自体干细胞移植治疗伴有严重肾功能不全的多发性骨髓瘤

 肾衰竭是多发性骨髓瘤（MM）患者常见的临床表现。伴有肾衰竭的MM患者对传统化疗的总缓解率为35 %～50 %（完全缓解少见），中位生存期为4个月～1年，均显著低于肾功能正常患者。有许多中心应用大剂量美法仑以及自体干细胞移植（ASCT）治疗伴有严重肾衰竭的MM患者。目前研究发现，患者肾功能严重程度以及是否接受透析对干细胞动员以及干细胞植入无明显影响。大剂量美法仑以及ASCT后，伴有肾衰竭MM患者的完全缓解率、无事件生存率以及总生存率，分别增加到30 %、20个月以及40个月左右。相当一部分患者脱离透析。但是，该领域存在的问题仍然相当多，如APBSCT导致较高的移植相关死亡率。另外，在沙利度胺、硼替佐米以及雷利度胺等新药应用于临床之后，对于ASCT治疗伴有肾衰竭MM患者的影响如何，也需要进一步探讨。

Autologous stem cell transplantation in multiple myeloma patients with renal failure

Renal failure is a common clinical feature in multiple myeloma (MM). The overall remission rate is 35 %-50% (complete remission is rare) in MM patients with renal failure treated by conventional chemotherapy. Many centers use high dose chemotherapy and autologous stem cell transplantation (ASCT) for the treatment of MM patients with renal failure. The current study showed that the severity of renal function damage and dialysis had no impact on stem cell mobilization and implantation. High dose melphalan and ASCT could increase the rates of complete remission, event free survival and overall survival to 30 %, about 20 and 40 months longer, respectively and some patients discontinued dialysis. However there are many problems in this area, such as a higher treatment related mortality leaded by APBSCT. In addition, the role of new agents, such as thalidomide, bortezomib and lenalidomide, require evaluation in MM patient with renal failure.