血浆置换联合经典化学治疗对多发性骨髓瘤患者肾功能的影响

doi:10.3969/j.issn.1674-8115.2025.07.003

摘要/Abstract

摘要：

目的·探讨血浆置换联合经典化学治疗（化疗）对多发性骨髓瘤（multiple myeloma，MM）患者肾功能的影响。方法·回顾性分析上海交通大学医学院附属瑞金医院血液科2021年10月—2023年9月收治的首次确诊为MM的患者的资料。以2021年10月—2022年9月收治的68例MM患者为对照组，2022年10月—2023年9月收治的41例为试验组。对照组采用MM经典化疗［PAD方案（硼替佐米＋阿霉素＋地塞米松）、PCD方案（硼替佐米＋环磷酰胺＋地塞米松）］，试验组在经典化疗前进行血浆置换。血浆置换频率根据患者M蛋白清除率决定，标准为置换后血浆M蛋白水平下降超过40%，共置换1~3次。2个化疗疗程后，比较2组患者的游离轻链差值（free light chain difference，dFLC）、血清肌酐（serum creatinine，Scr）等肾功能指标。结果·与对照组相比，治疗后试验组患者dFLC水平变化无统计学意义，Scr水平降低［67.00（54.00，75.00）μmol/L vs 77.50（63.00，94.00）μmol/L，P=0.011］，估算的肾小球滤过率（estimated glomerular filtration rate，eGFR）升高［97.80（92.80，101.30）mL/（min·1.73 m²）vs 85.80（61.35，95.35）mL/（min·1.73 m²），P<0.001］。治疗前，对照组与试验组患者MM相关重度肾损伤［eGFR<50 mL/（min·1.73 m²）］的例数分别为41例和28例；治疗后对照组肾脏反应达完全缓解［eGFR≥60 mL/（min·1.73 m²）］为8例（19.51%），试验组12例（42.86%），肾脏反应差异有统计学意义（P=0.036）。对照组和试验组2个疗程后临床总有效率（overall response rate，ORR）分别为76.47%和92.68%，总疗效差异有统计学意义（P=0.031）。结论·血浆置换联合经典化疗可在短时期内显著降低MM患者血清Scr水平，提高其eGFR，一定程度上改善MM相关的肾功能损伤，提高临床治疗效果。

关键词: 多发性骨髓瘤, 血浆置换, 肌酐, 肾小球滤过率, 治疗效果

Abstract:

Objective ·To investigate the effect of plasma exchange combined with classical chemotherapy on renal function in patients with multiple myeloma (MM). Methods ·A retrospective analysis was conducted on data from patients newly diagnosed with MM in the Department of Hematology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, between October 2021 and September 2023. Sixty-eight MM patients admitted from October 2021 to September 2022 served as the control group, and 41 patients admitted from October 2022 to September 2023 comprised the experimental group. The control group received classical chemotherapy for MM [PAD (bortezomib+adriamycin+dexamethasone) or PCD (bortezomib+cyclophosphamide+dexamethasone)], and the experimental group underwent plasma exchange before classic chemotherapy. The frequency of plasma exchange was determined according to the clearance rate of M-protein in patients, with the criterion being a reduction of more than 40% in plasma M-protein levels after exchange, and the total number of exchanges ranged from 1 to 3 sessions. After 2 chemotherapy courses, the free light chain difference (dFLC), serum creatinine (Scr), and other renal function indexes were compared between the two groups. Results ·Compared with the control group, the experimental group showed no statistically significant difference in dFLC levels. The Scr level decreased [67.00 (54.00, 75.00) μmol/L vs 77.50 (63.00, 94.00) μmol/L, P=0.011], and the estimated glomerular filtration rate (eGFR) increased [97.80 (92.80, 101.30) mL/(min·1.73 m²) vs 85.80 (61.35, 95.35) mL/(min·1.73 m²), P<0.001] after treatment. Before treatment, the numbers of patients with MM-related severe renal injury [eGFR<50 mL/(min·1.73 m²)] were 41 in the control group and 28 in the experimental group. After treatment, 8 patients (19.51%) in the control group achieved complete renal response [eGFR≥60 mL/(min·1.73 m²)], while 12 patients (42.86%) in the experimental group achieved the same, with the difference being statistically significant (P=0.036). After two courses of treatment, the overall response rates (ORR) of the control group and the experimental group were 76.47% and 92.68%, respectively, and the difference in overall therapeutic efficacy was statistically significant (P=0.031). Conclusion ·Plasma exchange combined with classical chemotherapy can significantly reduce the Scr levels and increase eGFR in MM patients within a short period, ameliorating the MM-related renal impairment to some extent and improving clinical treatment outcomes.

Key words: multiple myeloma (MM), plasma exchange, creatinine, glomerular filtration rate (GFR), therapeutic effect

中图分类号:

R551.2

林桐, 陶怡, 金诗炜, 孙淼, 糜坚青. 血浆置换联合经典化学治疗对多发性骨髓瘤患者肾功能的影响[J]. 上海交通大学学报（医学版）, 2025, 45(7): 823-828.

LIN Tong, TAO Yi, JIN Shiwei, SUN Miao, MI Jianqing. Effect of plasma exchange combined with classical chemotherapy on renal function in patients with multiple myeloma[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2025, 45(7): 823-828.

图/表 2

参考文献 24

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Item	Control group (n=68)	Experimental group (n=41)	χ²/Z value	P value
Gender/n(%)			0.850	0.357
Female	31 (45.59)	15 (36.59)
Male	37 (54.41)	26 (63.41)
Age/n(%)			2.114	0.146
<65 years	19 (27.94)	17 (41.46)
≥65 years	49 (72.06)	24 (58.54)
ISS/n(%)			1.657	0.198
Ⅰ+Ⅱ	48 (70.59)	24 (58.54)
Ⅲ	20 (29.41)	17 (41.46)
M-protein/n(%)			3.111	0.078
Non-IgG type	26 (38.24)	9 (21.95)
IgG type	42 (61.76)	32 (78.05)
ALB/n(%)			1.655	0.198
<30 g·L^-1	51 (75.00)	26 (63.41)
≥30 g·L^-1	17 (25.00)	15 (36.59)
β2-MG/n(%)			2.755	0.097
<3 000 ng·L^-1	29 (42.65)	11 (26.83)
≥3 000 ng·L^-1	39 (57.35)	30 (73.17)
ECOG score/n(%)			3.693	0.055
0‒1	49 (72.06)	36 (87.80)
≥2	19 (27.94)	5 (12.20)
Cytogenetic risk/n(%)
Standard-risk	22 (32.35)	14 (34.15)	0.037	0.847
High-risk	46 (67.65)	27 (65.85)
M-protein (IgG type)/(g·L^-1)	46.24 (24.97, 63.03)	49.38 (25.61, 69.81)	-0.581	0.561
Serum free κ chain/(mg·L^-1)	29.30 (10.55, 309.00)	38.20 (10.50, 164.00)	-0.015	0.988
Serum free λ chain/(mg·L^-1)	18.50 (9.43, 150.50)	18.00 (9.51, 388.00)	-0.456	0.649
dFLC/(mg·L^-1)	249.00 (87.19, 734.24)	380.99 (97.30, 03.70)	-0.063	0.950
Scr/(μmol·L^-1)	80.50 (66.75, 121.25)	85.00 (69.00, 113.00)	-0.388	0.698
eGFR/[mL·(min·1.73 m²)^-1]	80.50 (42.83, 95.05)	83.00 (51.90, 93.90)	-0.103	0.918

Item	Control group (n=68)	Experimental group (n=41)	χ²/Z value	P value
Gender/n(%)			0.850	0.357
Female	31 (45.59)	15 (36.59)
Male	37 (54.41)	26 (63.41)
Age/n(%)			2.114	0.146
<65 years	19 (27.94)	17 (41.46)
≥65 years	49 (72.06)	24 (58.54)
ISS/n(%)			1.657	0.198
Ⅰ+Ⅱ	48 (70.59)	24 (58.54)
Ⅲ	20 (29.41)	17 (41.46)
M-protein/n(%)			3.111	0.078
Non-IgG type	26 (38.24)	9 (21.95)
IgG type	42 (61.76)	32 (78.05)
ALB/n(%)			1.655	0.198
<30 g·L^-1	51 (75.00)	26 (63.41)
≥30 g·L^-1	17 (25.00)	15 (36.59)
β2-MG/n(%)			2.755	0.097
<3 000 ng·L^-1	29 (42.65)	11 (26.83)
≥3 000 ng·L^-1	39 (57.35)	30 (73.17)
ECOG score/n(%)			3.693	0.055
0‒1	49 (72.06)	36 (87.80)
≥2	19 (27.94)	5 (12.20)
Cytogenetic risk/n(%)
Standard-risk	22 (32.35)	14 (34.15)	0.037	0.847
High-risk	46 (67.65)	27 (65.85)
M-protein (IgG type)/(g·L^-1)	46.24 (24.97, 63.03)	49.38 (25.61, 69.81)	-0.581	0.561
Serum free κ chain/(mg·L^-1)	29.30 (10.55, 309.00)	38.20 (10.50, 164.00)	-0.015	0.988
Serum free λ chain/(mg·L^-1)	18.50 (9.43, 150.50)	18.00 (9.51, 388.00)	-0.456	0.649
dFLC/(mg·L^-1)	249.00 (87.19, 734.24)	380.99 (97.30, 03.70)	-0.063	0.950
Scr/(μmol·L^-1)	80.50 (66.75, 121.25)	85.00 (69.00, 113.00)	-0.388	0.698
eGFR/[mL·(min·1.73 m²)^-1]	80.50 (42.83, 95.05)	83.00 (51.90, 93.90)	-0.103	0.918

Item	Control group (n=68)	Experimental group (n=41)	χ²/Z value	P value
Renal function index
dFLC	22.48 (5.43, 298.98)	18.47 (8.10, 70.80)	-0.522	0.601
Scr	77.50 (63.00, 94.00)	67.00 (54.00, 75.00)	-2.531	0.011
eGFR	85.80 (61.35, 95.35)	97.80 (92.80, 101.30)	-3.750	<0.001
Renal response^①			4.405	0.036
Non-complete response	33 (80.49)	16 (57.14)
Complete response	8 (19.51)	12 (42.86)
Overall response			4.671	0.031
<PR	16 (23.53)	3 (7.32)
ORR	52 (76.47)	38 (92.68)

Item	Control group (n=68)	Experimental group (n=41)	χ²/Z value	P value
Renal function index
dFLC	22.48 (5.43, 298.98)	18.47 (8.10, 70.80)	-0.522	0.601
Scr	77.50 (63.00, 94.00)	67.00 (54.00, 75.00)	-2.531	0.011
eGFR	85.80 (61.35, 95.35)	97.80 (92.80, 101.30)	-3.750	<0.001
Renal response^①			4.405	0.036
Non-complete response	33 (80.49)	16 (57.14)
Complete response	8 (19.51)	12 (42.86)
Overall response			4.671	0.031
<PR	16 (23.53)	3 (7.32)
ORR	52 (76.47)	38 (92.68)