多发性骨髓瘤合并肾功能不全失代偿期的临床治疗

Treatment of Multiple Myeloma with Renal Insufficiency Decompensation

目的比较化疗与化疗联合血液透析治疗多发性骨髓瘤(multiple myeloma,MM)合并肾功能不全失代偿期患者的疗效,为临床治疗提供指导意义。方法回顾性分析59例MM合并肾功能不全失代偿期患者的临床资料。据初始治疗是否血液透析分为采用单纯化疗方案(29例,A组)和化疗合并血液透析方案(30例,B组),采用国际骨髓瘤工作组(international myeloma working group,IMWG)评价标准评定疗效,常见不良反应事件评价标准(common terminology criteria for adverse events,CTCAE)评价不良反应。结果 A组患者对化疗的反应率51.72%(15/29),B组患者对化疗的反应率53.33%(16/30);肾功能改善率A组为44.8%(13/29),B组43.3%(12/30),两组化疗反应率和肾功能改善率的比较差异无统计学意义(P>0.05)。A组化疗过程中出现肾功能恶化或者少尿必须增加血液透析8例,疗效不佳。结论 MM合并肾功能不全失代偿期的患者在保证尿量>1500 ml时单纯化疗效果与化疗联合血液透析疗效相当,一旦出现肾功能恶化或者少尿必须增加血液透析。

Objective To compare the clinical effect of chemotherapy alone and unified chemotherapy and hemodialysis treatment on multiple myeloma(MM)and renal dysfunction,and provided the theoretical basic for the MM theatment.Methods A total of 59 MM patients with renal insufficiency decompensation were randomly divided into groups A(29 cases)and group B(30 cases)treated by chemotherapy or unified chemotherapy and hemodialysis treatment respectively.The efficacy were evaluated with international myeloma working group(IMWG),and adverse reaction were evaluated with common terminology criteria for adverse events(CTCAE).Results The response rate and the renal reversal rate was 51.72%(15 cases)and44.8%(8 cases)in group A,and53.3%(16 cases)and43.3%(7 cases)in group B respectively,which were not significantly different between the two groups.Conclusion Pure chemotherapy in treatment of renal function in MM has almost the same effect as unified hemodialysis and chemotherapy when the patients' urine level is above 1500 ml,and hemodialysis is needed in the case of renal function deterioration or oliguria.