CHU de Bordeaux, Service de Néphrologie-Transplantation-Dialyse-Aphérèses, Hôpital Pellegrin, Bordeaux, France.
CNRS UMR 5164, ImmunoConcEpT, Université de Bordeaux, Bordeaux, France.
Nephrol Dial Transplant. 2021 Feb 20;36(3):482-490. doi: 10.1093/ndt/gfz211.
Renal impairment (RI), a severe complication in multiple myeloma (MM), is considered as a poor prognostic factor. Patient survival has increased with the use of novel drugs and autologous stem-cell transplantation (ASCT). However, specific evolution of the incidence of RI in MM and its impact on prognosis remain unclear.
Using a population-based registry of 1038 newly diagnosed MM in Gironde, France, we evaluated the incidence trends of RI in MM patients and assessed net survival according to factors of interest using Pohar-Perme indicator and excess mortality rate regression. We also reviewed 114 cases of MM with RI to describe their clinical outcomes.
In our population-based study, 24.6% of MM patients presented with RI (12.9% required haemodialysis). Median survival time was 21 months in patients with RI versus not reached at 3 years for other patients (P < 0.01). Age >73 years, RI, comorbidities and non-use of drugs or ASCT were associated with excess mortality risk. The effect of RI on excess mortality rates was maximum in the first 6 months after diagnosis. In the observational study, median follow-up time was 22.5 months; factors associated with renal response were haematologic response [odds ratio (OR) 6.81; P < 0.01] and previous chronic kidney disease (OR 0.26; P = 0.04). Factors associated with 1-year overall survival were haematological [hazard ratio (HR) 0.13; P < 0.01] and renal response (HR 0.27; P = 0.03).
RI represents an independent negative prognostic factor in MM in the first 6 months after diagnosis. Renal recovery and haematologic response are the strongest markers associated with patient survival.
肾功能损害（RI）是多发性骨髓瘤（MM）的一种严重并发症，被认为是预后不良的因素。随着新型药物和自体干细胞移植（ASCT）的应用，患者的生存率有所提高。然而，MM 中 RI 的发生率的具体演变及其对预后的影响尚不清楚。
我们使用法国吉伦特地区的一个包含 1038 例新诊断 MM 患者的基于人群的登记处，评估了 RI 在 MM 患者中的发生率趋势，并使用 Pohar-Perme 指标和超额死亡率回归法根据感兴趣的因素评估净生存。我们还回顾了 114 例 RI 合并 MM 的病例，以描述其临床结局。
在我们的基于人群的研究中，24.6%的 MM 患者出现 RI（12.9%需要血液透析）。RI 患者的中位生存时间为 21 个月，而其他患者的中位生存时间未达到 3 年（P<0.01）。年龄>73 岁、RI、合并症以及未使用药物或 ASCT 与超额死亡风险相关。RI 对超额死亡率的影响在诊断后 6 个月内最大。在观察性研究中，中位随访时间为 22.5 个月；与肾脏反应相关的因素包括血液学反应（比值比 [OR] 6.81；P<0.01）和先前的慢性肾脏病（OR 0.26；P=0.04）。与 1 年总生存率相关的因素包括血液学反应[风险比（HR）0.13；P<0.01]和肾脏反应（HR 0.27；P=0.03）。
RI 在诊断后 6 个月内是 MM 的独立预后不良因素。肾脏恢复和血液学反应是与患者生存最相关的最强标志物。
