Firsova M V, Mendeleeva L P, Solovev M V, Rekhtina I G, Pokrovskaya O S, Urnova E S, Soboleva N P, Dvirnyk V N, Klyasova G A, Kuzmina L A, Savchenko V G
National Research Center for Hematology.
Ter Arkh. 2020 Sep 1;92(7):70-76. doi: 10.26442/00403660.2020.07.000777.
To assess the safety and efficacy of autologous haematopoietic stem cell transplantation (auto-HSCT) in multiple myeloma (MM) patients with dialysis-dependent renal failure.
During a period from May 2010 to December 2016 fourteen MM patients with dialysis-dependent renal failure aged 48 to 65 years underwent auto-HSCT. After the induction therapy complete response, very good partial response, partial response were documented in 64, 29, 7% of patients, respectively. In no case was a renal response achieved. Haematopoietic stem cell mobilization in most patients (13/14) was performed according to the scheme: G-CSF 10 g/kg. Melphalan in 3 dosages was used as pre-transplant conditioning: 100, 140 and 200 mg/m2; 13 patients underwent a single and in one case underwent a tandem auto-HSCT against the background of hemodialysis. Evaluation of the antitumor and renal response was assessed on the 100th day after auto-HSCT. Subsequently, against the background of programmed hemodialysis and in the setting of high-dosed melphalan (100200 mg/m2), 13 patients underwent a single and one patient underwent a tandem auto-HSCT. At +100 days after auto-HSCT, an antitumor response and renal response were assessed.
The period of agranulocytosis after auto-HSCT was from 5 to 12 days (median 8,5) and was accompanied by infectious complications, cardiac and neurological dysfunctions. At +100 days after auto-HSCT, the complete response was confirmed in 71% patients and very good partial response was confirmed in 29% patients. The minimal renal response was registered in 2 patients (14%), hemodialysis was stopped. The transplant-related mortality was absent. After a median follow-up of 53 months 5-year progression-free survival was 59%, and overall survival was 93%.
Carrying out auto-HSCT in patients with dialysis-dependent renal failure contributed to the achievement of a minimal renal response in 14% of cases, which allowed these patients to stop hemodialysis. Patients whose conditioning regimen was performed using melphalan at a dose of 200 mg/m2showed more frequent complications in the early post-transplant period compared to patients who received a lower dose of melphalan (100140 mg/m2). Auto-HSCT in MM patients with dialysis-dependent renal failure is a feasible and effective treatment method, which in some cases contributes to independence from hemodialysis.
评估自体造血干细胞移植（auto-HSCT）在依赖透析的肾衰竭多发性骨髓瘤（MM）患者中的安全性和有效性。
2010年5月至2016年12月期间，14例年龄在48至65岁之间、依赖透析的肾衰竭MM患者接受了auto-HSCT。诱导治疗后，分别有64%、29%和7%的患者达到完全缓解、非常好的部分缓解和部分缓解。无一例患者出现肾脏缓解。大多数患者（13/14）按照以下方案进行造血干细胞动员：粒细胞集落刺激因子（G-CSF）10μg/kg。美法仑分3种剂量用作移植前预处理：100、140和200mg/m²；13例患者接受了单次auto-HSCT，1例患者在血液透析背景下接受了串联auto-HSCT。在auto-HSCT后第100天评估抗肿瘤和肾脏反应。随后，在计划性血液透析背景下以及高剂量美法仑（100 - 200mg/m²）的情况下，13例患者接受了单次auto-HSCT，1例患者接受了串联auto-HSCT。在auto-HSCT后 +100天时，评估抗肿瘤反应和肾脏反应。
auto-HSCT后粒细胞缺乏期为5至12天（中位值8.5天），并伴有感染性并发症、心脏和神经功能障碍。在auto-HSCT后 +100天时，71%的患者确认达到完全缓解，29%的患者确认达到非常好的部分缓解。2例患者（14%）出现最小程度的肾脏缓解，血液透析停止。无移植相关死亡。中位随访53个月后，5年无进展生存率为59%，总生存率为93%。
对依赖透析的肾衰竭患者进行auto-HSCT有助于14%的病例实现最小程度的肾脏缓解，从而使这些患者能够停止血液透析。与接受较低剂量美法仑（100 - 140mg/m²）的患者相比，使用200mg/m²美法仑进行预处理方案的患者在移植后早期出现并发症的频率更高。对依赖透析的肾衰竭MM患者进行auto-HSCT是一种可行且有效的治疗方法，在某些情况下有助于摆脱血液透析。
