老年多发性骨髓瘤肾损害患者的临床特征、预后及疗效分析

目的:探讨老年MM肾损害患者的临床特征、预后及疗效分析。方法:对本院2011年1月-2018年12月收治的118例初发老年MM患者进行回顾性分析,比较肾功能损害组(RI组)及肾功能正常组(非RI组)MM患者的临床特点、预后,比较RI组同时包含硼替佐米、沙利度胺的化疗方案(联合用药组)与只包含其中之一的化疗方案(单药组)的肾脏疗效及生存获益的差异。结果:单因素分析表明,RI组DS分期、肺部感染、尿酸、β2微球蛋白、白细胞较非RI组升高,血红蛋白较非RI组低(P<0.05)。多因素Logistic回归分析显示,β2微球蛋白为老年MM患者发生肾损害的独立危险因素。Kaplan-Meier方法结果显示,RI组OS及PFS均明显低于非RI组(P<0.05)。联合用药组的肾脏疗效明显优于单药组(P<0.05),且可为老年MM肾损害患者的PFS带来获益(P<0.05)。结论:老年MM患者肾损害后预后较差,积极监测及控制各种危险因素、选择同时含有硼替佐米及沙利度胺的化疗方案可使该类患者的预后得到改善。

Clinical Characteristic,Prognosis and Treatment Outcome of Elderly Multiple Myeloma Patients with Impaired Renal Function

Objective:To explore the risk factors,prognosis and curative effect of elderly patients with MM renal damage.Methods:118 patients with primary elderly MM treated in our hospital from January 2011 to December 2018,were enrolled analyzed retrospectively.The clinical characteristics and prognosis of renal function impairment group(RI group)and normal renal function group(non-RI group)were compared.The difference of renal efficacy and survival benefit between the patients treated with bortezomib,thalidomide(combination group)and chemotherapy regimen containing only one of them(single drug group)in RI group was compared.Results:Univariate analysis showed that DS stage,pulmonary infection,uric acid,β2 microglobulin and leukocyte in RI group were higher than those in non-RI group,but hemoglobin was lower than that in non-RI group(P<0.05).Multivariate logistic regression analysis showed thatβ2 microglobulin was the independent risk factor for renal damage in elderly patients with MM.Kaplan-Meier method showed that the OS and PFS in RI group were significantly lower than those in non-RI group(P<0.05).The renal efficacy in the combined treatment group was significantly better than that of the single drug group(P<0.05),and it could bring benefit to the PFS of the elderly patients with MM renal damage(P<0.05).Conclusion:The prognosis of elderly MM patients with impaired renal function is poor.The prognosis of these patients can be improved by selecting chemotherapy regimen containing bortezomib and thalidomide at the same time,and monitoring,controlling all kinds of risk factors actively.