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KMID : 0869620140310030806
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Journal of Korean Society of Hospital Pharmacists
2014 Volume.31 No. 3 p.806 ~ p.816
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Analysis of Incidence and Risk Factors for Bortezomib-induced Peripheral Neuropathy in Multiple Myeloma
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Jeon Ah-Young
Kim Sung-Hwan
Kim Kwi-Suk
Lee Hye-Sook
Kim Hyang-Suk
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Abstract
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Bortezomib acts by disrupting ubiquitin-proteasome pathway which regulates protein homeostasis within the cell and has demonstrated significant activity mainly against recurrent or newly diagnosed multiple myeloma(MM). Among bortezomib-related side effects, peripheral neuropathy( PN) as main dose-limiting non-haematological toxicity can substantially affect the quality of life of patients. It typically requires dose-reduction, delay, or even premature termination
of successful treatment. Therefore, predicting the risk for neuropathy before the therapy and a proper management of neurotoxicity are very important considerations. The aim of this study was to evaluate the incidence of PN, risk factors, and prior exposure to potentially neurotoxic chemotherapy. A total of 108 patients with multiple myeloma(MM) were included, who received bortezomib in Seoul National University of Hospital(SNUH) from May 2005 to April 2008. A retrospective chart review was performed on SNUH patients’Electronic Medical Records(EMR), and the SPSS Statistics 19.0 was used for analysis. In univariate analysis, no correlation was found between the development of PN, sex, or age,
but creatinine level (Scr≥2)(48% vs 78%, p=0.007, OR=0.264), presence of DM(50% vs 76%, p=0.034, OR=0.324) and number of therapy cycles(N>3)(84% vs 57%, p=0.002, OR=4.046) were significantly correlated with PN incidence. In a multivariate logistic regression, the risk of bortezomib- related PN was lower in patients whose creatinine level was high(Scr≥2)(OR=0.248) and greater in patients treated with high number of bortezomib cylces(N>3)(OR=4.235). Concerning that the prior exposure to chemotherapy could exacerbate neurotoxicity, there was lower incidence of PN in the prior bortezomib treated group(38% vs 62%, p=0.007), prior bortezomib with thalidomide treated group(36% vs 63%, p=0.003), and prior bortezomib with vincristine treated group(37% vs 60%, p=0.026).
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KEYWORD
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Bortezomib, Multiple Myeloma(MM), Peripheral Neuropathy(PN), Risk factor
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