自体干细胞移植有可能逆转骨髓瘤患者对透析的依赖:两个病例的报告和实际考虑因素。

Suvir Singh, Rintu Sharma, Jagdeep Singh, Kunal Jain, Rajesh Kumar, Vikram Narang
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引用次数: 0

摘要

背景 自体干细胞移植(ASCT)可能对骨髓瘤相关肾功能损害患者有益,但在依赖透析的患者中并发症发生率较高,需要采取特殊的预防措施。方法 被诊断患有骨髓瘤并同时伴有透析依赖性肾功能障碍的患者在接受硼替佐米诱导疗法至少获得部分应答后入院接受 ASCT。对于这两名患者,动员治疗包括使用粒细胞集落刺激因子 5 天,以及在第 1 天使用 CD34 引导的 Plerixafor。美法仑的剂量为140毫克/平方米,并计划在美法仑24小时后先行进行一次血液透析。24 小时后进行外周血干细胞输注。每天采集中心静脉样本进行血气分析,一旦出现代谢性酸中毒(pH 值为 6 mEq/L),即计划进行临时透析。结果 两名活检证实患有铸型肾病并依赖透析(每周两次)的患者按照上述方案进行了体外干细胞移植。与通常的干细胞产量或移植动力学相比,没有发现任何差异。患者1(男,49岁)在移植后获得了非常好的部分反应,并且在接受造血干细胞移植后的18个月内一直没有透析。患者 2(男,48 岁)在 ASCT 后免疫固定检测结果为阴性,移植后 9 个月无透析,此后因出现尿毒症症状,需要每 3-4 周透析一次。结论 依赖透析的患者进行 ASCT 与较高的药物毒性、感染和移植相关死亡率风险相关。使用小剂量美法仑、24 小时后进行先发制人的透析、监测酸中毒和尿毒症症状以尽早发现酸中毒,可以安全地进行大剂量化疗。大部分患者有可能在移植后减少或摆脱透析支持。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Autologous stem cell transplantation can potentially reverse dialysis dependence in patients with myeloma: Report of two cases and practical considerations.

Background Autologous stem cell transplantation (ASCT) is potentially beneficial for patients with myeloma-related renal impairment but is associated with high rates of complications in dialysis-dependent patients and requires specific precautions. Methods Patients diagnosed with myeloma and concomitant dialysis-dependent renal dysfunction were admitted for ASCT after achieving at least partial response with bortezomib-based induction therapy. For both patients, mobilization consisted of granulocyte colony stimulating factor for 5 days and CD34 directed Plerixafor on Day 1. Melphalan was administered at a dose of 140 mg/m2 and a pre-emptive session of haemodialysis was planned 24 hours after melphalan. Peripheral blood stem cell infusion was done after 24 hours. A central venous sample for blood gas analysis was obtained daily and ad hoc dialysis was planned at the earliest sign of metabolic acidosis (pH <7.35, HCO3 <15 or K >6 mEq/L). Results Two patients with biopsy proven cast nephropathy and dialysis dependence (twice a week) were taken for ASCT with the above protocol. No variation from usual stem cell yield or engraftment kinetics was noted. Patient 1 (M, 49 years) achieved very good partial response post-transplant and has been dialysis free for 18 months post-ASCT. Patient 2 (M, 48 years) achieved negative immunofixation post-ASCT and was dialysis free for 9 months post-transplant, following which he requires one session of dialysis every 3-4 weeks for onset of uraemic symptoms. Conclusions ASCT in dialysis-dependent patients is associated with a higher risk of drug toxicity, infections and transplant-related mortality. Use of reduced dose melphalan, pre-emptive dialysis after 24 hours and monitoring for acidosis and symptoms of uraemia to identify acidosis at an early stage allows safe administration of high dose chemotherapy. A major proportion of patients can potentially achieve reduction or freedom from dialysis support post-transplant.

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