伴肾损害的初诊多发性骨髓瘤患者肾功能疗效影响因素

The influencing factors of renal response in newly diagnosed multiple myeloma patients with renal impairment

目的探究初诊伴肾损害的多发性骨髓瘤(MM)患者肾功能疗效的影响因素。方法纳入2007年8月至2021年10月北京协和医院伴肾损害的MM患者181例,其基线慢性肾脏病(CKD)分期为3~5期。对不同肾功能疗效组患者的实验室检查、治疗方案、血液学反应深度、生存情况等进行分析。多因素分析采用Logistic回归模型。结果纳入181例初诊时即有肾功能损害患者,以277例肾功能正常(CKD分期1~2期)患者作为对照组。大多数患者应用BCD和VRD方案。与无肾损害患者相比,肾损害患者的无进展生存(PFS)时间(14.0个月对24.8个月,P<0.001)和总生存(OS)时间(49.2个月对79.7个月,P<0.001)均显著缩短。肾功能疗效有效组和无效组高钙血症(P=0.013,OR=5.654)、1q21+(P=0.018,OR=2.876)和血液学反应达部分缓解及以上(P=0.001,OR=4.999)的差异有统计学意义,且均为肾功能疗效的独立预后因素。治疗后肾功能有效者的PFS时间和OS时间均较治疗后肾功能无效者延长(PFS:15.6个月对10.2个月,P=0.074;OS:56.5个月对47.3个月,P=0.665),差异无统计学意义。结论高钙血症、1q21+和血液学反应深度是MM患者肾功能改善的独立预后因素。基线CKD分期3~5期的MM患者生存更差,治疗后肾功能疗效有效有助于改善PFS。

Objective To investigate the causative factors of renal function in newly diagnosed multiple myeloma(MM)patients with renal inadequacy.Methods 181 MM patients with renal impairment from August 2007 to October 2021 at Peking Union Medical College Hospital were recruited,whose baseline chronic kidney disease(CKD)stage was 3-5.Statistical analysis was performed based on laboratory tests,treatment regimens,hematological responses,and survival among various renal function efficacy groups.A logistic regression model was employed in multivariate analysis.Results A total of 181 patients were recruited,and 277 patients with CKD stages 1-2 were chosen as controls.The majority choose the BCD and VRD regimens.The progression-free survival(PFS)(14.0 months vs 24.8 months,P<0.001)and overall survival(OS)(49.2 months vs 79.7 months,P<0.001)of patients with renal impairment was considerably shorter.Hypercalcemia(P=0.013,OR=5.654),1q21 amplification(P=0.018,OR=2.876),and hematological response over a partial response(P=0.001,OR=4.999)were independent predictive factors for renal function response.After treatment,those with improvement in renal function had a longer PFS than those without(15.6 months vs 10.2 months,P=0.074),but there was no disparity in OS(56.5 months vs 47.3 months,P=0.665).Conclusion Hypercalcemia,1q21 amplification,and hematologic response were independent predictors of the response of renal function in NDMM patients with renal impairment.MM patients with CKD 3-5 at baseline still have worse survival.Improvement in renal function after treatment is attributed to the improvement in PFS.