ISSN 1006-298X      CN 32-1425/R

导航

肾脏病与透析肾移植杂志 ›› 2021, Vol. 30 ›› Issue (6): 501-506.DOI: 10.3969/j.issn.1006-298X.2021.06.001

• •    下一篇

伊沙佐米联合地塞米松治疗难治复发轻链型淀粉样变性的临床观察

  

  • 出版日期:2021-12-28 发布日期:2021-12-27

A retrospective study of ixazomib and dexamethasone in patients with relapsed and refractory light chain amyloidosis

  • Online:2021-12-28 Published:2021-12-27

摘要: 目的:观察伊沙佐米联合地塞米松(ID)方案治疗系统性轻链(AL)型淀粉样变性的疗效及安全性。
方法:回顾性分析2018年7月至2020年9月间采用ID方案的难治复发的AL型淀粉样变性患者的临床资料,观察其血液学、器官反应及不良反应。
结果:18例难治复发的AL型淀粉样变性患者中,15例纳入疗效分析。12例可评估血液学疗效的患者中,1667%取得血液学缓解,833%血液学进展,75%维持稳定。10例心脏受累患者中20%缓解,60%进展,20%维持稳定。11例可评估的肾脏受累患者中1818%缓解,5455%维持稳定,2727%进展。其中,前期治疗中未使用硼替佐米的患者在接受ID治疗后反应率达50%(1/2),而使用过硼替佐米的患者治疗反应率仅1111%(1/9)。1年总体生存率及无进展生存率分别为714%和 718%。主要不良反应为消化道反应及贫血,3/4级不良反应发生率1667%,为腹泻、呕吐以及疱疹病毒感染。
结论:ID方案可作为复发难治性AL型淀粉样变性的候选治疗方案,在前期未接受蛋白酶体抑制剂的患者中更可能获得治疗反应,在难治复发性AL型淀粉样变性患者中有一定疗效。且ID方案的安全性较好,不良反应可控。

Abstract: Objective:This study aimed to assess the safety and efficacy of ixazomib and dexamethasone (ID) in patients with relapsed or refractory light chain amyloidosis(AL).
Methodology:ID were administered to patients with relapsed or refractory AL amyloidosis. The hematology and organ responses and adverse events (AEs) were observed.
Results:18 patients with relapsed or refractory AL amyloidosis were treated with ID. Overall, 15 patients treated for more than 1 cycle were recruited to assess the efficacy. The hematology response rate was 1667% in 12 patients. The progression rate was 833% and 75% patients kept disease stable. Cardiac responses were seen in 20% of 10 patients, 60% patients had cardiac progression and 20% patients kept cardiac stable. Renal responses were seen in 1818% of 11 patients, 2727% patients had renal progression and 5455% patients kept renal function stable. Among the hematology response assessable patients, the hematology response ratio was 50%(1/2) in patients without bortezomib treatment previously, while 1111%(1/9) in patients with bortezomib treatment. Oneyear progressionfree and overall survival rates were 718% and 714% respectively. Most common AEs were gastrointestinal reactions and anemia. 1667% patients experienced grade 3/4 AEs,such as diarrhea and vomit and herpesvirus infection.
Conclusion:ID is an effective treatment in patients with relapsed and refractory AL amyloidosis with manageable toxicity. Better effects could be achieved in patients without proteasome inhibitor treatment previously.