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目的:探讨硼替佐米治疗肾功能不全多发性骨髓瘤(MM)患者的疗效及安全性。方法:肾功能正常的MM患者11例,为对照组;肾功能不全的MM患者8例,为观察组。均接受硼替佐米为主的方案化疗。观察、记录化疗前后肾功能的变化、化疗效果、不良反应。结果:①8例观察组患者7例呈现疗效反应,有效率87.50%;11例对照组患者9例呈现疗效反应,有效率81.82%,两组比较差异无统计学意义(P>0.05);两组患者治疗后β2-微球蛋白均明显下降(P<0.05);②肾功能不全患者化疗前血清肌酐为(316.75±162.09)μmol/L,化疗后为(179.25±112.59)μmol/L,较化疗前显著下降(P<0.01);8例肾功能不全患者硼替佐米化疗后,有5例获得肾功能逆转,1例肾功能好转,无1例患者出现肾功能恶化情况,肾功能改善率达75%;③不良反应:以消化道反应、1～2级血液学毒性为主,少数患者有较轻的神经损害症状,这些不良反应两组无显著差异。结论:对肾功能不全MM患者,硼替佐米为主的治疗方案兼顾疗效和安全性,并多能实现肾功能逆转,可作为一线治疗方案选择。
Objective: To investigate the efficacy and safety of bortezomib in the treatment of patients with multiple myeloma (MM) with renal insufficiency. Methods: Eleven patients with normal renal function were selected as control group. Eight patients with renal dysfunction were selected as observation group. All received bortezomib-based regimen chemotherapy. Observation, record changes in renal function before and after chemotherapy, chemotherapy, adverse reactions. Results: ① The response rate was 87.50% in 7 cases in 8 cases and 9 cases in 11 cases. The effective rate was 81.82%. There was no significant difference between the two groups (P> 0.05) Β2-microglobulin decreased significantly after treatment (P <0.05); ② The serum creatinine in patients with renal insufficiency before chemotherapy was (316.75 ± 162.09) μmol / L and (179.25 ± 112.59) μmol / L after chemotherapy, (P <0.01). After 8 cases of renal insufficiency with bortezomib chemotherapy, 5 cases had renal function reversal, 1 case had renal function improvement, 1 case had no renal function deterioration and renal function improvement rate reached 75%; ③ adverse reactions: the digestive tract reactions, 1 to 2 hematological toxicity-based, a small number of patients with mild nerve damage symptoms, these adverse reactions no significant difference between the two groups. CONCLUSIONS: Bortezomib-based treatment regimens for both patients with MM and renal failure can be used as a first-line treatment option with both efficacy and safety.