PCD与PDD方案治疗新诊断多发性骨髓瘤合并肾功能不全患者的临床分析  

Clinical analysis of PCD and PDD in patients with newly diagnosed multiple myeloma with renal insufficiency

作　　者：崔静 刘瑶[1] 常玉莹[1] 陈曦[1] 赵薇薇 刘娟[1] 金英兰 于丽倩[1] 王巍[1] CUI Jing;LIU Yao;CHANG Yu-ying;CHEN Xi;ZHAO Wei-wei;LIU Juan;JIN Ying-lan;YU Li-qian;WANG Wei(Department of Hematology,The Second Affiliated Hospital of Harbin Medical University,Harbin 150081,China)

机构地区：[1]哈尔滨医科大学附属第二医院血液内科,黑龙江哈尔滨150081

出　　处：《哈尔滨医科大学学报》2024年第6期601-606,共6页Journal of Harbin Medical University

基　　金：黑龙江省自然科学基金项联合引导项目(LH2022H021);北京利泽慈善基金会DVD方案治疗伴肾功能不全初治多发性骨髓瘤患者的单中心、单臂、前瞻性临床研究项目(C-J-2021-020)。

摘　　要：目的通过单中心回顾性分析PCD方案(硼替佐米+环磷酰胺+地塞米松)与PDD方案(硼替佐米+脂质体阿霉素+地塞米松)对新诊断多发性骨髓瘤(newly diagnosed multiple myeloma,NDMM)合并肾功能不全(renal impairment,RI)患者的临床疗效及安全性。方法回顾性分析2018年7月~2023年2月由哈尔滨医科大学附属第二医院血液科收治的36例新诊断多发性骨髓瘤(newly diagnosed multiple myeloma,NDMM)合并肾功能不全(renal insufficiency,RI)患者的临床资料,其中PCD组16例,PDD组20例,比较两组患者肾脏反应、骨髓瘤治疗效果及不良反应。结果PCD与PDD组患者治疗3个疗程后肾脏总反应率(≥MR,微小缓解),肾脏主要反应率(≥PR,部分缓解)差异无统计学意义(P>0.05)。两组患者治疗4个疗程后肾脏总反应率、肾脏主要反应率差异无统计学意义(P>0.05)。两组患者治疗4个疗程后骨髓瘤的总缓解率(≥PR,部分缓解),高质量缓解率(≥VGPR,非常好的部分缓解)差异无统计学意义(P>0.05)。两组患者治疗后反应肾脏功能的临床指标肌酐、尿素氮等呈下降趋势,反应肿瘤负荷的指标血轻链、β2微球蛋白等显著下降,血红蛋白水平显著上升,但差异无统计学意义(P均>0.05)。ISSⅢ期患者治疗3个疗程及4个疗程后,PCD组和PDD组肾脏总反应率均无统计学差异(P>0.05)。治疗4个疗程后,两组患者骨髓瘤的总缓解率差异无统计学差异(P>0.05)。治疗后两组患者中与治疗相关的不良反应:贫血是两组患者最常见的不良反应,肺部感染发生率PCD组显著高于PDD组,分别68.75%(11/16)、30%(6/20),差异有统计学意义(P=0.042)。结论PDD方案改善肾功能、降低骨髓瘤负荷的疗效不劣于PCD方案,且肺部感染发生率低,可作为NDMM合并RI患者的首选方案。Objective To compare the treatment efficacy and safety of PCD regimen(borte-zomib+cyclophosphamide+dexamethasone)and PDD protocol(bortezomib+liposomal doxo-rubicin+dexamethasone)in the treatment of patients with newly diagnosed multiple myeloma(NDMM),combined with renal insufficiency(RI).Methods The clinical data of 36 NDMM patients combined with RI admitted to the Department of Hematology,the Second Affiliated Hospital of Harbin Medical University from July 1st,2018 to February 20th,2023 were retro-spectively analyzed,including 16 patients in the PCD group and 20 patients in the PDD group.Renal response,myeloma treatment efficacy and adverse reactions of the two groups were com-pared.Results The total renal response rate(>MR,minor response)in PCD and PDD groups,the main renal response rate(≥PR,partial response)after 3 courses of treatment,without statistical significance(P>0.05).After 4 courses of treatment,the total renal re-sponse rate and the main renal response rate,without statistically significant difference between the two groups(P>0.05).The overall response rates(≥PR,partial response)of myeloma in 2 groups and the high-quality response rates(≥VGPR,very good partial response),after 4 courses of treatment,without statistical significance(P>0.05).Clinical indicators of creati-nine and urea,which react to renal function,showed a decreasing trend after treatment in the two groups,and indicators of blood light chain andβ2-microglobulin,which react to tumor load,decreased significantly,and hemoglobin level increased significantly,but the difference between the two groups was not statistically significant(P>0.05).After 3 courses and 4 cour-ses of treatment in ISSⅢstage patients,the total renal response rates in PCD group and PDD group,without statistical significance(P>0.05).After 4 courses of treatment,the total re-sponse rates of myeloma in the two groups,without statistical difference(P>0.05).Treat-ment-related adverse reactions in both groups after treatment:Anemia was the most common ad-verse react

关 键 词：多发性骨髓瘤 肾功能不全 PDD PCD 

分 类 号：R733.3[医药卫生—肿瘤]