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.
目的： 探究初诊伴肾损害的多发性骨髓瘤（MM）患者肾功能疗效的影响因素。 方法： 纳入2007年8月至2021年10月北京协和医院伴肾损害的MM患者181例，其基线慢性肾脏病（CKD）分期为3~5期。对不同肾功能疗效组患者的实验室检查、治疗方案、血液学反应深度、生存情况等进行分析。多因素分析采用Logistic回归模型。 结果： 纳入181例初诊时即有肾功能损害患者，以277例肾功能正常（CKD分期1~2期）患者作为对照组。大多数患者应用BCD和VRD方案。与无肾损害患者相比，肾损害患者的无进展生存（PFS）时间（14.0个月对24.8个月，P<0.001）和总生存（OS）时间（49.2个月对79.7个月，P<0.001）均显著缩短。肾功能疗效有效组和无效组高钙血症（P=0.013，OR=5.654）、1q21+（P=0.018，OR=2.876）和血液学反应达部分缓解及以上（P=0.001，OR=4.999）的差异有统计学意义，且均为肾功能疗效的独立预后因素。治疗后肾功能有效者的PFS时间和OS时间均较治疗后肾功能无效者延长（PFS：15.6个月对10.2个月，P=0.074；OS：56.5个月对47.3个月，P=0.665），差异无统计学意义。 结论： 高钙血症、1q21+和血液学反应深度是MM患者肾功能改善的独立预后因素。基线CKD分期3~5期的MM患者生存更差，治疗后肾功能疗效有效有助于改善PFS。.
Keywords: 1q21 amplification; Hematological response; Hypercalcemia; Multiple myeloma; Renal function.