Bachmann Friederike, Schreder Martin, Engelhardt Monika, Langer Christian, Wolleschak Denise, Mügge Lars Olof, Dürk Heinz, Schäfer-Eckart Kerstin, Blau Igor Wolfgang, Gramatzki Martin, Liebisch Peter, Grube Matthias, V Metzler Ivana, Bassermann Florian, Metzner Bernd, Röllig Christoph, Hertenstein Bernd, Khandanpour Cyrus, Dechow Tobias, Hebart Holger, Jung Wolfram, Theurich Sebastian, Maschmeyer Georg, Salwender Hans, Hess Georg, Bittrich Max, Rasche Leo, Brioli Annamaria, Eckardt Kai-Uwe, Straka Christian, Held Swantje, Einsele Hermann, Knop Stefan
Division of Nephrology and Medical Intensive Care, Charité University Medicine, 10117 Berlin, Germany.
Division of Hematology and Oncology, Würzburg University Hospital Medical Center, 97080 Würzburg, Germany.
Cancers (Basel). 2021 Mar 16;13(6):1322. doi: 10.3390/cancers13061322.
Preservation of kidney function in newly diagnosed (ND) multiple myeloma (MM) helps to prevent excess toxicity. Patients (pts) from two prospective trials were analyzed, provided postinduction (PInd) restaging was performed. Pts received three cycles with bortezomib (btz), cyclophosphamide, and dexamethasone (dex; VCD) or btz, lenalidomide (len), and dex (VRd) or len, adriamycin, and dex (RAD). The minimum required estimated glomerular filtration rate (eGFR) was >30 mL/min. We analyzed the percent change of the renal function using the International Myeloma Working Group (IMWG) criteria and Kidney Disease: Improving Global Outcomes (KDIGO)-defined categories.
Seven hundred and seventy-two patients were eligible. Three hundred and fifty-six received VCD, 214 VRd, and 202 RAD. VCD patients had the best baseline eGFR. The proportion of pts with eGFR <45 mL/min decreased from 7.3% at baseline to 1.9% PInd ( < 0.0001). Thirty-seven point one percent of VCD versus 49% of VRd patients had a decrease of GFR ( = 0.0872). IMWG-defined "renal complete response (CRrenal)" was achieved in 17/25 (68%) pts after VCD, 12/19 (63%) after RAD, and 14/27 (52%) after VRd ( = 0.4747).
Analyzing a large and representative newly diagnosed myeloma (NDMM) group, we found no difference in CRrenal that occurred independently from the myeloma response across the three regimens. A trend towards deterioration of the renal function with VRd versus VCD may be explained by a better pretreatment "renal fitness" in the latter group.
在新诊断的（ND）多发性骨髓瘤（MM）中保留肾功能有助于预防过度毒性。对来自两项前瞻性试验的患者（pts）进行了分析，前提是进行诱导后（PInd）重新分期。患者接受了三个周期的硼替佐米（btz）、环磷酰胺和地塞米松（dex；VCD）或硼替佐米、来那度胺（len）和地塞米松（VRd）或来那度胺、阿霉素和地塞米松（RAD）治疗。所需的最低估计肾小球滤过率（eGFR）>30 mL/分钟。我们使用国际骨髓瘤工作组（IMWG）标准和肾脏病：改善全球预后（KDIGO）定义的类别分析了肾功能的变化百分比。
772例患者符合条件。356例接受VCD治疗，214例接受VRd治疗，202例接受RAD治疗。VCD组患者的基线eGFR最佳。eGFR<45 mL/分钟的患者比例从基线时的7.3%降至诱导后（PInd）的1.9%（<0.0001）。VCD组37.1%的患者与VRd组49%的患者出现肾小球滤过率下降（P = 0.0872）。VCD治疗后，25例患者中有17例（68%）达到IMWG定义的“肾脏完全缓解（CRrenal）”，RAD治疗后19例中有12例（63%），VRd治疗后27例中有14例（52%）（P = 0.4747）。
通过分析一个大型且具有代表性的新诊断骨髓瘤（NDMM）组，我们发现三种治疗方案中独立于骨髓瘤缓解的肾脏完全缓解（CRrenal）没有差异。与VCD相比，VRd治疗后肾功能有恶化趋势，这可能是因为后一组患者的预处理“肾脏健康状况”更好。
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