Bortezomib-induced peripheral neuropathy in multiple myeloma: A comparison between previously treated and untreated patients
Bortezomib-induced peripheral neuropathy in multiple myeloma: A comparison between previously treated and untreated patients
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DOI：
10.1016/j.leukres.2009.07.022
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发表时间：
2010-04-01
影响因子：
2.7
通讯作者：
Lazzarino, Mario
中科院分区：
文献类型：
--
作者：
Corso, Alessandro;Mangiacavalli, Silvia;Lazzarino, Mario
周围神经病变（PN）是蛋白酶体抑制剂硼替佐米的剂量限制性毒性，以神经性疼痛为主要症状。本研究的目的是比较预先或复发时接受硼替佐米治疗的患者的PN和神经性疼痛的发生率、危险因素、严重程度和结局。我们研究了55例接受硼替佐米一线治疗的多发性骨髓瘤（MM）患者和70例接受硼替佐米治疗的复发或进展患者。关于PN，未接受治疗和接受治疗前患者的发生率（55% vs 52%，p = 0.43）、严重程度（NCI 3级-49% vs 14%，p = 0.27）和结局（改善/消退90% vs 91%，p = 0.58）无差异。关于神经性疼痛，与治疗前患者相比，未治疗患者的发生率较低（50% vs 81%，p = 0.008）且消退较早（35天vs 91天，p = 0.02）。未经治疗的患者需要剂量调整的频率较低（36% vs 73%，p = 0.012）。未发现PN的发生与既往暴露于潜在神经毒性药物（如沙利度胺、长春新碱和顺铂）之间存在相关性。年龄是PN的主要风险因素（p = 0.036），PN风险增加6%/岁。总之，未治疗和预治疗MM患者中硼替佐米相关PN的发生率、严重程度和结局相似，但神经性疼痛除外，其在未治疗患者中的发生率较低且持续时间较短，硼替佐米停药的需要频率较低。年龄是周围神经病变最相关的风险因素，PN的风险每增加1岁增加6%。(C)2009爱思唯尔有限公司保留所有权利。
Peripheral neuropathy (PN), with neuropathic pain as main symptom, represents the dose-limiting toxicity of the proteasome inhibitor bortezomib. Aim of this study was to compare the incidence, risk factors, severity and outcome of PN and neuropathic pain in patient treated with bortezomib up-front or at relapse. We studied 55 patients with multiple myeloma ( MM) who received bortezomib as first line therapy and 70 pre-treated patients who received bortezomib in relapse or progression. Regarding PN, no differences were found among untreated and pre-treated patients in the incidence (55% vs 52%, p = 0.43), severity (NCI grade 3-49% vs 14%, p = 0.27), and outcome (improved/resolved 90% vs 91%, p = 0.58). Concerning neuropathic pain, the incidence was lower (50% vs 81%, p = 0.008) and solved earlier ( 35 days vs 91 days, p = 0.02) in untreated compared with pre-treated patients. Untreated patients needed dose modification less frequently (36% vs 73%, p = 0.012). No correlation was found between development of PN and prior exposure to potentially neurotoxic drugs such as thalidomide, vincristine, and cysplatin. Age represented the main risk factor for PN (p = 0.036) with an increase in risk of PN amounting to 6% per year of age. In conclusion, incidence, severity and outcome of bortezomib-related PN are similar in untreated and pre-treated MM patients except for neuropathic pain which has lower incidence and shorter duration in untreated patients with less frequent need for bortezomib discontinuation. Age emerges as the most relevant risk factor for peripheral neuropathy, with a risk increase for PN of 6% per year of age. (C) 2009 Elsevier Ltd. All rights reserved.