Improvement in renal function and its impact on survival in patients with newly diagnosed multiple myeloma.
Improvement in renal function and its impact on survival in patients with newly diagnosed multiple myeloma.
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DOI：
10.1038/bcj.2015.20
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发表时间：
2015-03-20
影响因子：
12.8
通讯作者：
Kumar SK
中科院分区：
文献类型：
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作者：
Gonsalves WI;Leung N;Rajkumar SV;Dispenzieri A;Lacy MQ;Hayman SR;Buadi FK;Dingli D;Kapoor P;Go RS;Lin Y;Russell SJ;Lust JA;Zeldenrust S;Kyle RA;Gertz MA;Kumar SK
超过四分之一的新诊断多发性骨髓瘤（NDMM）患者出现肾损害（RI）。目前尚不清楚RI逆转是否能改善无RI的NDMM患者的预后。我们评估了2003年1月至2012年12月在梅奥诊所连续就诊的1135例NDMM患者。RI定义为肌酐清除率(CrCl) <40ml/min。RI患者在诊断时接受和未接受新型药物诱导治疗的中位总生存期（OS）未达到46个月（P<0.001）。诊断时CrCl小于40 ml/min，诊断时CrCl小于40 ml/min，但在诊断时改善到小于40 ml/min和CrCl小于40 ml/min并保持小于40 ml/min的患者的中位生存期分别为112个月，56个月和33个月（P<0.001）。诊断时接受新型药物诱导治疗的RI患者的完全肾脏缓解率为40% vs 16% （P<0.001）。总之，RI逆转患者的预后有所改善，但仍不如诊断时肾功能正常的患者。这些结果对确定有发展为肾功能不全风险的患者的早期治疗策略具有启示意义。
Renal impairment (RI) is seen in over a quarter of patients with newly diagnosed multiple myeloma (NDMM). It is not clear if reversal of RI improves the outcome to that expected for NDMM patients without RI. We evaluated 1135 consecutive patients with NDMM seen at the Mayo Clinic between January 2003 and December 2012. RI was defined as having a creatinine clearance (CrCl) <40ml/min. The median overall survival (OS) for patients with RI at diagnosis receiving and not receiving novel agent induction therapy was not reached vs 46 months (P<0.001). The median OS for patients with CrCl ⩾40 ml/min at diagnosis, CrCl <40 ml/min at diagnosis but improved to ⩾40 ml/min and CrCl <40 ml/min at diagnosis and remained <40 ml/min, were 112, 56 and 33 months, respectively (P<0.001). The complete renal response rate for patients with RI at diagnosis receiving novel agent induction therapy compared to the rest was 40 vs 16% (P<0.001). In conclusion, patients with reversal of RI have improved outcomes, but it remains inferior to patients with normal renal function at diagnosis. These results have implications for identifying early treatment strategies for patients at risk of developing renal insufficiency.