初诊多发性骨髓瘤合并肾功能不全患者的临床分析

Clinical analysis of newly diagnosed multiple myeloma patients with renal dysfunction

目的 分析初诊多发性骨髓瘤（MM）及MM合并肾功能不全（MM-RI）患者的临床特点.方法 回顾性分析3家医院2010年1月1日至2012年6月30日收治的897例初诊MM患者中MM-RI患者的临床和病例特点、生存情况及影响初诊MM患者预后的因素.结果 897例初诊MM中有177例为MM-RI患者,占总例数的19.7％（177/897）.MM-RI患者平均年龄为59岁,年龄＞65岁的占28.2％（50/177）,男性占70.6％（125/177）,M蛋白分型中IgDλ型占17.2％（30/174）、轻链型占27.6％（48/174）,DSⅢ期（167/176）及ISSⅢ期（166/175）占94.9％.相比于MM肾功能正常（MM-RN）患者,MM-RI患者分型中IgD-λ型及轻链型比例高,分期中DS和ISSⅢ期比例高;骨髓浆细胞、白细胞和尿酸水平高;血红蛋白和J血小板水平低（均P ＜0.05）.中位随访24（2～114）个月,MM-RI及MM-RN患者的中位无进展生存期分别为28.0和29.0个月,差异无统计学意义（P =0.457）;MM-RI及MM-RN患者的预期中位总生存期分别为44.0和59.2个月,差异有统计学意义（P =0.033）.Cox回归多因素分析显示年龄、乳酸脱氢酶、β2微球蛋白、一线方案是否含硼替佐米、是否曾接受移植是MM患者的独立预后因素.结论 MM-RI与MM-RN患者有着不同的临床特点,年龄、乳酸脱氢酶、β2微球蛋白及一线方案是否含硼替佐米、是否曾接受移植为初诊MM患者的独立预后因素.

Objective To explore the clinical features and prognostic factors of newly diagnosed multiple myeloma patients with renal insufficiency （MM-RI）.Methods The clinical features,survival rates and prognostic factors were retrospectively analyzed for 897 newly diagnosed multiple myeloma （MM） patients at three hospital from January 1,2010 to June 30,2012.Results Among them,there were 177 cases （19.7％） of MM-RI patients.There were 125 males and 52 females with an average age of 59 years.And 28.2％ （50/177） were over 65 years.The types were 17.2％ （30/174） of immunoglobulin （Ig） D-λ and 27.6％ （48/174） of light chain isotype.And the stages were 94.9％ of DS stage Ⅲ （167/176） and ISS stage Ⅲ （166/175）.Compared with MM patients with normal renal function （MM-RN）,MM-RI group had a higher proportion of patients with IgD-λ and light chain isotype,more patients of DS and ISS stage Ⅲ; elevated bone marrow plasma cells,white blood cells and uric acid ; lower hemoglobin and platelet （all P ＜ 0.05）.After a median follow-up period of 24（2-114） months,the median progression-free survival （PFS） was 28.0 months for MM-RI patients and 29.0 months for MM-RN patients.And the difference was not statistically significant （P =0.457）.The estimated median overall survival （OS） was 44.0 months for MM-RI patients and 59.2 months for MM-RN patients.And the difference was statistically significant （P =0.033）.Log-rank univariate analysis showed that age,LDH,β2-MG,first-line treatment with or without bortezomib and previous transplantation or not were independent prognostic factors of MM patients.Conclusions MM-RI and MM-RN patients have different clinical features.Age,LDH,β2-MG,first-line treatment with or without bortezomib and previous transplantation or not are independent prognostic factors for newly diagnosed MM patients.