伴肾损害的初诊多发性骨髓瘤患者肾功能疗效影响因素

OBJECTIVE: To investigate the causative factors of renal function in newly diagnosed multiple myeloma（MM）patients with renal inadequacy. METHODS: 181 MM patients with renal impairment from August 2007 to October 2021 at Peking Union Medical College Hospital were recruited, whose baseline chronic kidney disease（CKD）stage was 3–5. Statistical analysis was performed based on laboratory tests, treatment regimens, hematological responses, and survival among various renal function efficacy groups. A logistic regression model was employed in multivariate analysis. RESULTS: A total of 181 patients were recruited, and 277 patients with CKD stages 1–2 were chosen as controls. The majority choose the BCD and VRD regimens. The progression-free survival（PFS）（14.0 months vs 24.8 months, P<0.001）and overall survival（OS）（49.2 months vs 79.7 months, P<0.001）of patients with renal impairment was considerably shorter. Hypercalcemia（P＝0.013, OR＝5.654）, 1q21 amplification（P＝0.018, OR＝2.876）, and hematological response over a partial response（P＝0.001, OR＝4.999）were independent predictive factors for renal function response. After treatment, those with improvement in renal function had a longer PFS than those without（15.6 months vs 10.2 months, P＝0.074）, but there was no disparity in OS（56.5 months vs 47.3 months, P＝0.665）. CONCLUSION: Hypercalcemia, 1q21 amplification, and hematologic response were independent predictors of the response of renal function in NDMM patients with renal impairment. MM patients with CKD 3–5 at baseline still have worse survival. Improvement in renal function after treatment is attributed to the improvement in PFS.