肾功能衰竭行替代治疗的肿瘤患者化疗疗效和不良反应

目的分析合并肾功能衰竭并需要行替代治疗的恶性肿瘤患者临床特点、化疗疗效和对患者生存的影响。方法选取合并肾功能衰竭并需要行替代治疗的恶性肿瘤患者，分析其所采用的化疗方案、药物的剂量强度、有效率和对患者生存的影响及其不良反应。结果共22例肾功能衰竭合并替代治疗患者进行化疗，其中骨髓瘤患者10例，非骨髓瘤患者12例。骨髓瘤合并肾功能衰竭行替代治疗患者化疗平均剂量强度为标准剂量的91±19．12％，化疗有效率为87．5％，6个月、1年、2年和3年生存率分别达到80％、60％、不低于25％和不低于12．5％。3例患者肾功能好转。非骨髓瘤患者化疗平均剂量强度为标准剂量的82．55±17．73％，行辅助化疗患者6个月、1年和2年无病生存率分别为83．33％，不低于60％和不低于40％。晚期患者化疗有效率为80％，6个月、1年、2年和3年生存率分别为83．33％、不低于80％，不低于40％和不低于20％。常见的不良反应：Ⅲ-Ⅳ度骨髓抑制发生率为18．18％，感染率发生率为31．82％。结论合并肾功能衰竭并需要行替代治疗的恶性肿瘤患者可以进行化疗并获得一定的长期生存，医师需要根据药物的代谢特点和患者个体化需求进行剂量调整并监测不良反应。

Effect of chemotherapy for patients with malignancies and renal failure receiving renal replacement therapy

Objective To analyze the clinical course of renal replacement therapy in patients with malignancies treated by chemotherapy. Methods We retrospectively analyzed the dose adjustments, effectiveness and side effects of chemotherapy given to 22 patients with malignancies and renal failure receiving renal replacement therapy. Results All these 22 patients receiving renal replacement therapy received chemotherapy, and 10 of them had multiple myeloma. The average dose intensity of the chemotherapy given to the patients with multiple myeloma was 91% ±19. 12% of the standard dose. The response rate was 87.5%. The 6-month, 1-year, 2-year and 3-year survival rates were 80%, 60%, 〉 25%, and 〉 12.5%, respectively. Renal functions were recovered in 3 patients and they did not need haemodialysis any more. The average dose intensity of the chemotherapy given to the non-multiple myeloma patients was 82. 55% ±17.73% of the standard dose. The 6-months, 1-year, and 2-year diseasefree survival rates of patients who got adjuvant chemotherapy were 83.33%, 〉60%, and 〉40%, respectively. The response rate of advanced patients was 80%. The 6-month, 1-year, 2-year and 3-year survival rates were 83.33%, 〉 80%, 〉 40%, and 〉 20%, respectively. The most common side effect was bone marrow suppression. Grade 3 - 4 neutropenia occurred in 4 patients （ 18. 18% ）. Conclusion Chemotherapy in patients with malignancies and renal failure receiving renal replacement therapy is feasible. Individualized dose adjustment should be performed on the basis of pharmacokinetic data and side effects.