Fan Li, Ma Yan-Ping, Chao Yao, Gao Xiao-Yun
Department of Hematology, The Second Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China.
Department of Hematology, The Second Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China,E-mail:
Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2021 Feb;29(1):145-151. doi: 10.19746/j.cnki.issn.1009-2137.2021.01.023.
To explore the risk factors, prognosis and curative effect of elderly patients with MM renal damage.
118 patients with primary elderly MM treated in our hospital from January 2011 to December 2018, were enrolled analyzed retrospectively. The clinical characteristics and prognosis of renal function impairment group (RI group) and normal renal function group (non-RI group) were compared. The difference of renal efficacy and survival benefit between the patients treated with bortezomib, thalidomide (combination group) and chemotherapy regimen containing only one of them (single drug group) in RI group was compared.
Univariate analysis showed that DS stage, pulmonary infection, uric acid, β microglobulin and leukocyte in RI group were higher than those in non-RI group, but hemoglobin was lower than that in non-RI group (P<0.05). Multivariate logistic regression analysis showed that β microglobulin was the independent risk factor for renal damage in elderly patients with MM. Kaplan-Meier method showed that the OS and PFS in RI group were significantly lower than those in non-RI group (P<0.05). The renal efficacy in the combined treatment group was significantly better than that of the single drug group (P<0.05), and it could bring benefit to the PFS of the elderly patients with MM renal damage (P<0.05).
The prognosis of elderly MM patients with impaired renal function is poor. The prognosis of these patients can be improved by selecting chemotherapy regimen containing bortezomib and thalidomide at the same time, and monitoring, controlling all kinds of risk factors actively.
探讨老年多发性骨髓瘤(MM)肾损害患者的危险因素、预后及疗效。
回顾性分析2011年1月至2018年12月在我院治疗的118例老年原发性MM患者。比较肾功能损害组(RI组)和肾功能正常组(非RI组)的临床特征及预后。比较RI组中接受硼替佐米、沙利度胺治疗的患者(联合组)与仅接受其中一种治疗的患者(单药组)在肾脏疗效和生存获益方面的差异。
单因素分析显示,RI组的DS分期、肺部感染、尿酸、β2微球蛋白及白细胞均高于非RI组,但血红蛋白低于非RI组(P<0.05)。多因素logistic回归分析显示,β2微球蛋白是老年MM患者肾损害的独立危险因素。Kaplan-Meier法显示,RI组的总生存期(OS)和无进展生存期(PFS)均显著低于非RI组(P<0.05)。联合治疗组的肾脏疗效显著优于单药组(P<0.05),且能为老年MM肾损害患者的PFS带来获益(P<0.05)。
老年MM肾功能损害患者预后较差。通过选择同时包含硼替佐米和沙利度胺的化疗方案,并积极监测、控制各种危险因素,可改善这些患者的预后。