Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.
Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom.
Blood Adv. 2020 Nov 24;4(22):5836-5845. doi: 10.1182/bloodadvances.2020002872.
Renal injury is a common complication of multiple myeloma (MM) and is associated with adverse outcome. Despite this, the natural history of renal injury in patients with MM remains uncertain especially in the context of intensive therapy and novel therapies. To address the lack of data, we evaluated the renal function of 2334 patients from the UK National Cancer Research Institute Myeloma XI trial at baseline and at 12 months to assess renal function over time and the factors associated with change. Patients who had severe acute kidney injury or a requirement for dialysis were excluded. At 12 months of the 1450 evaluable patients planned for autologous transplantation; 204 (14%) patients had a decline in estimated glomerular filtration rate (eGFR) ≥25% from baseline, 341 (23.5%) had an improvement and 905 (62%) had no significant change in eGFR. Renal outcome at 12 months for the 884 evaluable patients who were not planned for transplant was similar. Improved renal function was more likely if patients were <70 years old, male, had an average eGFR <60 mL per minute per 1.73 m2 and a higher baseline free light chain level >1000 mg/L, and/or a free light chain response of >90%. It did not correlate with monoclonal-protein response, transplantation, or use of a bortezomib-based regimen. We show that with current therapies the proportion of patients who have a significant decline in renal function in the first 12 months is small. The greatest relative improvement in eGFR is seen in patients with high free light chain at baseline and a high light chain response. This trial was registered at http://www.isrctn.com as #49407852.
肾脏损伤是多发性骨髓瘤（MM）的常见并发症，与不良预后相关。尽管如此，MM 患者肾脏损伤的自然病程仍不确定，尤其是在强化治疗和新型治疗的背景下。为了解决数据缺乏的问题，我们评估了英国国家癌症研究所骨髓瘤 XI 试验的 2334 例患者的基线和 12 个月时的肾功能，以评估肾功能随时间的变化情况以及与变化相关的因素。排除了有严重急性肾损伤或需要透析的患者。在计划进行自体移植的 1450 例可评估患者中，12 个月时，有 204 例（14%）患者的估算肾小球滤过率（eGFR）较基线下降≥25%，341 例（23.5%）患者有所改善，905 例（62%）患者 eGFR 无明显变化。未计划移植的 884 例可评估患者的 12 个月肾脏结局相似。如果患者年龄<70 岁、男性、平均 eGFR<60 mL/分钟/1.73 m2 且基线游离轻链水平较高（>1000 mg/L）和/或游离轻链反应>90%，则更有可能改善肾功能。它与单克隆蛋白反应、移植或使用硼替佐米为基础的方案无关。我们表明，在当前治疗下，在前 12 个月内肾功能显著下降的患者比例较小。基线游离轻链高且轻链反应高的患者 eGFR 相对改善最大。该试验在 http://www.isrctn.com 注册，编号为 #49407852。
