大剂量地塞米松联合硼替佐米及沙利度胺治疗多发性骨髓瘤合并肾衰竭的临床研究

Therapeutic effects of high-dose dexamethasone combined with thalidomide and bortezomib on renal function in patients newly diagnosed multiple myeloma

目的观察以大剂量地塞米松为基础的常规化疗加用硼替佐米及沙利度胺治疗后对多发性骨髓瘤合并急性肾衰竭患者的影响。方法对23例伴肾衰竭的新发骨髓瘤患者均采用大剂量地塞米松加用硼替佐米和沙利度胺治疗，观察患者在用药前后肾损害的改善情况。结果严重肾衰竭的12例患者中逆转1例，好转6例，总有效率58．3％；肾衰竭的11例患者中逆转4例，好转5例，总有效率81．8％。全部病例总有效率69．5％（16／23）。对原发病骨髓瘤治疗总有效率60．9％（14／23）。中位显效时间为2个月（1。5个月）。3年总体生存率为56．5％，中位生存期34．4个月。结论大剂量地塞米松联合硼替佐米和沙利度胺对新发骨髓瘤患者的肾衰竭逆转率高，对原发病治疗效果较好，不良反应少、安全可靠、见效快，可作为一线治疗用药。

Objective To assess the efficacy of high dose dexamethasone combined with bortezomib and thalidomide in muttiple myeloma （MM） patients with acute renal failure. Methods 23 newly diagnosed MM patients with acute renal failure were treated with high dose dexamethasone combined with bortezomib and thalidomide. Results Reversal of renal failure was documented in 58.3 % （7/12） of those severe renal failure patients and 81.8 % （9/11） of renal failure patients.Renal function was reversed in 69.5 % （16/23） of all patients. The total response rate for MM was 60.9 % （14/23）. The median time to response was 2 （1-5） months. Overall survival （OS） at 3 years was 56.5 % and the median survival time was 34.4 months. Conclusion Renal failure was reversible in the majority of newly diagnosed MM patients treated with high- dose dexamethasone containing regimens. The addition of novel agents thalidomide and （or） bortezomib is safe and induces a more rapid renal failure reversal compared with routine chemotherapy.