文章：

肾功能改善及其对新诊断多发性骨髓瘤患者生存的影响

Improvement in renal function and its impact on survival in patients with newly diagnosed multiple myeloma

原文发布日期：2015-03-20

DOI: 10.1038/bcj.2015.20

类型: Original Article

开放获取: 是

英文摘要：

Renal impairment (RI) is seen in over a quarter of patients with newly diagnosed multiple myeloma (NDMM). It is not clear if reversal of RI improves the outcome to that expected for NDMM patients without RI. We evaluated 1135 consecutive patients with NDMM seen at the Mayo Clinic between January 2003 and December 2012. RI was defined as having a creatinine clearance (CrCl) <40ml/min. The median overall survival (OS) for patients with RI at diagnosis receiving and not receiving novel agent induction therapy was not reached vs 46 months (P<0.001). The median OS for patients with CrCl ⩾40 ml/min at diagnosis, CrCl <40 ml/min at diagnosis but improved to ⩾40 ml/min and CrCl <40 ml/min at diagnosis and remained <40 ml/min, were 112, 56 and 33 months, respectively (P<0.001). The complete renal response rate for patients with RI at diagnosis receiving novel agent induction therapy compared to the rest was 40 vs 16% (P<0.001). In conclusion, patients with reversal of RI have improved outcomes, but it remains inferior to patients with normal renal function at diagnosis. These results have implications for identifying early treatment strategies for patients at risk of developing renal insufficiency.

摘要翻译： 

肾功能不全可见于超过四分之一的新诊断多发性骨髓瘤患者。目前尚不清楚肾功能逆转是否能使患者预后改善至与无肾功能不全的多发性骨髓瘤患者相当的水平。我们评估了2003年1月至2012年12月期间在梅奥诊所连续就诊的1135例新诊断多发性骨髓瘤患者。肾功能不全定义为肌酐清除率<40毫升/分钟。诊断时伴有肾功能不全的患者中，接受与未接受新型药物诱导治疗者的中位总生存期分别为未达到与46个月（P<0.001）。诊断时肌酐清除率≥40毫升/分钟者、诊断时肌酐清除率<40毫升/分钟但改善至≥40毫升/分钟者、以及诊断时肌酐清除率<40毫升/分钟且持续未达40毫升/分钟者的中位总生存期分别为112个月、56个月和33个月（P<0.001）。诊断时伴有肾功能不全并接受新型药物诱导治疗的患者完全肾脏缓解率与其他患者相比为40%对16%（P<0.001）。总之，肾功能逆转的患者预后有所改善，但仍逊于诊断时肾功能正常的患者。这些结果对制定肾功能不全风险患者的早期治疗策略具有重要指导意义。

原文链接：

Improvement in renal function and its impact on survival in patients with newly diagnosed multiple myeloma