This review discusses the most common issues concerning multiple myeloma (MM)-related peripheral neuropathy (PN). This is an important MM complication, observed in up to 54% of newly diagnosed patients, caused by the disease itself or its treatment. Although its aetiology is largely unknown, a number of mechanisms are suspected. It is important to know the neurological status of a patient, as many new antimyeloma medicines can trigger or exacerbate any pre-existing neuropathy. Examples include thalidomide-induced and bortezomib-induced PN (TiPN and BiTN, respectively), which are key MM treatment options. TiPN is usually sensory and sensorimotor, whereas BiPN is typically sensory. The mechanisms of chemotherapy-induced neurotoxicity in MM are well known; thalidomide seems to induce PN through its antiangiogenic properties, whereas bortezomib neurotoxicity is connected with disrupted calcium homeostasis. TiPN incidence ranges from 25% to 75%, and its prevalence and severity appears to be dose-dependent. BiPN incidence is almost 40% and is dose-related as well. Poor (25%) reversibility of TiPN prompted the recommendations for dose and exposure reduction, whereas BiPN cases are mostly reversible (64%). Peripheral sensory neuropathy is very rare in patients receiving bendamustine monotherapy. Because of this favourable toxicity profile, bendamustine may be considered a promising option for combination therapies in pre-existing PN in myeloma patients. Considering the lack of curative therapy for treatment-emergent PN, prevention is a key management strategy in MM patients. All patients should be evaluated for PN before the administration of a neurotoxic drug, and those under treatment should be closely monitored by a neurologist.
The study presents an atypical location of Non-Hodgkin lymphoma of the oral cavity in the area of the palate. Pathological changes of the mucosa of the palate in an 85-year-old female patient had been developing for many years as a result of upper denture irritation without any major symptoms. Histological examination revealed a Diffuse large B cell lymphoma. Due to being advanced in years, the patient was qualified for the local radiotherapy. In this particular case, the clinical picture of lymphoma imitated an inflammation of the mucosa of the oral cavity which resulted in delayed diagnosis and treatment.
Biphosphonate-related osteonecrosis of the jaw (BRONJ) is a common complication of the therapy of malignant cancers. Drugs improve bone density and reduce hypercalcaemia in patients with primary tumours, as well as their metastases to the bones. A characteristic feature are emerging foci of osteonecrosis of the jaws, with secondary infection which is often actinomycotic. Actinomyces are Gramm-positive bacteria which colonize the mucous membrane and in favourable conditions are the cause of inflammation. BRONJ appears spontaneously or may be a consequence of surgical treatment in the area of the jaws. The case is presented of an 82-year-old woman after hysterectomy due to a cancerous lesion who had taken ibandronic acid for a long time. Because of the severe pain in the mandible and the advanced disease, surgical sequestration of the necrosis and antibiotic treatment of the actinomycosis were necessary.
The study presents the case of a 25-year-old patient with the diagnosis of diffuse large B cell lymphoma treated autologously with haematopoietic stem cells transplantation. During the period of aplasia after chemotherapy severe sore lips, mouth and esophagus herpes simplex mucositis developed and is successfully treated with foscarnet. The clinical course, localized causal and symptomatic treatment, along with the therapy imaging, are presented.
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