硼替佐米致周围神经病变27例临床分析

摘要

目的:分析和研究硼替佐米致周围神经病变(BIPN)的临床特征.方法:以2014年5月至2015年5月于中国医科大学附属盛京医院血液科住院接受硼替佐米治疗的27例多发性骨髓瘤患者为研究对象,统计分析其治疗过程中周围神经病变发生情况.结果:经硼替佐米方案化疗后,40. 7%的患者出现了BIPN,其中初治患者4人,复发难治患者7人;3-4级神经毒性占27. 3%(3/11),其中初治患者1人,复发难治患者2人.复发难治组患者11人既往接受过长春新碱、沙利度胺等神经毒性药物化疗,63. 6%的患者产生BIPN,其中2人为3-4级神经毒性.既往糖尿病或酗酒患者共7人,BIPN发生率为85. 7%.年轻患者(年龄≤60岁)BIPN发生率为27. 3%,低于老年患者(50. 0%).停止治疗后再次评价,81. 8%患者症状和体征得到改善.结论:高龄、糖尿病、酗酒,接受过长春新碱、沙利度胺等治疗是硼替佐米致周围神经病变发生的主要危险因素.3-4级神经毒性需要减量或停药,BIPN具有剂量依赖性和可逆性,停止治疗后患者症状和体征会有改善.%Objective:To analyze and investigate the clinical characteristics of bortezomib -induced peripheral neuropathy (BIPN). Methods:Twenty-seven multiple myeloma patients with bortezomib chemotherapy in Shengjing Hospital of China Medical University were enrolled in this study between May 2014 and May 2015. Incidence and characteristics of peripheral neuropathy were statistical analyzed during treatment. Results:After chemotherapy with bortezomib,40. 7 percent of patients occured BIPN,including 4 patients with de novo treatment and 7 patients with re-current or refractory disease. 27. 3 percent (3/11)of patients had stage 3 to 4 neurotoxicity,including 1 patient with de novo treatment and 2 patients with recurrent or refractory disease. Eleven patients with recurrent or refractory multi-ple myeloma used neurotoxic chemotherapy drugs before,such as vincristine,thalidomide,and so on,and 63. 6 percent of them occurred BIPN,including 2 patients with stage 3 to 4 neurotoxicity. 85. 7 percent patients with diabetes or al-coholism had BIPN. Incidence of BIPN were 27. 3% in young patients (age≤60 years old),and 50% in old patients (age ＞60 years old). The symptoms and signs of 81. 8 percent patients were improved after stopping the bortezomib chemotherapy. Conclusion:Older than 60 years old,diabetes,alcoholism,and previous treatment of vincristine and thalidomide were the main risk factors for the BIPN. Stage 3 to 4 neurotoxicity needed to reduce or stop bortezomib therapy. BIPN was dose-dependent and reversible,and the symptoms and signs of the patient would improve after stopping treatment.