Peripheral Neuropathy Associated With Novel Therapies in Patients With Multiple Myeloma: Consensus Statement of the IMF Nurse Leadership Board

Tariman, Joseph D.; Love, Ginger; McCullagh, Emily; Sandifer, Stacey

doi:10.1188/08.cjon.s1.29-35

Cited by 47 publications

(38 citation statements)

References 30 publications

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“…2 Peripheral neuropathy (PN) is a key iatrogenic toxicity in patients with MM, often leading to dose modification and drug discontinuation. 6 In newly diagnosed patients, bortezomib-induced PN incidences of 47%-64% and rates of dose modification or drug discontinuation attributable to PN of 14%-30% have been reported. 2,7,8 Bortezomib-induced PN is considered a secondary effect of proteasome inhibition, 9-11 producing a primarily small fiber and painful, axonal, sensory distal neuropathy; motor neuropathy is rare.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of once-weekly bortezomib in multiple myeloma patients

Bringhen

Larocca

Rossi

et al. 2010

Blood

349

200

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In a recent phase 3 trial, bortezomibmelphalan-prednisone-thalidomide followed by maintenance treatment with bortezomib-thalidomide demonstrated superior efficacy compared with bortezomib-melphalan-prednisone. To decrease neurologic toxicities, the protocol was amended and patients in both arms received once-weekly instead of the initial twice-weekly bortezomib infusions: 372 patients received once-weekly and 139 twice-weekly bortezomib. In this posthoc analysis we assessed the impact of the schedule change on clinical outcomes and safety. Long-term outcomes appeared similar: 3-year progression-free survival rate was 50% in the once-weekly and 47% in the twice-weekly group (P > .999), and 3-year overall survival rate was 88% and 89%, respectively (P ‫؍‬ .54). The complete response rate was 30% in the onceweekly and 35% in the twice-weekly group (P ‫؍‬ .27). Nonhematologic grade 3/4 adverse events were reported in 35% of once-weekly patients and 51% of twice-weekly patients (P ‫؍‬ .003). The incidence of grade 3/4 peripheral neuropathy was 8% in the once-weekly and 28% in the twice-weekly group (P < .001); 5% of patients in the once-weekly and 15% in the twice-weekly group discontinued therapy because of peripheral neuropathy (P < .001). This improvement in safety did not appear to affect efficacy. This study is registered at http://www.clinicaltrials.gov as NCT01063179. (Blood. 2010;116(23): 4745-4753)

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Section: Introductionmentioning

confidence: 99%

Efficacy and safety of once-weekly bortezomib in multiple myeloma patients

Bringhen

Larocca

Rossi

et al. 2010

Blood

349

200

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“…Możliwości leczenia bólu neuropatycznego u chorych na szpiczaka mnogiego z polineuropatią wywołaną talidomidem i bortezomibem przedstawiono w 2008 r. [62][63][64]. Propozycje te, z modyfikacjami, mogą znaleźć zastosowanie również w leczeniu pozostałych neuropatii polekowych.…”

Section: Ocena Stopnia Zaawansowania Polekowych Neuropatiiunclassified

Drug-induced neuropathies

Banach¹,

Juranek²,

Antczak³

2015

fmpcr

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A -przygotowanie projektu badania, B -zbieranie danych, C -analiza statystyczna, D -interpretacja danych, E -przygotowanie maszynopisu, F -opracowanie piśmiennictwa, G -pozyskanie funduszy Działania niepożądane leków stanowią najczęstszą przyczynę toksycznego uszkodzenia obwodowego ukła-du nerwowego. Częstość ich występowania waha się od 10 do 100% i zależy od rodzaju zastosowanego leku, długości terapii oraz obecności chorób towarzyszących. Neurotoksyczność polekowa stanowi jedną z najczęstszych przyczyn zmniejszania dawki terapeutycznej danego leku bądź całkowitego przerwania dotychczasowej terapii, osłabiając jej skuteczność i negatywnie wpływając na stan zdrowia pacjentów oraz generując dodatkowe koszty opieki zdrowotnej. W praktyce lekarskiej coraz częściej obserwuje się negatywnie oddziałujące na układ nerwowy objawy niepożądane podstawowych leków opieki medycznej, począwszy od leków stosowanych w zaburzeniach rytmu serca oraz obniżających poziom cholesterolu (amiodaron, statyny), przez leki stosowane w chorobach autoimmunologicznych (etanercept, infliksymab, leflunomid), przeciwpadaczkowe (fenytoina), przeciwzakaźne -bakteriobójcze, przeciwgrzybicze lub pierwotniakobójcze (nitrofurantoina, metronidazol, izoniazyd), aż do leków przeciwnowotworowych (talidomid, bortezomib, oksaliplatyna, cisplatyna, suramina, paklitaksel, winkrystyna i inne). Niewykryte i nieleczone neurotoksyczne objawy niepożądane leków mogą doprowadzić do trwałych zmian w obwodowym układzie nerwowym, upośledzając samodzielne funkcjonowanie pacjentów (doprowadzając niekiedy nawet do trwałego kalectwa), negatywnie oddziałując na przebieg terapii oraz na samopoczucie i stan psychiczny chorych. W niniejszej pracy skupimy się na kilku wybranych lekach z wymienionych wyżej kategorii, opisując skutki ich negatywnego oddziaływania na obwodowy układ nerwowy, co w znaczny sposób wpływa na stan zdrowia pacjentów. Słowa kluczowe: neurotoksyczność, statyny, polekowe neuropatie, amiodaron, talidomid, bortezomib.Neurotoxicity is one of the most common side effects of many routinely used drugs, affecting the peripheral nervous system and impairing treatment efficiency. Drug-induced neurotoxicity ranges from 10% to 100% and depends on the medicine used, duration of therapy, and presence of concomitant disorders. Neurotoxic side effects have been increasingly reported by primary care physicians, affecting treatment and generating additional costs both for patients and for health care providers. Many of the most neurotoxic drugs are also the most widely used, often listed as essential medicines for the most common ailments and disorders, and include cardiovascular/blood pressure drugs (statins, amiodarone), drugs for autoimmune diseases (etanercept, infliximab, leflunomide), anticonvulsants (phenytoin), drugs for bacterial, protozoan, or viral infections (nitrofurantoin, metronidazole, isoniazid), and antineoplastic drugs (thalidomide, bortezomib, oxaliplatin, cisplatin, suramin, paclitaxel, vincristine, and others). Undetected and untreated drug-induced n...

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“…Neurotoxicity assessment tools (see an example in Figure 1) may be useful for quantifying PN severity based on patient self-reports. 12 Patients should be evaluated for evidence of neuropathy at baseline, before initiating a change in therapeutic regimen, in conjunction with new or worsening signs or symptoms, and periodically throughout treatment. Patient-or agent-specific risk factors may necessitate more aggressive or targeted assessments.…”

Section: Assessment/monitoringmentioning

confidence: 99%

“…Therapeutic Intervention: Nonpharmacologic management of sensory PN symptoms or neuropathic pain may involve the use of daily vitamins and nutritional supplements (e.g., multi-B complex vitamins [B 1 , B 6 , B 12 ], folic acid, magnesium, potassium, vitamin E, acetyl l-carnitine, α-lipoic acid, l-glutamine; see Table 3 for dosing), emollient creams (e.g., cocoa butter, menthol, and eucalyptus-based creams), and physical therapy, as well as therapeutic massage.…”

mentioning

confidence: 99%

Complications of Multiple Myeloma Therapy, Part 1: Risk Reduction and Management of Peripheral Neuropathy and Asthenia

Richardson

Laubach

Schlossman

et al. 2010

J Natl Compr Canc Netw

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Peripheral neuropathy (PN) and asthenia (fatigue) occur as both disease-and treatment-related complications in patients with multiple myeloma (MM). Risk factors for treatment-related PN, which has an estimated incidence of 37% to 83% among patients with MM, include therapy duration, dose intensity, cumulative dose, and the presence of preexisting neuropathy. Asthenia is the most common adverse effect of treatment, occurring in approximately 76% to 96% of patients receiving therapy. The severity of PN and asthenia can range from mild to potentially debilitating. These conditions can be dose limiting; they may interfere with optimizing duration of therapy and may also substantially affect patient qualPeripheral neuropathy (PN) and asthenia (fatigue) are among the most commonly seen complications in patients undergoing multiple myeloma (MM) therapy. These potentially debilitating adverse effects are frequently dose limiting, and they may interfere with optimal therapy and substantially affect patient quality of life as well as outcome. Effective strategies for preventing and managing these complications of MM therapy are thus critical. Peripheral NeuropathyOverview PN occurs in MM both as a disease-related complication in newly diagnosed patients and as a side effect of MM therapy. The reported incidence is 1% to 20% in untreated patients with MM and 37% to 83% in previously treated individuals; neurophysiologic evidence of neuropathy may be detected in 11% to 52% and 39% to 46% of these populations, respectively.1-6 Risk factors for PN include treatment-specific characteristics, such as therapy duration, dose intensity, and cumulative dose, and patient-specific factors, such as age, comorbidities (e.g., diabetes mellitus, alcoholism), and the presence of preexisting neuropathy.

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Peripheral Neuropathy Associated With Novel Therapies in Patients With Multiple Myeloma: Consensus Statement of the IMF Nurse Leadership Board

Cited by 47 publications

References 30 publications

Efficacy and safety of once-weekly bortezomib in multiple myeloma patients

Efficacy and safety of once-weekly bortezomib in multiple myeloma patients

Drug-induced neuropathies

Complications of Multiple Myeloma Therapy, Part 1: Risk Reduction and Management of Peripheral Neuropathy and Asthenia

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