硼替佐米治疗伴有肾脏损害的多发性骨髓瘤临床研究

本研究分析伴有肾脏损害和无肾脏损害的多发性骨髓瘤(MM)患者临床特点,探讨硼替佐米在治疗伴有肾脏损害MM患者中的作用。对2007年1月至2011年8月在我院血液科接受硼替佐米治疗的39例MM患者(15例伴有肾脏损害,24例不伴肾脏损害)的临床资料进行了分析。对硼替佐米治疗前后的临床特点、疗效、肾脏损害的转归以及化疗相关的不良反应进行了对比研究。结果表明:①两组患者的一般临床特点在疾病类型、肌酐、尿酸、血钙及β2微球蛋白水平等方面存在明显的差异,而贫血、球蛋白等无显著差异;②2组均接受了硼替佐米为基础的化疗方案治疗,在治疗效果上,伴有肾脏损害的MM患者组和不伴有肾脏损害的MM患者组在总有效率及总生存时间上无显著性差异,但后者中位生存时间略长于前者;③伴有肾脏损害的治疗组经硼替佐米治疗后肾脏损害可以逆转,且以第1个疗程效果最为明显,有20.0%的患者肌酐水平下降到正常范围,第2个疗程后此比例达到38.4%。第2个疗程后肌酐水平下降幅度在两组间无统计学差异;④2组的主要不良反应为消化道症状、血小板减少、周围神经病变和感染等,发生率均无统计学差异。结论:选用硼替佐米为基础的化疗方案治疗伴有和不伴有肾脏损害的MM患者,在有效性和安全性方面没有明显的差异,且肾脏功能异常者多在2个疗程后得到明显逆转。

Clinical study of bortezomib for treating multiple myeloma with renal impairment

This study was purposed to analyze the clinical characteristics of multiple myeloma (MM) patients with and without renal impairment (RI) and to investigate the effect of bortezomib (Bor) on MM with RI. Clinical data of 39 MM patients (15 cases with RI, 24 cases without RI) received treatment of Bor in department of hematology in our hospital from Jan 2007 to Aug 2011 were collect and analyzed in term of clinical characteristics, curative efficacy, outcome of renal impairment and toxic reaction associated to chemotherapy. The results showed that (1) the obvious difference of the disease type, the creatinine, uric acid, serum calcium and β2-microglobulin levels existed in patients with and without RI, while there were no significant difference in hemoglobin and globin levels; (2) there were no significant difference in overall reaction rate and overall survival rate between MM patients with and without RI, however the median survival time of patients without RI was longer than that of patients with RI; (3) the RI could be reversed after the treatment with Bor, and the effect was most obvious after the first cycle. 20% MM patients with RI had recovered from RI after the first cycle; and the recovery rate from RI got up to 38.4% after the second cycle. The decline of creatinine levels had no difference between MM patients with or without RI after the second cycle. (4) The adverse events included gastrointestinal symptoms, peripheral neuropathy, thrombocytopenia and infection. There was also no difference between the 2 groups. It is concluded that Bor-based regimens for the MM patients with RI are effective and safe, and the renal function would be reversed after 2 cycle of Bor-based regimen.