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[新诊断的肾功能损害多发性骨髓瘤患者肾脏反应的影响因素]

[The influencing factors of renal response in newly diagnosed multiple myeloma patients with renal impairment].

作者信息

Song Y H, Zhang F J, Hu R R, Chen M, Yang C, Wang W, Qin Y, Zhou D B, Zhuang J L

机构信息

Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China.

Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China.

出版信息

Zhonghua Xue Ye Xue Za Zhi. 2023 Feb 14;44(2):141-147. doi: 10.3760/cma.j.issn.0253-2727.2023.02.010.

Abstract

To investigate the causative factors of renal function in newly diagnosed multiple myeloma (MM) patients with renal inadequacy. 181 MM patients with renal impairment from August 2007 to October 2021 at Peking Union Medical College Hospital were recruited, whose baseline chronic kidney disease (CKD) stage was 3-5. Statistical analysis was performed based on laboratory tests, treatment regimens, hematological responses, and survival among various renal function efficacy groups. A logistic regression model was employed in multivariate analysis. A total of 181 patients were recruited, and 277 patients with CKD stages 1-2 were chosen as controls. The majority choose the BCD and VRD regimens. The progression-free survival (PFS) (14.0 months 24.8 months, <0.001) and overall survival (OS) (49.2 months 79.7 months, <0.001) of patients with renal impairment was considerably shorter. Hypercalcemia (=0.013, =5.654) , 1q21 amplification (=0.018, =2.876) , and hematological response over a partial response (=0.001, =4.999) were independent predictive factors for renal function response. After treatment, those with improvement in renal function had a longer PFS than those without (15.6 months 10.2 months, =0.074) , but there was no disparity in OS (56.5 months 47.3 months, =0.665) . Hypercalcemia, 1q21 amplification, and hematologic response were independent predictors of the response of renal function in NDMM patients with renal impairment. MM patients with CKD 3-5 at baseline still have worse survival. Improvement in renal function after treatment is attributed to the improvement in PFS.

摘要

探讨初诊肾功能不全的多发性骨髓瘤(MM)患者肾功能的致病因素。选取2007年8月至2021年10月在北京协和医院就诊的181例肾功能损害的MM患者,其基线慢性肾脏病(CKD)分期为3 - 5期。基于实验室检查、治疗方案、血液学反应以及不同肾功能疗效组的生存率进行统计分析。多因素分析采用逻辑回归模型。共招募181例患者,并选取277例CKD 1 - 2期患者作为对照。大多数患者选择BCD和VRD方案。肾功能损害患者的无进展生存期(PFS)(14.0个月对24.8个月,<0.001)和总生存期(OS)(49.2个月对79.7个月,<0.001)明显更短。高钙血症(=0.013,=5.654)、1q21扩增(=0.018,=2.876)以及血液学反应优于部分缓解(=0.001,=4.999)是肾功能反应的独立预测因素。治疗后,肾功能改善的患者PFS长于未改善的患者(15.6个月对10.2个月,=0.074),但OS无差异(56.5个月对47.3个月,=0.665)。高钙血症、1q21扩增和血液学反应是初诊肾功能损害的MM患者肾功能反应的独立预测因素。基线CKD 3 - 5期的MM患者生存情况仍较差。治疗后肾功能的改善归因于PFS的改善。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f189/10033274/b93054f74feb/cjh-44-02-141-g001.jpg

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