基于大剂量地塞米松的化疗方案治疗合并肾功能不全的初治多发性骨髓瘤的疗效和安全性

Efficacy and Safety of High-dose Dexamethasone-based Regimens in the Newly Diagnosed Multiple Myeloma Patients with Renal Impairment

目的评估基于大剂量地塞米松的化疗方案治疗合并肾功能不全的初治多发性骨髓瘤患者的疗效和安全性。方法回顾性分析2006年8月-2008年8月在北京协和医院接受基于大剂量地塞米松化疗方案治疗的22例合并肾功能不全的初治多发性骨髓瘤患者的临床资料。结果在接受中位4个疗程基于大剂量地塞米松的化疗方案后,22例患者中,有7例（31.8%）肾功能恢复,中位至恢复时间为31 d;16例（72.7%）有效,其中7例（31.8%）完全或接近完全缓解。3-4级副作用包括粒细胞减少（13.6%）、感染（22.7%）、周围神经病变（9.1%）和肠梗阻（4.5%）。结论基于大剂量地塞米松的化疗方案可以安全、有效地治疗合并肾功能不全的初治多发性骨髓瘤患者。

Objective To evaluate the efficacy and safety of high-dose dexamethasone-based regiments in newly diagnosed multiple myeloma patients with renal impairment. Methods The clinical data of 22 patients with newly diagnosed multiple myeloma patients with renal impairment who received high-dose dexam- ethasone-based regiments from August 2006 to August 2008 in Peking Union Medical College Hospital were retro- spectively reviewed. Results After receiving a median 4 cycles of high-dose dexamethasone-based regiments, renal impairment was reversed in 7 patients （31.8%） with a median time to reversal of 31 days. Sixteen patients （72.7%） achieved overall response, including 7 patients （31.8%） had complete remission / near complete remission. The grade 3 or 4 adverse events included neutropenia （13.6%）, infections （22.7%）, peripheral neuropathy （9. 1% ）, and ileus （4.5 % ）. Conclusion The high-dose dexamethasone-hased regiments are safe and effective for newly diagnosed multiple myeloma patients with renal imnairment.