| Objective:Clinical data and laboratory indicators of multiple myeloma（MM）accompanied by renal impairment（RI）patients were collected.To analyze the clinical characteristics,renal response after treatment and the impact of different degrees of RI on the survival of MM patients,and to explore whether renal function reversal can improve the prognosis of newly diagnosed MM patients with RI.Methods:The clinical data of 112 newly diagnosed MM patients with RI in the Second Hospital of Jilin University from June 2015 to June 2021 were retrospectively analyzed.Patients were divided into three groups based on estimated glomerular filtration rate（e GFR）,defined as mild RI group（30 m L/min ≤ e GFR < 60 m L/min）,moderate RI group（15 m L/min ≤ e GFR < 30 m L/min）,and severe RI group（e GFR <15m L/min）.The clinical data,laboratory indicators and renal function recovery of patients in the three groups were analyzed,and follow-up investigation was conducted to analyze the survival and prognosis of patients.SPSS 26.0（IBM）software was used for data processing,and P < 0.05 was considered as statistically significant difference.Results:1.There were no significant differences among the three groups in age,sex,immunoglobulin type,platelet,lactate dehydrogenase,serum calcium,albumin,bone lesion and proportion of clonal marrow plasma cells（P > 0.05）.There were significant differences in ISS stage,hemoglobin,β 2-Mg and urea nitrogen among the three groups（P < 0.05）.2.There was no significant correlation between cytogenetic abnormality and renal function damage.3.There were 77 patients（68.8%）with renal response（RR）,including 52patients（46.2%）with complete renal response（CR）,13 patients（11.6%）with partial renal response（PR）,12 patients（10.7%）with mild renal response（MR）,and 35patients（31.3%）with no response to treatment.There were 5 cases（17.2%）of renal CR in the severe RI group,9 cases（39.1%）in the moderate RI group,and 38 cases（63.3%）in the mild RI group,with statistically significant differences（P < 0.001）.There were 8 cases（27.6%）of renal PR in the severe RI group,4 cases（17.4%）in the moderate RI group,and 1 case（1.7%）in the mild RI group,with statistically significant differences（P = 0.001）.There were 7 cases（24.1%）of renal MR in severe RI group,5 cases（21.7%）in moderate RI group,and 0 cases（0.0%）in mild RI group,with statistically significant differences（P < 0.001）.There were 9 cases（31.0%）of renal NR in the severe RI group,5 cases（21.7%）in the moderate RI group,and 21cases（35.0%）in the mild RI group,with no statistically significant difference（P =0.506）.4.The total renal response rate（CR + PR + MR）of patients receiving combination drugs was higher than that of patients receiving single drug（78.6% vs65.5%,P = 0.195）.The renal CR of patients receiving combination drugs was higher than that of patients receiving single drug,the difference was statistically significant（64.3% vs 40.5%,P = 0.029）.5.The median OS of the severe RI group was 21 months,the median OS of the moderate RI group was 42 months,and the median OS of the mild RI group was 55 months,with statistically significant differences（P < 0.001）.The median OS of the group with RR and without RR was 46 months and 30 months,respectively,and the difference was statistically significant（P = 0.023）.In the severe RI group,there was no significant difference in OS with or without RR（P = 0.608）.In the moderate RI group,there was also no statistical significance in OS with or without RR（P = 0.130）.In the mild RI group,the median OS without RR was 39 months,and the median OS with RR was not reached,the difference was statistically significant（P = 0.031）.6.Univariate analysis showed that age > 65 years,e GFR < 30ml/min,renal reaction,hemoglobin < 100g/L,lactate dehydrogenase > 250U/L,β 2-MG > 5.5 mg/L were significantly correlated with OS.Further multivariate analysis showed that age >65 years and e GFR < 30ml/min were independent risk factors for OS.7.The median survival time of the 16 patients requiring dialysis was 27 months.A total of 7 patients（43.8%）obtained RR and 9 patients（56.3%）were treated without dialysis dependence.Conclusions:1.ISS stage III,decreased hemoglobin,increased β 2-MG,and increased urea nitrogen were positively correlated with the degree of renal impairment.2.Patients with mild RI were more likely to experience deep renal response,and the severity of RI was negatively correlated with the depth of renal response.3.The total renal response rates and complete renal response rates of patients receiving combination therapy were higher than those receiving monotherapy.4.Obtaining a renal response can improve patient survival,mainly in patients with mild RI.5.Age > 65 years,e GFR < 30 m L/min is an independent risk factor for OS. |
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