Renal insufficiency retains adverse prognostic implications despite renal function improvement following Total Therapy for newly diagnosed multiple myeloma.
Renal insufficiency retains adverse prognostic implications despite renal function improvement following Total Therapy for newly diagnosed multiple myeloma.
复制标题
尽管肾功能改善了新诊断的多发性骨髓瘤，但肾功能不全仍保留了不良预后的影响。
作者：
肾功能不全（RI）是多发性骨髓瘤（MM）的常见并发症，对患者生存率有负面影响。连续的全面治疗（TT）方案改善的临床结局仅限于无RI的患者。因此，我们对入组TT 2和TT 3的患者的总生存期、无进展生存期和至疾病进展时间（TTP）与基线和移植前RI的关系进行了回顾性分析。肾小球滤过率分为4个肾功能分级（RC），RC 1-RC 4（RC 1 ≤ 90 ml/min/1.73 m2，RC 2 60-89 ml/min/1.73 m2，RC 3 30-59 ml/min/1.73 m2和RC 4 <30 ml/min/1.73 m2）。RC 1 -3具有相当的临床结果，而RC 4是有害的，即使在移植后改善到更好的RC之后。在85%的基因表达谱确定为低风险MM的患者中，基线和移植前特征的考克斯回归模型（还考虑了RC改善和MM完全缓解（CR））将中期细胞遗传学异常和基线RC 4的存在确定为与移植后不良TTP相关的自变量，而MM CR使进展和TTP的风险降低了60%以上。尽管RI改善，但临床结局未能改善，提示MM相关原因。虽然区分RC 4与RC<4，但46个基因探针与MM生物学或存活没有明显关系。
Renal insufficiency (RI) is a frequent complication of multiple myeloma (MM) with negative consequences for patient survival. The improved clinical outcome with successive Total Therapy (TT) protocols was limited to patients without RI. We therefore performed a retrospective analysis of overall survival, progression-free survival and time to progression (TTP) of patients enrolled in TT2 and TT3 in relationship to RI present at baseline and pre-transplant. Glomerular filtration rate was graded in four renal classes (RCs), RC1–RC4 (RC1 ⩾90 ml/min/1.73 m2, RC2 60–89 ml/min/1.73 m2, RC3 30–59 ml/min/1.73 m2 and RC4 <30 ml/min/1.73 m2). RC1–3 had comparable clinical outcomes while RC4 was deleterious, even after improvement to better RC after transplant. Among the 85% of patients with gene expression profiling defined low-risk MM, Cox regression modeling of baseline and pre-transplant features, which also took into consideration RC improvement and MM complete response (CR), identified the presence of metaphase cytogenetic abnormalities and baseline RC4 as independent variables linked to inferior TTP post-transplant, while MM CR reduced the risk of progression and TTP by more than 60%. Failure to improve clinical outcomes despite RI improvement suggested MM-related causes. Although distinguishing RC4 from RC<4, 46 gene probes bore no apparent relationship to MM biology or survival.
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