多発性骨髄腫に対するレナリドミド初期投与量の適正使用と治療継続性の検討
「緒言」多発性骨髄腫において腎機能障害は, 高頻度に発生する合併症であり, 診断時には20～40%の患者にすでに発生しているとされている. その機序は高カルシウム血症や腎障害性の薬剤による影響よりも, 微小管構造や細繊維状, 細顆粒状の沈着物が糸球体において沈着することや, 軽鎖型M蛋白が近位尿細管において再吸収しきれずに遠位尿細管で重合を形成・閉塞させることが原因であると考えられている. しかし, プロテアソーム阻害薬や免疫調節薬などの新規薬剤の使用により70%前後の患者において多発性骨髄腫による腎機能障害は改善し, 腎機能の改善は予後延長の予測因子としても有用であることが報告されている....
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| Published in | 医療薬学 Vol. 43; no. 10; pp. 563 - 568 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人日本医療薬学会
10.10.2017
日本医療薬学会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1346-342X 1882-1499 |
| DOI | 10.5649/jjphcs.43.563 |
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| Abstract | 「緒言」多発性骨髄腫において腎機能障害は, 高頻度に発生する合併症であり, 診断時には20～40%の患者にすでに発生しているとされている. その機序は高カルシウム血症や腎障害性の薬剤による影響よりも, 微小管構造や細繊維状, 細顆粒状の沈着物が糸球体において沈着することや, 軽鎖型M蛋白が近位尿細管において再吸収しきれずに遠位尿細管で重合を形成・閉塞させることが原因であると考えられている. しかし, プロテアソーム阻害薬や免疫調節薬などの新規薬剤の使用により70%前後の患者において多発性骨髄腫による腎機能障害は改善し, 腎機能の改善は予後延長の予測因子としても有用であることが報告されている. そのなかでも, 免疫調節薬であるサリドマイドの薬効増強と副作用軽減を目的として開発されたレナリドミドは, 2015年12月に国内で未治療の多発性骨髄腫も適応が追加となった. |
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| AbstractList | 「緒言」多発性骨髄腫において腎機能障害は, 高頻度に発生する合併症であり, 診断時には20～40%の患者にすでに発生しているとされている. その機序は高カルシウム血症や腎障害性の薬剤による影響よりも, 微小管構造や細繊維状, 細顆粒状の沈着物が糸球体において沈着することや, 軽鎖型M蛋白が近位尿細管において再吸収しきれずに遠位尿細管で重合を形成・閉塞させることが原因であると考えられている. しかし, プロテアソーム阻害薬や免疫調節薬などの新規薬剤の使用により70%前後の患者において多発性骨髄腫による腎機能障害は改善し, 腎機能の改善は予後延長の予測因子としても有用であることが報告されている. そのなかでも, 免疫調節薬であるサリドマイドの薬効増強と副作用軽減を目的として開発されたレナリドミドは, 2015年12月に国内で未治療の多発性骨髄腫も適応が追加となった. |
| Author | 谷川, 大夢 木村, 美智男 宇佐美, 英績 吉村, 知哲 市川, 訓 矢野, 忠 |
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| References | 6）Knudsen LM, Hjorth M, Hippe E, Nordic Myeloma Study Group, Renal failure in multiple myeloma: reversibility and impact on the prognosis, Eur J Haematol, 2000, 65, 175-181. 12）Yamasaki S, Kohno K, Kadowaki M, Takase K, Okamura S, Dose-adjusted Lenalidomide Combined with Low-dose Dexamethasone Rescues Older Patients with Bortezomib-resistant Multiple Myeloma, Intern Med, 2015, 54, 1711-1715. 10）Kanda Y, Investigation of the freely available easy-to-use software 'EZR' for medical statistics, Bone Marrow Transplant, 2013, 48, 452-458. 2）Kyle RA, Gertz MA, Witzig TE, Lust JA, Lacy MQ, Dispenzieri A, Fonseca R, Rajkumar SV, Offord JR, Larson DR, Plevak ME, T-herneau TM, Greipp PR, Review of 1027 patients with newly diagnosed multiple myeloma, Mayo Clin Proc, 2003, 78, 21-33. 1）Eleutherakis-Papaiakovou V, Bamias A, Gika D, Simeonidis A, Pouli A, Anagnostopoulos A, Michali E, Economopoulos T, Zervas K, Dimopoulos MA; Greek Myeloma Study Group, Renal failure in multiple myeloma: incidence, correlations, and prognostic significance, Leuk Lymphoma, 2007, 48, 337-341. 7）Chanan-Khan AA, San Miguel JF, Jagannath S, Ludwig H, Dimopoulos MA, Novel therapeutic agents for the management of patients with multiple myeloma and renal impairment, Clin Cancer Res, 2012, 18, 2145-2163. 13）Paiva B, van Dongen JJ, Orfao A, New criteria for response assessment: role of minimal residual disease in multiple myeloma, Blood, 2015, 125, 3059-3068. 8）Chen N, Lau H, Kong L, Kumar G, Zeldis JB, Knight R, Laskin OL, Pharmacokinetics of lenalidomide in subjects with various degrees of renal impairment and in subjects on hemodialysis, J Clin Pharmacol, 2007, 47, 1466-1475. 4）Terpos E, Kleber M, Engelhardt M, Zweegman S, Gay F, Kastritis E, van de Donk NW, Bruno B, Sezer O, Broijl A, Bringhen S, Beksac M, Larocca A, Hajek R, Musto P, Johnsen HE, Morabito F, Ludwig H, Cavo M, Einsele H, Sonneveld P, Dimopoulos MA, European Myeloma Network guidelines for the management of multiple myeloma-related complications, Haematologica, 2015, 100, 1254-1266. 5）Dimopoulos M, Alegre A, Stadtmauer EA, Goldschmidt H, Zonder JA, de Castro CM, Masliak Z, Reece D, Olesnyckyj M, Yu Z, Weber DM, The efficacy and safety of lenalidomide plus dexamethasone in relapsed and/or refractory multiple myeloma patients with impaired renal function, Cancer, 2010, 116, 3807-3814. 11）Kumar SK, Dispenzieri A, Lacy MQ, Gertz MA, Buadi FK, Pandey S, Kapoor P, Dingli D, Hayman SR, Leung N, Lust J, McCurdy A, Russell SJ, Zeldenrust SR, Kyle RA, Rajkumar SV, Continued improvement in survival in multiple myeloma: changes in early mortality and outcomes in older patients, Leukemia, 2014, 28, 1122-1128. 9）Hostenkamp G, Lichtenberg FR, The impact of recent chemotherapy innovation on the longevity of myeloma patients, US and international evidence, Soc Sci Med, 2015, 130, 162-171. 3）Hutchison CA, Batuman V, Behrens J, Bridoux F, Sirac C, Dispenzieri A, Herrera GA, Lachmann H, Sanders PW, The pathogenesis and diagnosis of acute kidney injury in multiple myeloma, Nat Rev Nephrol, 2011, 8, 43-51. |
| References_xml | – reference: 5）Dimopoulos M, Alegre A, Stadtmauer EA, Goldschmidt H, Zonder JA, de Castro CM, Masliak Z, Reece D, Olesnyckyj M, Yu Z, Weber DM, The efficacy and safety of lenalidomide plus dexamethasone in relapsed and/or refractory multiple myeloma patients with impaired renal function, Cancer, 2010, 116, 3807-3814. – reference: 8）Chen N, Lau H, Kong L, Kumar G, Zeldis JB, Knight R, Laskin OL, Pharmacokinetics of lenalidomide in subjects with various degrees of renal impairment and in subjects on hemodialysis, J Clin Pharmacol, 2007, 47, 1466-1475. – reference: 11）Kumar SK, Dispenzieri A, Lacy MQ, Gertz MA, Buadi FK, Pandey S, Kapoor P, Dingli D, Hayman SR, Leung N, Lust J, McCurdy A, Russell SJ, Zeldenrust SR, Kyle RA, Rajkumar SV, Continued improvement in survival in multiple myeloma: changes in early mortality and outcomes in older patients, Leukemia, 2014, 28, 1122-1128. – reference: 9）Hostenkamp G, Lichtenberg FR, The impact of recent chemotherapy innovation on the longevity of myeloma patients, US and international evidence, Soc Sci Med, 2015, 130, 162-171. – reference: 4）Terpos E, Kleber M, Engelhardt M, Zweegman S, Gay F, Kastritis E, van de Donk NW, Bruno B, Sezer O, Broijl A, Bringhen S, Beksac M, Larocca A, Hajek R, Musto P, Johnsen HE, Morabito F, Ludwig H, Cavo M, Einsele H, Sonneveld P, Dimopoulos MA, European Myeloma Network guidelines for the management of multiple myeloma-related complications, Haematologica, 2015, 100, 1254-1266. – reference: 7）Chanan-Khan AA, San Miguel JF, Jagannath S, Ludwig H, Dimopoulos MA, Novel therapeutic agents for the management of patients with multiple myeloma and renal impairment, Clin Cancer Res, 2012, 18, 2145-2163. – reference: 2）Kyle RA, Gertz MA, Witzig TE, Lust JA, Lacy MQ, Dispenzieri A, Fonseca R, Rajkumar SV, Offord JR, Larson DR, Plevak ME, T-herneau TM, Greipp PR, Review of 1027 patients with newly diagnosed multiple myeloma, Mayo Clin Proc, 2003, 78, 21-33. – reference: 1）Eleutherakis-Papaiakovou V, Bamias A, Gika D, Simeonidis A, Pouli A, Anagnostopoulos A, Michali E, Economopoulos T, Zervas K, Dimopoulos MA; Greek Myeloma Study Group, Renal failure in multiple myeloma: incidence, correlations, and prognostic significance, Leuk Lymphoma, 2007, 48, 337-341. – reference: 3）Hutchison CA, Batuman V, Behrens J, Bridoux F, Sirac C, Dispenzieri A, Herrera GA, Lachmann H, Sanders PW, The pathogenesis and diagnosis of acute kidney injury in multiple myeloma, Nat Rev Nephrol, 2011, 8, 43-51. – reference: 12）Yamasaki S, Kohno K, Kadowaki M, Takase K, Okamura S, Dose-adjusted Lenalidomide Combined with Low-dose Dexamethasone Rescues Older Patients with Bortezomib-resistant Multiple Myeloma, Intern Med, 2015, 54, 1711-1715. – reference: 6）Knudsen LM, Hjorth M, Hippe E, Nordic Myeloma Study Group, Renal failure in multiple myeloma: reversibility and impact on the prognosis, Eur J Haematol, 2000, 65, 175-181. – reference: 10）Kanda Y, Investigation of the freely available easy-to-use software 'EZR' for medical statistics, Bone Marrow Transplant, 2013, 48, 452-458. – reference: 13）Paiva B, van Dongen JJ, Orfao A, New criteria for response assessment: role of minimal residual disease in multiple myeloma, Blood, 2015, 125, 3059-3068. |
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| Title | 多発性骨髄腫に対するレナリドミド初期投与量の適正使用と治療継続性の検討 |
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