Chen Xuduan, Luo Xiaofeng, Zu Yanping, Issa Hajji Ally, Li Linlin, Ye Hong, Yang Ting, Hu Jianda, Wei Lixin
Department of Nephrology, Fujian Medical University Union Hospital, Fuzhou, China.
Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou, China.
J Clin Lab Anal. 2020 Sep;34(9):e23416. doi: 10.1002/jcla.23416. Epub 2020 Jul 25.
Renal impairment (RI) is associated with poor survival in newly diagnosed multiple myeloma (MM) patients. Renal function recovery has been one of the main therapeutic goals in those patients.
The records from 393 newly diagnosed MM patients in our hospital between January 2012 and December 2016 were retrospectively analyzed. RI was defined as an eGFR < 40 mL/min according to the novel IMWG criteria. RI patients were categorized based on their renal function at diagnosis: severe RI: eGFR < 30 mL/min, and mild RI: 30 mL/min ≤ eGFR <40 mL/min. We explored whether RI, and particularly severe RI, was an adverse prognostic factor for survival, and investigated the impact of renal function recovery on survival.
Severe RI, hemoglobin <100 g/L, LDH ≥ 245 U/L, hyperuricemia, 1q21 amplification, and lack of novel agent treatment were associated with decreased overall survival (OS). Severe RI patients with renal response had a median OS of 27 months compared with 18 months for those patients without renal response (P = .030), but their median OS was still significantly lower than that for patients without severe RI, which was 51 months. In severe RI patients, the overall renal response rate in bortezomib-based regimens was significantly higher than that in nonbortezomib-based regimens.
Our results suggest that severe RI is an adverse prognostic factor for survival in newly diagnosed MM patients, restoration of renal function may improve survival, and bortezomib-based regimens may be the preferred treatment in patients with severe RI.
肾功能损害（RI）与新诊断的多发性骨髓瘤（MM）患者的不良生存相关。肾功能恢复一直是这些患者的主要治疗目标之一。
回顾性分析了2012年1月至2016年12月期间我院393例新诊断的MM患者的记录。根据国际骨髓瘤工作组（IMWG）的新标准，RI定义为估算肾小球滤过率（eGFR）<40 mL/分钟。RI患者根据诊断时的肾功能进行分类：重度RI：eGFR<30 mL/分钟，轻度RI：30 mL/分钟≤eGFR<40 mL/分钟。我们探讨了RI，尤其是重度RI是否是生存的不良预后因素，并研究了肾功能恢复对生存的影响。
重度RI、血红蛋白<100 g/L、乳酸脱氢酶（LDH）≥245 U/L、高尿酸血症、1q21扩增以及缺乏新型药物治疗与总生存期（OS）降低相关。有肾脏反应的重度RI患者的中位OS为27个月，而无肾脏反应的患者为18个月（P = 0.030），但其中位OS仍显著低于无重度RI的患者，后者为51个月。在重度RI患者中，基于硼替佐米的方案的总体肾脏反应率显著高于非基于硼替佐米的方案。
我们的结果表明，重度RI是新诊断的MM患者生存的不良预后因素，肾功能恢复可能改善生存，基于硼替佐米的方案可能是重度RI患者的首选治疗方法。
