| [purpose]To investigate the efficacy and safety of bortezomib combined with thalidomide and dexamethasone triple chemotherapy(PTD)in multiple myeloma(MM)patients with severe renal insufficiency.[Method]A retrospective analysis of 38 MM patients with severe renal insufficiency who were treated with bortezomib plus thalidomide and dexamethasone triple chemotherapy regimen from May 2013 to February 2018 in The First Affiliated Hospital Of Soochow University.Bortezomib usage:38 patients were given subcutaneous injection of 1.3 mg/m2 on the 1st,4th,8th and 11th day of chemotherapy;the dosage of thalidomide:All 38 patients started at 50mg each day,and gradually increased to 100mg each day according to their tolerance;dexamethasone usage:38 patients all recived intravenous drip of 10mg twice a day on the 1st,2nd,4th,5th,8th,9th,11th,and 12th day of chemotherapy.Patients with estimated glomerular filtration rate(eGFR)lower than 15mL/min/1.73m2,meanwhile creatinine greater than 400 ?mol/L were supplemented with regular hemodialysis.[Result]1.The proportion of patients in Phase ? of the International Staging System(ISS)was 92.1%(35/38).The proportion of patients with Revised International Staging System(R-ISS)? was 61.3%(19/31),while seven patients with incomplete cytogenetics testing were excluded.A total of 45.2%(14/31)of patients had high-risk genetic abnormalities,including 17p-,t(4,14),t(14,16)and 1q gain.2.All patients received induction chemotherapy of PTD regimen,and the median course of treatment was 4(2-6)courses.After 4 courses of PTD induction chemotherapy in the 38 patients,the remission of myeloma was as follows(excluding 2 patients who refused to be assessed):the overall response rate(ORR):77.8%(28/36),in which complete remission(CR)accounted for 47.2%(17/36),very good partial remission(VGPR)accounted for 22.2%(8/36),and partial remission(PR)accounted for 8.3%(3/36).3.Patients with chronic renal insufficiency accounted for 21.1%(8/38),and patients with acute renal impairment accounted for 78.9%(30/38).94.7%(36/38)of the patients with eGFR<30mL/min/1.73m2,and 60.5%(23/3 8)of the patients with eGFR<15mL/min/1.73m2.After 4 courses of PTD induction chemotherapy,the overall remission rate of renal function(?MR)was 80%(28/35),with CR accounted for 31.4%(11/35),PR accounted for 11.4%(4/35)and MR accounted for 27.1%(13/35),excluding 3cases of death and loss of follow-up.52.6%(20/38)of patients with creatinine greater than 400 1 mol/L.Among them,95%(19/20)received hemodialysis.Until the end of follow-up,55%(11/20)of the patients became dialysis independent,and the median time to dialysis indpendent was:56(15-118)days of treatment.4.Follow-up to January 2019,the median follow-up time was 32(3-61)months.The 5 years progression free survival(PFS)rate was 37.4%and 5 years overall survival(OS)rate was 63.78%.The median PFS time was 24months.Abnormal karyotype,R-ISS stage ?,high-risk genetic abnormalities and induction therapy without PR or above are independent risk factors affecting OS.5.Safety analysis showed that the PTD triple chemotherapy regimen in MM patients complicated with severe renal insufficiency had a higher incidence of neurotoxicity and hematologic toxicity.Among them,10.5%(4/38)had grade 3 neurotoxicity,15.8%(6/38)had grade 3 thrombocytopenia,and 1 patient had grade 4 thrombocytopenia.Treatment-related death(TRM)occurred in 5.3%(2/38)of the patients.[Conclusion]Bortezomib combined with thalidomide and dexamethasone triple chemotherapy has a good effect in MM patients with severe renal insufficiency,and has a high safety.Abnormal karyotype,R-ISS stage ?,high-risk genetic abnormalities and induction therapy have not achieved partial remission or above are independent prognostic factors affecting overall survival. |
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