多发性骨髓瘤肾损伤治疗策略：新药和新疗法

doi:10.16138/j.1673-6087.2025.03.01

摘要/Abstract

摘要：

多发性骨髓瘤（multiple myeloma，MM）肾损伤发生率高，肾损伤与MM患者总生存期降低和早期死亡风险增加相关。近年来，MM治疗取得重大进展，新药和新疗法改善了患者预后，但与肾功能正常者相比，合并肾损伤患者的预后仍较差。本文对MM伴肾损伤患者的治疗进展及相关策略进行述评，当前研究支持在这些患者中联用单克隆抗体与蛋白酶体抑制剂或免疫调节药物，嵌合抗原受体T细胞疗法、双特异性抗体、抗体偶联药物等新型疗法仅在小规模回顾性研究中评估可用于肾损伤患者。体外清除游离轻链的疗法如血浆置换、高截留量透析等获益虽尚未得到验证，但配合化疗等可能为肾脏功能的恢复提供机会。在未来治疗MM的随机对照研究中，应积极对肾损伤患者的疗效及安全性进行前瞻性评估。

关键词: 多发性骨髓瘤, 肾损伤, 抗骨髓瘤治疗, 游离轻链体外清除

Abstract:

Multiple myeloma (MM) is associated with a high incidence of renal impairment, which correlates with decreased overall survival and increased risk of early mortality in these patients. In recent years, there has been great progress in the treatment of MM, and new drugs and therapies have improved prognosis of the patients. However, the prognosis of MM patients with concurrent renal impairment remains poorer compared with those with normal renal function. This article reviews the advancements in treatment and relevant strategies for MM patients with renal impairment. Current research supports the regime of combining monoclonal antibodies with proteasome inhibitors or immunomodulatory drugs in MM treatment. Chimeric antigen receptor T cells therapy, T-cell directing bispecific antibodies and antibody-drug conjugates have only been evaluated in small-scale retrospective studies for patients with renal impairment. Although the benefits of mechanical approaches aiming at rapid clearance of free light chains, such as plasmapheresis and high-cutoff hemodialysis, have not been confirmed, they may provide opportunities for renal recovery as combing with chemotherapy. The efficacy and safety of treatment in MM patients with renal impairment should be proactively assessed in prospective randomized controlled trials.

Key words: Multiple myeloma, Renal impairment, Anti-myeloma therapy, Extracorporeal free light chain removal

中图分类号:

R733.3
R692

史浩, 王朝晖. 多发性骨髓瘤肾损伤治疗策略：新药和新疗法[J]. 内科理论与实践, 2025, 20(03): 185-190.

SHI Hao, WANG Zhaohui. Treatment strategies for renal impairment in multiple myeloma: a review of new drugs and novel therapies[J]. Journal of Internal Medicine Concepts & Practice, 2025, 20(03): 185-190.

图/表 1

参考文献 27

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药物	肌酐清除率（mL/min）				透析
药物	≥60	30~59	15~29	<15	透析
硼替佐米（iv或sc）	1.3 mg/m²	无需调整	无需调整	无需调整	透析后用，无需调整
伊沙佐米（口服）	4 mg	4 mg	3 mg	3 mg	3 mg
卡非佐米（初始/后续，iv）	20/27或20/56或20/70 mg·m²	无需调整	无需调整	无需调整	透析后用无需调整
沙利度胺（口服）	50~200 mg/d	无需调整	无需调整	无需调整	无需调整
来那度胺（口服）	25 mg/d	10 mg/d	15 mg隔日	5 mg/d	透析后5 mg
泊马度胺（口服）	4 mg/d	无需调整	无需调整	无需调整	无需调整
Dara	16 mg/kg iv或1 800 mg sc	无需调整	无需调整	无需调整	无需调整
艾莎妥昔单抗（iv）	10 mg/kg	无需调整	无需调整	无需调整	无需调整
依洛妥珠单抗（iv）	10 mg/kg	无需调整	无需调整	无需调整	无需调整
艾基维仑赛（iv）	2.6~5.0亿CAR-T细胞	尚不确定	尚不确定	尚不确定	尚不确定
特立妥单抗（sc）	1.5 mg/kg	CrCl>40 mL/min无需调整	尚不确定	尚不确定	尚不确定
玛贝妥单抗（iv）	2.5 mg/kg	无需调整	尚不确定	尚不确定	尚不确定