The Study On Clinical Features Of Multiple Myeloma With Renal Insufficiency

General Background Information and Objective:To analyses the clinical features, type of immunoglobulin and prognosis of patients with renal insufficiency of multiple myeloma.Methods:Retrospective analysis of hospital treatment in our hospital was used since August 2002 to August 2008,204 cases of MM patients were included with a median follow-up time of 22.5 months (1—84). The clinical data of renal insufficiency caused by the other diseased are exclude. All the cases of renal insufficiency are divided into three group, Group A are patients with renal insufficiency when MM are diagnosed or before MM are diagnosed (n=68). Group B are patients with renal insufficiency during the disease process (n=24). Group C are patients without renal in sufficiency during the disease process (n=112).These clinical data are compared between each group. Comparisons of measurement data of the groups were performed by one-way ANOVA; Comparisons of enumeration data of the groups were performed byχ2 test. Multiple factors analysis is performed by Cox proportional hazard model. Survival analysis is performed by Kaplan-Meier method and the comparison between the groups is performed by Log-rank test.Results:Patients with initial renal insufficiency showed significantly higherβ2-microglobulin and plasma cell levels than patients with renal insufficiency during the disease process, suggesting that the former group suffered a higher tumor burden. Meanwhile, there was no significantly different in median survival (38 months vs 40 months) between two groups, but not in patients without renal insufficiency group (51 months) (p=0.012). Surprisingly, the overall survival showed no significant difference between patients with reversal of renal function and patients with normal renal function (46 months), but better than patients without recovery of renal function (25 months), (P= 0.001). Multivariate analysis indicated that whether renal function can be reversed or not is an independent prognostic factor (P=0.000, RR=3.645). The ratio of renal insufficiency happen in the X type is higher than theκtype in the free light chain type (89.5%,p=0.01),.But the ratio of renal insufficiency happen in theκtype and theλ type are nearly the same in the IgG and IgA type of multiple myeloma (P=0.21 and 0.18)。Referred to patients with renal insufficiency,there are moreλtype involved thanκtype in the IgA type (70% vs 30%),no significant difference is found compared with the IgG type and free light chain type. Survival time of patients requiring dialysis is 5.5months,survival time of patients who are dialysis-independence is 21 months.(p=0.026)Conclusions:the median survival of patients with initial renal insufficiency and patients with renal insufficiency during the disease process are shorter than patients with normal renal function, but there are no difference between them. We demonstrated that patients without renal function recovery after removing etiologies suffered poor prognosis. The probability of theκtype and theλtype involve in the renal insufficiency are different, referred to patients with renal insufficiency, there are moreκtype involved thanλtype in the IgA type. The use of hemodialysis for patients with renal insufficiency had no effect on the prognosis, but patients achieve dialysis independence show excellent survival compared to those who remained dialysis-independent...