mg/m2 的 5 年 PFS 为 46(36-57)%，P=0.009。在重度 RI 患者中，美法仑 140mg/m2 的 5 年 PFS 为 25(11-41)%，美法仑 200mg/m2 的 5 年 PFS 为 32(11-58)%，P=0.37。综上，本研究认为 AHCT 治疗 RI 的 MM 患者是安全有效的。
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