需要透析的新诊断多发性骨髓瘤患者的预后。

IF 2.7 4区医学 Q2 HEMATOLOGY

Clinical Lymphoma, Myeloma & Leukemia Pub Date : 2025-03-04 DOI:10.1016/j.clml.2025.03.003

Despina Fotiou , Foteini Theodorakakou , Eirini Solia , Vasiliki Spiliopoulou , Ioannis Ntanasis-Stathopoulos , Panagiotis Malandrakis , Erasmia Psimenou , Nikolaos Kanellias , Maria Roussou , Magdalini Migkou , Evangelos Eleutherakis-Papaiakovou , Angeliki Andrikopoulou , Stavroula Giannouli , Maria Gavriatopoulou , Evangelos Terpos , Efstathios Kastritis , Meletios A. Dimopoulos

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引用次数: 0

摘要

简介：肾损害（RI）是新诊断的多发性骨髓瘤（NDMM）的常见并发症，1-5%的严重RI患者需要透析，这与显著的发病率和早期死亡率相关。这些患者的治疗结果的真实数据有限。目的/方法：我们评估了73例连续需要透析的NDMM患者的肾脏反应模式和结果决定因素（2010年至2023年）。结果：中位年龄69岁；52%有高危细胞遗传学。所有患者均接受以硼替佐米为基础的诱导治疗(19%双胎，71%三胞胎，10%四胞胎；12%抗cd38抗体)。中位随访时间为37.2个月。31名患者（42.5%）在中位52天（范围3-247）后实现了独立透析。透析独立性与改善的生存（中位36个月对13.3个月，P = 0.085）和较低的早期死亡率（3.2%对14.3%,P = 0.15）相关。与独立透析相关的因素有：年龄较小（OR 0.92, P = 0.003）、高钙血症（OR 1.43, P = 0.013）和1个月时血液学反应（≥PR）（OR 3.7, P = 0.015）。在多因素分析中，年龄较小（P = 0.012, OR 0.93）和1个月时血液学反应（≥PR）（P = 0.014, OR 4.94）是透析独立性的独立预测因素。血液学反应深度（≥VGPR）显著影响肾脏恢复（OR 4.0, P = 0.020）。高危细胞遗传学独立预测不良预后（HR 3.67, P = 0.003）。结论：在以硼替佐米为基础的方案时代，42.5%的NDMM患者在没有特殊过滤器的情况下实现了透析独立，对预后有显著影响。对于诊断时依赖透析的患者，总体结果仍然很差，需要进一步评估抗cd38抗体的四联体方案。

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Outcomes of Newly Diagnosed Multiple Myeloma Patients Requiring Dialysis

Introduction

Renal impairment (RI) is a common complication in newly diagnosed multiple myeloma (NDMM), with 1-5% of patients presenting with severe RI requiring dialysis, which is associated with significant morbidity and early mortality. Limited real-world data exist on outcomes for these patients.

Aim/Methods

We assessed renal response patterns and outcome determinants in 73 consecutive NDMM patients requiring dialysis, treated in a single centre (2010 to 2023).

Results

Median age was 69 years; 52% had high-risk cytogenetics. All patients received bortezomib-based induction therapy (19% doublets, 71% triplets, 10% quadruplets; 12% anti-CD38 antibodies). Median follow-up was 37.2 months. Dialysis independence was achieved by 31 patients (42.5%) after a median of 52 days (range 3-247). Dialysis independence was associated with improved survival (median 36 vs. 13.3 months, P = .085) and lower early mortality (3.2% vs. 14.3%, P = .15). Factors associated with independence from dialysis were younger age) OR 0.92, P = .003), hypercalcemia (OR 1.43, P = .013) and hematologic response (≥ PR) at 1 month (OR 3.7, P = .015). In multivariate analysis, younger age (P = .012, OR 0.93) and hematologic response (≥ PR) at 1 month (P = .014, OR 4.94) were independent predictors of dialysis independence. Depth of hematologic response (≥ VGPR) significantly impacted renal recovery (OR 4.0, P = .020). High-risk cytogenetics independently predicted poor outcomes (HR 3.67, P = .003).

Conclusion

Dialysis independence is achievable in 42.5% of NDMM patients without special filters in the era of bortezomib-based regimens, with significant impact on outcome. Outcomes remain poor overall for patients who are dialysis-dependent at diagnosis and further evaluation of quadruplet regimens with anti-CD38 antibodies is needed.

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来源期刊

Clinical Lymphoma, Myeloma & Leukemia ONCOLOGY-HEMATOLOGY

CiteScore

2.70

自引率

3.70%

发文量

1606

审稿时长

26 days

期刊介绍： Clinical Lymphoma, Myeloma & Leukemia is a peer-reviewed monthly journal that publishes original articles describing various aspects of clinical and translational research of lymphoma, myeloma and leukemia. Clinical Lymphoma, Myeloma & Leukemia is devoted to articles on detection, diagnosis, prevention, and treatment of lymphoma, myeloma, leukemia and related disorders including macroglobulinemia, amyloidosis, and plasma-cell dyscrasias. The main emphasis is on recent scientific developments in all areas related to lymphoma, myeloma and leukemia. Specific areas of interest include clinical research and mechanistic approaches; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; and integration of various approaches.