Plasma exchange followed by chemotherapy treatment for multiple-myeloma patients with high viscosity syndrome and renal dysfunction: a clinical analysis / 中国输血杂志

ABSTRACT

Objective To assess the clinical performance of plasma exchange (PE) followed by chemotherapy treatment for multiple-myeloma patients with high-viscosity syndrome and renal dysfunction.Methods 20 cases of multiple-myeloma patients with high viscous syndrome and various levels of renal dysfunction,were randomly divided into PE-chemotherapy group (the experiment groups) and chemotherapy-only group (the control group).In the experiment groups,the patients received PE via blood cell separators for 3 times (2 600±580 mLeach time,1 day interval) followed by VAD regimens chemotherapy (0.5 mg vincristine continuous intravenous drip for 12 h,adriamycin 10 mg continuous intravenous drip for 12 h and dexamethasone 40 mg qd1-4).In the control group,patients received standard VAD regimen.After 2 cycles of chemotherapy,globulin (GLB),blood sedimentation (ESR) and hemorheology properties were compared between the two groups before and after treatment.Results The symptoms of high viscosity syndrome(gingivial blood/nosebleed,dizziness and extremities numbness)in the treatment group were significantly improved compared with that in the control group (P＜ 0.05).Before and after therapy,the GLB (g/L) were 80.0± 19.6 vs 30.0±10.5 in the treatment group and 85.5±21.5 vs 53.5± 16.0 in the control group (P＜0.05),respectively;the Cr (μmol/L) were 359.0±30.5 vs 105.0±25.0 and 362.0±39.6 vs 190.0±43.0,respectively(P＜0.05);the ESR (mm/h) were 80.0±22.5 vs 12±0.6 and 83.0±23.6 vs 30.0+3.6 (P＜0.05),respectively;the whole blood high shear reductive viscosity were 16.2±2.1 vs 8.5±0.6 and 15.8±2.0 vs 12.8±0.8 (P＜0.05),respectively;the whole blood middle shear reductive viscosity were 19.0±0.5 vs 10.8±0.6 and 20.0±0.6 vs 15.2±0.8 (P＜0.05),respectively;the whole blood low shear reductive viscosity were 50.3±2.9 vs 28.1±1.2 and 52.7±3.5 vs 40.2±3.5(P＜0.05),respectively.Conclusion Plasma exchange treatment combined with sequential chemotherapy presents better clinical performances compared to the chemotherapy-only solution for multiple-myeloma patients with high viscosity syndrome and renal dysfunction.