Daratumumab in dialysis-dependent multiple myeloma patients with acute renal failure: 2 cases report and literature review
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摘要: 目的 探讨Daratumumab治疗多发性骨髓瘤并发急性肾衰竭需要血液透析患者的疗效与安全性。方法 报道2例应用Daratumumab治疗新诊断多发性骨髓瘤依赖血液透析的急性肾衰竭患者，并结合现有文献探讨其疗效及临床特点。结果 2例患者应用Daratumumab后均迅速达到深度缓解并成功脱离血液透析。第1例患者在第4剂Daratumumab治疗后脱离透析。不幸的是，此患者在第1剂Daratumumab输注后出现巨细胞病毒再激活，于是暂停Daratumumab，并给予更昔洛韦抗病毒联合丙种免疫球蛋白治疗，直至病毒载量降至0拷贝/mL后继续输注Daratumumab。另外1例患者首先接受了4个疗程的硼替佐米-环磷酰胺-地塞米松方案，由于疗效评估仅达部分缓解因此加入Daratumumab，第3剂后患者脱离透析。后续该患者接受了普乐沙福联合粒细胞集落刺激因子进行造血干细胞动员，并顺利完成自体干细胞移植。结论 基于硼替佐米的诱导治疗联合Daratumumab可以使合并急性肾功能衰竭需要透析的新诊断多发性骨髓瘤患者达到快速的深度缓解，并有望使患者脱离血液透析。Abstract: Objective To investigate the efficacy and safety of Daratumumab in the treatment of multiple myeloma complicated with acute renal failure need for hemodialysis.Methods Two dialysis-dependent newly diagnosed multiple myeloma patients were treated with Daratumumab, and the efficacy and clinical features were discussed in combination with the existing literature.Results After treatment with Daratumumab, both of the two patients achieved rapid and deep remission and remain dialysis-independent. The first patient was dialysis-independent after the fourth Daratumumab dose. Unfortunately, he had cytomegalovirus reactivation after the first dose of Daratumumab. Daratumumab was discontinued until cytomegalovirus viral load level dropped to 0 copies/mL after treatment with antiviral ganciclovir plus immune globulin. The other patient received Bortezomib-Cyclophosphamide-Dexamethasone regimen at first. However, only partial remission of the disease was reached after 4 cycles. Then, Daratumumab was added into the regimen and dialysis-independent after 3 doses. Hematopoietic stem cell mobilization was then performed with plerixafor and granulocyte colony-stimulating factor and autologous stem cell transplantation was also completed successfully.Conclusion Induction therapy based on Bortezomib plus Daratumumab can achieve rapid and deep remission in patients with newly diagnosed multiple myeloma complicated with acute renal failure requiring dialysis, and is expected to remain a long-lasting complete response with dialysis-independence.
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Key words:
- multiple myeloma /
- monoclonal antibodies /
- acute renal failure /
- dialysis
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