Introduction. Kidney damage at the onset of multiple myeloma (MM) is observed in 20–40 % of patients, which requires renal replacement therapy in 2–4 % of cases. Deterioration in kidney function is associated with frequent complications and a decline in the quality of life, as well as carries a high risk of early death.Aim. To analyze the treatment of patients first diagnosed with MM, complicated by severe and dialysis-dependent renal failure.Materials and methods. 62 MM patients with a glomerular filtration rate of <30 ml/min /1.73 m2 participated in a retrospective study (11.2014–11.2017) with the following inclusion criteria: the concentration of free light chains in blood serum being >500 mg/l and the selective nature of proteinuria. Diagnosed AL-amyloidosis served as the exclusion criterion. Depending on the need for haemodialysis, patients were divided into two groups: (I) those not requiring it (n = 16) and (II) dialysis-dependent patients (n = 46).Results. The induction therapy included the following bortezomib-containing regimens: VCD — 41 (66.1 %), PAD — 2 (3.2 %), VD — 12 (19.4 %) and VMP — 7 (11.3 %). High-dose consolidation along with autologous hematopoietic stem cell transplantation was performed in 10 patients (16.1 %). The overall rate of anti-myeloma response in the groups came to 64.3 % (I) and 85.3 % (II) (p = 0.047), including complete and strong complete remissions in 14.3 % (I) and 14.7 % (II) of cases. The renal response was achieved by 57.2 % and 23.5 % (p = 0.032) of patients from the first and second groups, respectively. With a median follow-up of 32.1 months, throughout the entire cohort the median of progression-free survival (PFS) amounted to 14.5 months, with a 3-year PFS of 27.4 ± 6.6 %; whereas the median of overall survival (OS) came to 33.6 months, with a 3-year OS of 41.5 ± 7.7 %. There are no differences between the compared groups in terms of the survival rates. In the examined patients (n = 48), the achievement of any renal response was associated with an improvement in the 3-year PFS — 61.1 ± 11.5 % versus 17.7 ± 7.7 % (p = 0.045) — and 3-year OS — 72,2 ± 10.6 % versus 38.1 ± 10.4 % (p= 0.069). The time elapsed between the first haemodialysis procedure and the onset of anti-myeloma chemotherapy served as the predictor value of the renal response. In the group of patients who achieved a renal response, the average time came to 8.6 (95 % confidence interval of 3.5–13.7) days, as compared to 42.5 (12.6–72.5) days for patients without a renal response (p = 0.045).Conclusion. The use of bortezomib-based regimens provides a high frequency of antitumour responses with a probability of stopping dialysis in 23.5 % of dialysis-dependent patients. Possible reasons for the low frequency of renal response include the late diagnosis of MM as a cause of kidney damage, as well as the lack of access to new anti-myeloma drugs if the induction therapy needs to be changed.
The effects of baricitinib, a selective reversible inhibitor of Janus kinase 1 and 2, in the treatment of COVID-19 are associated with different aspects of pathogenesis — inhibition of viral endocytosis, reduction of excessive inflammatory response, and mitigation of vascular and pulmonary damage, which is a strong rationale for using baricitinib to treat patients with COVID-19. In the period from April to May 2020, City Clinical Hospital No. 52 obtained clinical experience of baricitinib clinical use in the therapy of 113 patients with COVID-19: 58 (51%) women and 55 (49%) men, whose average age was 57±12.6 years old. Analysis of the results of using baricitinib showed that therapy with baricitinib against the background of standard pathogenetic therapy was found to be effective in 95 (84%) patients and ineffective in 18 (16%). Significant positive changes were shown in comparison with the baseline level of the following indicators: body temperature (from 37.2±0.8˚C to 36, ±0.68˚C, P=0.000), blood oxygen saturation (from 95.5±3.0% to 96.5±2.2%, P=0.011), C-reactive protein (from 46.1±48.0 mg/L to 33.5±43.7 mg/L, P=0.010 ), National Early Warning Score (NEWS) (from 1.7±1.3 to 1.1±1.2, p=0.001). From the safety point of view, patients showed a slight decrease in the average value of the number of neutrophils — from (3.1±1.4)×109 to (3.0±2.0)×109 and lymphocytes — from (1.8±0,9)×109 to (1.7±0.9)×109, as well as minimal multidirectional changes in the mean values of transaminase activity — alanine aminotransferase changed from 33.9±23.6 U/L to 34.9±47.5 U/L, aspartate aminotransferase — from 40.6±49.0 U/L to 38.5±25.5 U/L. In general, the results obtained within the experience of the clinical use of baricitinib in 113 Russian patients with COVID-19 are consistent with the available data from foreign clinical studies and confirm the efficacy and safety of baricitinib.
В эпоху COVID-19 химиотерапевтическое лечение пациентов со злокачественными заболеваниями системы крови стало краеугольным камнем в гематологии. Вторичный иммунодефицит, развивающийся на фоне гемобластозов, предрасполагает к более тяжелому течению коронавирусной инфекции, а специфическое противоопухолевое лечение лишь усугубляет иммунодефицитный статус пациентов. Таким образом, встает вопрос о рисках проведения курсов химиотерапии во время пандемии COVID-19. На данный момент не разработаны унифицированные рекомендации для оценки риска и выбора тактики лечения пациентов с онкогематологическими заболеваниями и сопутствующей коронавирусной инфекцией. В настоящей статье мы представляем серию клинических случаев пациентов с гемобластозами, у которых была диагностирована коронавирусная инфекция в дебюте гематологического заболевания или после проведенного химиотерапевтического лечения. В отдельную группу были выделены пациенты с длительно персистирующей коронавирусной инфекцией, нуждающиеся в проведении специфического противоопухолевого лечения. Мы надеемся, что данная статья поможет задать вектор для дальнейших исследований, а также послужит наглядным примером клинических ситуаций, с которыми может столкнуться гематолог в период пандемии COVID-19.
Background: Background: Patients with multiple myeloma have higher risk of SARS-CoV-2 infection and higher risk of death than patients without MM Aims: Aims: Analysis of features of the course of COVID-19 in patients with MM.
Methods: Methods:89 pts with MM and COVID-19 were treated in the hospital from March 2020 to October 2021, 53 (60%) female, 36 (40%) male. The median age was 64 years (35-88 years). 32 pts (36%) were presented with active myeloma, 19 (21%) -R/R myeloma, 21 (24%) -CR, 17 (19%) -PR or VGPR. The majority of patients -56 (63%) had III st. (Durie-Salmon). Kidney damage was presented in 33 pts (37%). The majority of patients had severe lung damage: CT 2 st. -26 pts (30%), III st. -35 (39%), IV st.-17 (19%).Patients received standard therapy for COVID19: etiotropic (antiviral, viral neutralizing MAB, convalescent plasma, immunoglobulin), pathogenetic (GCS, interleukin inhibitors, anticoagulants), therapy for secondary infectious complications.
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