Peripheral neuropathy and new treatments for multiple myeloma: background and practical recommendations
Peripheral neuropathy and new treatments for multiple myeloma: background and practical recommendations
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DOI：
10.3324/haematol.2009.012674
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发表时间：
2010-02-01
期刊：
影响因子：
--
通讯作者：
Mohty, Mohamad
中科院分区：
文献类型：
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作者：
Mohty, Bilal;El-Cheikh, Jean;Mohty, Mohamad
在多发性骨髓瘤中，周围神经病变长期以来被认为主要继发于浆细胞恶液质本身。随着沙利度胺、硼替佐米等新型靶向药物的出现，医源性神经毒性已成为周围神经病变的主要原因。本文综述了多发性骨髓瘤新药（主要是硼替佐米和沙利度胺）相关的周围神经病变的发病机制、发病率、危险因素、诊断、特点和治疗。目前对新形式周围神经病变的病理生理学的了解仍然有限。所涉及的机制取决于所用药物、患者病史、暴露持续时间和/或治疗剂量或顺序。这种周围神经病变的诊断往往比治疗容易。完整的病史和定期的临床评估是必要的。电生理学评估可能支持诊断，尽管其贡献仍然不足。复杂的临床特征可能需要在多学科方法的背景下进行专门的神经系统评估。最后，早期发现周围神经病变和使用剂量调整算法，如硼替佐米的情况下，应有助于减少副作用，同时保持抗肿瘤疗效。
In multiple myeloma, peripheral neuropathy has for a long time been considered as mainly secondary to the plasma cell dyscrasia itself. With the advent of new targeted drugs such as thalidomide and bortezomib, the iatrogenic neurotoxicity has become the leading cause of peripheral neuropathy. This review discusses the pathogenesis, incidence; risk factors, diagnosis, characteristics, and management of peripheral neuropathy related to new multiple myeloma drugs, mainly bortezomib and thalidomide. The current knowledge of the pathophysiology of the new forms of peripheral neuropathy is still limited. The mechanisms involved depend on the agents used; patient's medical history, and duration of exposure and/or treatment doses or sequence. Diagnosis of such peripheral neuropathy is often easier than treatment. A full anamnesis and regular clinical evaluation are necessary. Electrophysiological assessments may support the diagnosis, although their contribution remains insufficient. Complex clinical features may require a specialized neurological assessment within the context of a multi-disciplinary approach. Finally, early detection of peripheral neuropathy and the use of dose adjustment algorithms as in the case of bortezomib, should help reduce the side effects while maintaining anti-tumor efficacy.