Analysises Of Bortezomib-induced Periph-eral Neuropathy: Based On Literature And Real-world Data

Objective: Bortezomib induced peripheral neuropathy(BIPN)has been being reported,while there is less systematical study on the risk factors and clinical characteristics about BIPN in real-world application.Here to investigate and summarize the risk factors and clinical characteristics of BIPN,literature analysis and real-world clinical case observation study have been operated.Methods: Through searching and analyzing case reports about BIPN,summary and analysis were done on occurrence rule and clinical characteristics of BIPN.A retrospective case-control study was conducted on multiple myeloma patients admitted to the hematology department of a hospital in Chongqing from January 2016 to February 2018.Risk factors and clinical characteristics of BIPN were analyzed based the real-world cases' data collected through hospital electronic medical record.Results: 33 patients from 21 case reports were enrolled in to literature analyses,older men,who had previously received neurotoxic chemotherapy drugs,and who had not been combined with dexamethasone might be risk factors for BIPN.Lower cumulative dose and shorter cycle of bortezomib would lead to the occurrence of peripheral neuropathy.Mild sensory peripheral neuropathy was the main clinical manifestations,while motor and autonomic peripheral neuropathy could occur simultaneously and successively.Most peripheral neuropathy was axonal demyelinating and axonal neuropathy.The management of BIPN mainly included reduction and withdrawal,and it took a long time for symptoms to relief and disappear.The prognosis might be related to the severity of BIPN.86 patients were included in the real-world study with the incidence of BIPN was 51.2%.Logistic regression showed that the total cumulative dose of bortezomib,IgA type MM,lambda chain type MM,or female were risk factors for BIPN.The median cumulative dose of the first onset in BIPN was 9mg,and the median treatment cycle was 1 cycle.The median cumulative dose of persistent lesions was 30 mg,and the median treatment cycle was 3 cycles.The degree of lesion was mainly mild sensory peripheral neuropathy,numbness as the main manifestation,while motor and sensory peripheral neuropathy may occur simultaneously or subsequently.Conclusion: The characteristics of BIPN in the real world are not exactly the same as those recorded in the package inserts of bortezomib,with its higher incidence rate.The main risk factors are bortezomib cumulative total dose,myeloma immunologic type,and female.BIPN has earlier onset of the first lesion,smaller drug exposure,which is mainly mild sensory peripheral neuropathy.This study could provide a basis for BIPN risk prevention,early detection and clinical safe drug use of bortezomib,and pro-vide help for large-scale multi-center real-world research...