以硼替佐米为主方案治疗多发性骨髓瘤肾损伤的临床研究

Clinical research of multiple myeloma patients with renal function impairment treated by bortezomib based chemotherapy

目的:观察硼替佐米联合地塞米松、沙利度胺(BDT)治疗骨髓瘤肾损害患者的疗效。方法:选择初诊多发性骨髓瘤(MM)合并肾损伤接受硼替佐米联合地塞米松、沙利度胺治疗的患者26例,观察用药后疗效及肾损害恢复情况。对其中9例患者行肾活组织检查明确病理类型。结果:26例患者中,MM治疗的总体有效率为76.9%,其中完全反应率为19.2%,非常好的部分反应率为30.8%,部分反应率为26.9%,肾功能恢复的总体反应率为76.9%。9例肾活检的病理分型分别为管型肾病5例,淀粉样变性4例。其中3例以肾病综合征为首发症状,经硼替佐米联合地塞米松、沙利度胺治疗后仍有明显的低蛋白血症和非选择性蛋白尿,给予足量足疗程的糖皮质激素治疗后患者症状改善。结论:BDT方案治疗伴有肾损害的MM患者安全、疗效好,且能很好逆转肾功能,不良反应可耐受。但是对有肾病综合征表现的患者给予足量足疗程糖皮质激素可能会很好地改善低蛋白血症。

Objective： To explore the efficacy of bortezomib（ BDT） combined with dexamethasone and thalidomide in multiple myeloma（ MM） patients with renal function impairment（ RI）. Methods： All 26 newly diagnosed MM patients with RI accepted BDT. Therapeutic efficacy was observed in patients with multiple myeloma itself and renal damage. 9 patients were made renal biopsy to prove pathological types. Results ： In 2 6 cases,overall response rate（ ORR） of MM was 7 6. 9 %,including19. 2% complete response rate,30. 8% very good partial response rate,26. 9% the partial response rate. And ORR of renal function recovery was 76. 9%. In 9 renal biopsy patients,5 cases were cast nephropathy,and 4 cases were amyloidosis. 3 cases began nephrotic syndrome,which treated by bortezomib combined dexamethasone and thalidomide still were significant hypoproteinemia and Non-selective albuminur Ia. But these patients accepted adequate glucocorticoid,above symptoms had shown greatly improvement. Conclusion： BDT treatment is safe and effective in MM patients with renal function impairment,and can reverse renal function. And adverse reactions can be tolerated. But patients with nephrotic syndrome accept adequate dosage and time glucocorticoid seem to improve hypoproteinemia.