| BackgroundMultiple myeloma（MM）is a malignant plasma cell disease with the second highest incidence of hematological malignancies in China.With the application of proteasome inhibitors and immunomodulators,the incidence of peripheral neuropathy associated with MM chemotherapy is getting higher these years.Some researchers assume that acupuncture may improve the therapeutic effect,but there is lack of definite conclusion.ObjectiveTo analyze and discuss the clinical characteristics of patients with MM in our hospital from 2018 to 2021,and to explore the clinical characteristics of bortezomib-induced peripheral neuropathy（BiPN）in patients with multiple myeloma,and the efficacy of symptom relief in patients with MMPN with or without acupuncture.MethodsFrom January 2019 to November 2021,126 newly diagnosed MM patients in the blood ward of our hospital were retrospectively analyzed,and the clinical characteristics of the patients were counted;the incidence,symptoms,and occurrence time of BiPN during the treatment of patients were observed.To observe and compare the efficacy of drug therapy and acupuncture combined with drug therapy.Results1.Among the 126 MM patients in the Department of Hematology of our hospital,the misdiagnosis rate for the first diagnosis was 22%,and the majority of the patients were males（59.52% 75 cases）),with a male-to-female ratio of 1.47:1.Age range: 43-83 years old.The median age was 64 years.Ig G subtype is more common,accounting for 52.38%of the total к subtype is more common,and the subtype ratio: к:λ is 1.10:1.At the time of diagnosis,DS（Durie-Salmon）stage III was more common,accounting for 88.89% of the total,A subtype was mainly 70.63%,ISS stage III was more common（45.24%）,and R-ISS stage II was more common（61.90%）.Cytogenetic changes were more common with 1q21amplification（56.35%）.The comorbidities were mainly bone destruction in 82 cases（65.07%）,followed by kidney injury（33.33%）,infection（19.05%）,peripheral neuropathy（5.56%）and amyloidosis（7.14%）.The median plasma cell percentage at baseline was32.75%.The median baseline serum calcium was 2.295 mmol/L,and the mean was 2.37± 0.41 mmol/L.2.Among the 120 patients with multiple myeloma,53 cases（41.67%）had BiPN,of which 23 cases（39.66%）had secondary peripheral neuropathy and 12 cases（20.69%）had≥ grade 3 peripheral neuropathy.And motor neuropathy were all Ig A patients.The time of occurrence was mostly during the third to fifth chemotherapy,with 41 cases（77.35%）.The main symptoms were numbness of the limbs in 32 cases（60.38%）.The signs of mild sensory abnormalities of the limbs were "hosiery sensory disorder".Physical examination showed the decrease or disappearance of knee reflex or Achilles tendon reflex of both lower limbs in 18 cases（33.96%）.3.Among the 120 MM patients included,53 were BiPN patients,with an incidence rate of 41.67%,among which grade 2 peripheral neuropathy was the most common,accounting for 39.66% of 53 BiPN patients,and ≥ grade 3 peripheral neuropathy accounted for 20.69% of BiPN patients.All patients with motor neuropathy were Ig A patients.The most common occurrence time was the 3rd to 5th chemotherapy cycles,accounting for 77.35%.Symptoms of BiPN were mainly paresthesia with limb numbness in 32 cases（60.38%）,mild limb paresthesia was manifested as "socks and gloves",and physical examination showed decreased knee reflex or Achilles tendon reflex of both lower extremities or disappeared in 18 cases（33.96%）.Conclusion1 Most of the patients in our hospital were Ig G type,and the main type was bone destruction;and the incidence of light chain renal injury was high.In the cytogenetics of MM patients in our hospital,the positive rate of 1q21 amplification is high,and the expression is the highest in Ig D subtypes.2 BiPN is mainly manifested by limb numbness,and grade 2 sensory peripheral neuropathy is the most common.3 BiPN was improved to varying degrees after acupuncture combined treatment or simple drug treatment;however,the efficacy of acupuncture combined with neurotrophic drugs in the treatment of BiPN was better than that of single neurotrophic drugs. |
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