Premuzic Vedran, Batinic Josip, Roncevic Pavle, Basic-Jukic Nikolina, Nemet Damir, Jelakovic Bojan
Department of Nephrology, Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, Zagreb, Croatia.
Department of Haematology, University Hospital Centre Zagreb, Zagreb, Croatia.
Ther Apher Dial. 2018 Feb;22(1):79-86. doi: 10.1111/1744-9987.12606. Epub 2017 Dec 14.
The aim of the current study was to determine whether plasmapheresis in combination with chemotherapy could significantly remove free light chains (FLC) in multiple myeloma (MM) patients with acute kidney injury (AKI) and therefore improve renal recovery and patient survival. During the study period, 29 patients with MM and AKI presented to our unit and were treated with two different therapy modalities (plasmapheresis with chemotherapy or bortezomib). At the end of treatment, a significant decrease of FLCs was present in the group treated with plasmapheresis compared to the bortezomib group. Patients treated with plasmapheresis had similar survival compared to patients treated with bortezomib. There was a significantly higher decrease of FLCs and longer survival in patients treated with three or more plasmapheresis sessions than in patients treated with two plasmapheresis sessions. Plasmapheresis therapy still remains a useful and effective method in the treatment of AKI in MM patients. Plasmapheresis significantly reduces FLCs compared to bortezomib especially with higher number of plasma exchange sessions but it must be combined with other chemotherapy agents in order to prolong renal recovery and therefore patient survival.
本研究的目的是确定血浆置换联合化疗是否能显著清除急性肾损伤（AKI）的多发性骨髓瘤（MM）患者的游离轻链（FLC），从而改善肾脏恢复情况及患者生存率。在研究期间，29例MM合并AKI患者到我院就诊，并接受了两种不同的治疗方式（血浆置换联合化疗或硼替佐米）。治疗结束时，与硼替佐米组相比，接受血浆置换治疗的组中FLC显著降低。接受血浆置换治疗的患者与接受硼替佐米治疗的患者生存率相似。接受三次或更多次血浆置换治疗的患者，其FLC降低幅度显著高于接受两次血浆置换治疗的患者，且生存期更长。血浆置换疗法在MM合并AKI患者的治疗中仍然是一种有用且有效的方法。与硼替佐米相比，血浆置换能显著降低FLC，尤其是在血浆置换次数较多时，但必须与其他化疗药物联合使用，以延长肾脏恢复时间，从而提高患者生存率。
