以肾功能不全起病的多发性骨髓瘤69例临床分析  

A clinical analysis of 69 newly diagnosed multiple myeloma patients with renal insufficiency

作　　者：安娜[1] 李新[1] 申曼[1] 陈世伦[1] 黄仲夏[1] 

机构地区：[1]首都医科大学附属北京朝阳医院京西院区血液肿瘤科,100043

出　　处：《中华内科杂志》2016年第10期764-768,共5页Chinese Journal of Internal Medicine

基　　金：北京市科技计划课题（Z161100000516231）

摘　　要：目的 探讨以肾功能不全起病的多发性骨髓瘤患者应用含硼替佐米或沙利度胺方案治疗的疗效和生存情况.方法 回顾性分析2006年8月至2014年8月北京朝阳医院京西院区血液肿瘤科收治的69例以肾功能不全起病的多发性骨髓瘤患者的临床资料.根据初始治疗方案将69例患者分为硼替佐米组（39例）和沙利度胺组（30例）,比较其疗效和肾功能改善及生存情况.结果 （1）硼替佐米组总有效率为89.7％,完全缓解＋接近完全缓解（CR＋ nCR）率为41.0％;沙利度胺组的总有效率为83.3％,CR＋ nCR率为26.7％;两组的总有效率及CR＋ nCR率比较,差异均无统计学意义.（2）硼替佐米组的肾功能改善率为87.2％,高于沙利度胺组（60.0％）,差异有统计学意义（P=0.012）.52例肾功能改善者的中位肾功能损伤时间为45d,17例肾功能未改善者的中位肾功能损伤时间为222 d,两者差异有统计学意义（P＜0.05）;而两者治疗前的血肌酐及内生肌酐清除率的差异均无统计学意义.（3）69例患者总的中位无进展生存（PFS）期和总生存（OS）期分别为18和33.5个月,3年OS率为57％,5年OS率为17％.其中,硼替佐米组的中位PFS期和OS期分别为19和36.5个月,沙利度胺组的中位PFS期和OS期分别为12和25.5个月;两组比较,PFS期的差异有统计学意义（P =0.023）,OS期的差异无统计学意义（P=0.285）.结论 与沙利度胺为主的化疗方案相比,以肾功能不全起病的多发性骨髓瘤患者应用以硼替佐米为主的化疗方案可以取得更高的总有效率,PFS时间延长,肾功能改善率也显著提高,提高了患者的生活质量.Objective To investigate the efficacy and outcome in newly diagnosed multiple myeloma （MM） patients with renal insufficiency using bortezomib-or thalidomide-based regimens as front line treatment.Method Sixty-nine newly diagnosed MM patients with renal insufficiency were retrospectively analyzed from August 2006 to August 2014.Results ① Among thirty-nine patients with bortezomib based regimens （the bortezomib group）,the overall response rate （ORR） was 89.7% and complete response （CR） plus near CR（nCR） rate was 41.0%.By contrast,among thirty patients with thalidomide based regimens （the thalidomide group）,the ORR was 83.3% and CR ＋ nCR rate was 26.7%.There was no significant difference of either ORR or CR ＋ nCR rate between bortezomib and thalidomide groups.② The improvement rate of renal function in bortezomib group and thalidomide group were 87.2% and 60.0%respectively （P =0.012）.The median duration time of renal injury was 45 days in 52 patients with renal function improved,which was significantly shorter compared with 222 days in 17 patients without improvement （P 〈 0.05）.There was no difference of median serum creatinine and creatinine clearance rate between the two groups.③ The median progression-free survival （PFS） and the overall survival （OS） were 18 and 33.5 months,respectively in all patients.The three-year and five-year OS rates were 57% and 17%,respectively.The median PFS was 19 months in bortezomib group,while it was only 12 months in thalidomide group （P =0.023）.The median OS were 36.5 months and 25.5 months respectively,which was no difference （P =0.285）.Conclusions The newly diagnosed MM patients with renal insufficiency could get higher ORR and the longer PFS using bortezomib-containing regimens as initial therapy.Meanwhile the improvement rate of renal function and the living quality in patients with bortezomib are better compared with those with thalidomide based treatment.

关 键 词：多发性骨髓瘤 肾功能不全 肾功能改善 生存 

分 类 号：R733.3[医药卫生—肿瘤]