Renal Impairment at Diagnosis in Myeloma: Patient Characteristics, Treatment, and Impact on Outcomes. Results From the Australia and New Zealand Myeloma and Related Diseases Registry
Renal Impairment at Diagnosis in Myeloma: Patient Characteristics, Treatment, and Impact on Outcomes. Results From the Australia and New Zealand Myeloma and Related Diseases Registry
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DOI：
10.1016/j.clml.2019.05.010
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发表时间：
2019-08-01
影响因子：
2.7
通讯作者：
Spencer, Andrew
中科院分区：
文献类型：
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作者：
Ho, P. Joy;Moore, Elizabeth M.;Spencer, Andrew
肾损害（RI）在多发性骨髓瘤（MM）患者中很常见，并且与预后不良相关。澳大利亚和新西兰骨髓瘤登记处用于评估> 1000例新诊断的MM患者，其中383例在诊断时患有RI。接受自体干细胞移植（ASCT）的患者，尽管RI改善了生存率;一个劣效的潜在因素包括次优使用硼替佐米和ASCT.Background：肾损害（RI）是多发性骨髓瘤（MM）的常见并发症，仍然是一个预后不良的因素，尽管改善生存与新的疗法。患者和方法：我们评估了截至2018年4月的5年内，澳大利亚和新西兰骨髓瘤及相关疾病登记研究中诊断时伴有RI的新诊断MM患者的基线特征、治疗和结局;我们比较了RI患者（估计肾小球滤过率[ eGFR] = 60。在自体干细胞移植（ASCT）分析中，纳入了年龄在70岁及以下且距诊断时间>= 1年的患者。结果如下：总体而言，36%的新诊断MM患者患有RI;他们年龄较大，患有更晚期的疾病和合并症，体能状态更差。硼替佐米为基础的诱导治疗是最常用的，虽然管理较少的RI患者，尽管相似的反应率。RI患者不太可能接受ASCT;然而，接受者的无进展生存期（PFS）和总生存期（OS）较长。在调整年龄后，RI患者的OS和PFS较短。在ASCT受体RI与无RI，有无PFS和OS. Conclusion差异：我们的研究结果在“真实的世界”MM患者RI证实，患者，疾病和治疗相关因素（如次优硼替佐米和ASCT的使用），并延迟开始治疗，可能会导致较差的结果，并支持使用ASCT的RI患者。(C)2019爱思唯尔公司All rights reserved.
Renal impairment (RI) is common in patients with multiple myeloma (MM) and is associated with poor prognosis. The Australia and New Zealand Myeloma Registry was used to assess > 1000 newly diagnosed MM patients, of whom 383 had RI at diagnosis. Patients who underwent autologous stem cell transplantation (ASCT) despite RI had improved survival; potential factors for an inferior outcome include suboptimal use of bortezomib and ASCT.Background: Renal impairment (RI) is a common complication of multiple myeloma (MM) and remains a poor prognostic factor despite improved survival with newer therapies. Patients and Methods: We evaluated baseline characteristics, treatment, and outcomes of newly diagnosed MM patients with RI at diagnosis in the Australia and New Zealand Myeloma and Related Diseases Registry over 5 years to April 2018; we compared patients with RI (estimated glomerular filtration rate [ eGFR] = 60. In autologous stem cell transplantation (ASCT) analyses, patients aged 70 years and younger and >= 1 year from diagnosis were included. Results: Overall, 36% of patients with newly diagnosed MM had RI; they were older, had more advanced disease and comorbidities, and worse performance status. Bortezomib-based induction therapy was most commonly used, although administered to fewer RI patients, despite similar response rates. Patients with RI were less likely to receive ASCT; however, recipients had longer progression-free survival (PFS) and overall survival (OS). Patients with RI had shorter OS and PFS after adjusting for age. In ASCT recipients with RI versus no RI, there was no difference in PFS and OS. Conclusion: Our findings in "real world" MM patients with RI confirm that patient-, disease-, and treatment-related factors (such as suboptimal bortezomib and ASCT use), and delays in commencing therapy, might contribute to poorer outcomes, and support the use of ASCT in patients with RI. (C) 2019 Elsevier Inc. All rights reserved.