| Objective: To investigate the effect of bortezomib chemotherapy and the improvement of renal function in patients with multiple myeloma with renal impairment.Methods: Retrospective analysis was performed on 62 MM patients with renal impairment admitted to the department of hematology,XXX general hospital from February2009 to February 2019.According to the treatment plan,62 patients were divided into bortezomib group and non-bortezomib group.The median treatment time of bortezomib group was 8 months and the median treatment course was 4 cycles.The median treatment time of non-bortezomib was 4 months and the median treatment course was 2 cycles.The therapeutic effect of primary disease and the improvement of renal function in the two groups were compared.Results:(1)The total response rate(including CR,VGPR and PR)of bortezomib group was 82.35%,reaching 4 CR(11.42%),10 VGPR(28.58%)and 15 PR(42.85%).The total response rate of non-bortezomib was 66.67%,reaching CR 2(7.4%),VGPR 5(18.51%)and PR 11(40.47%).There was no significant difference in the total effective rate between the two groups(P=0.745).(2)The total renal function response rate of bortezomib was 82.84%,12patients(34.28%)had complete renal response(CR),8 patients(22.85%)had partial renalresponse(PR),9 patients(25.71%)had minimal renal response(MR),and 6 out of the 10 patients were on dialysis.The total renal response rate of non-bortezomib was 55.54%,including 9 patients(33.33%)who achieved complete renal response(CR),1 patient(3.7%)who achieved partial renal response(PR),5 patients(18.51%)who achieved minimal renal response(MR),and 1 patient who got out of dialysis.The difference in total response rate between the two groups was statistically significant(P=0.044).(3)After treatment,47 patients in the two groups were relieved of the primary disease,39 of whom had improved renal function,with an improvement rate of 83%.The primary disease was not alleviated in 15 patients,and renal function was modified in 5 patients,with the improvement rate of 33.3%.The difference of the improvement rate between the two groups was statistically significant(P=0.001).(4)the median total survival(0S)and progression-free survival(PFS)of all patients were 21 months and 12 months,respectively.Bortezomib had an OS of 25 months and a PFS of 12 months,while non-bortezomib had an OS of 11.5 months and a PFS of 9.5months.Compared with the two groups,the median OS stage of the bortezomib group was longer than that of the non-bortezomib group,with a statistically significant difference(P=0.044),while the PFS stage had no significant difference(P=0.75).(5)The main adverse reactions in bortezomib group were peripheral nerve damage,with 11 cases(31.4%)having peripheral nerve damage,among which 2 cases were discontinued due to severe peripheral nerve damage,and 5 cases(31.2%)having non-bortezomib group.The difference between the two groups was not statistically significant(P=0.249).The main adverse reactions of non-bortezomib were bone marrow suppression and infection,among which 12(44.4%)hadbone marrow suppression after chemotherapy,and 4(11.4%)had bone marrow suppression in bortezomib.The difference between the two groups was statistically significant(P=0.003).Conclusion: compared with non-bortezomib chemotherapy,the application of bortezomib based chemotherapy in multiple myeloma patients with renal damage can improve the total response rate,significantly improve renal function,and prolong OS period,but the side effects of drugs for peripheral nerve damage should be paid attention to. |
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