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Chan C, Foster ST, Chan KG, Cacace MJ, Ladd SL, Sandum CT, Wright PT, Volmert B, Yang W, Aguirre A, Li W, Wright NT. Repositioned Drugs for COVID-19-the Impact on Multiple Organs. SN COMPREHENSIVE CLINICAL MEDICINE 2021; 3:1484-1501. [PMID: 33898925 PMCID: PMC8057921 DOI: 10.1007/s42399-021-00874-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/22/2021] [Indexed: 02/02/2023]
Abstract
This review summarizes published findings of the beneficial and harmful effects on the heart, lungs, immune system, kidney, liver, and central nervous system of 47 drugs that have been proposed to treat COVID-19. Many of the repurposed drugs were chosen for their benefits to the pulmonary system, as well as immunosuppressive and anti-inflammatory effects. However, these drugs have mixed effects on the heart, liver, kidney, and central nervous system. Drug treatments are critical in the fight against COVID-19, along with vaccines and public health protocols. Drug treatments are particularly needed as variants of the SARS-Cov-2 virus emerge with some mutations that could diminish the efficacy of the vaccines. Patients with comorbidities are more likely to require hospitalization and greater interventions. The combination of treating severe COVID-19 symptoms in the presence of comorbidities underscores the importance of understanding the effects of potential COVID-19 treatments on other organs. Supplementary Information The online version contains supplementary material available at 10.1007/s42399-021-00874-8.
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Affiliation(s)
- Christina Chan
- Department of Chemical Engineering and Materials Sciences, Michigan State University, 428 S. Shaw Lane, Room 2100 EB, East Lansing, MI 48824 USA ,Department of Biochemistry and Molecular Biology, Michigan State University, East Lansing, MI USA ,Department of Biomedical Engineering, Michigan State University, East Lansing, MI USA ,Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI USA
| | - Sean T. Foster
- Department of Chemical Engineering and Materials Sciences, Michigan State University, 428 S. Shaw Lane, Room 2100 EB, East Lansing, MI 48824 USA
| | - Kayla G. Chan
- Integrative Neuroscience Program, Binghamton University, Binghamton, NY USA
| | - Matthew J. Cacace
- Department of Mechanical Engineering, The Pennsylvania State University, University Park, PA USA
| | - Shay L. Ladd
- Department of Chemical Engineering and Materials Sciences, Michigan State University, 428 S. Shaw Lane, Room 2100 EB, East Lansing, MI 48824 USA
| | - Caleb T. Sandum
- Department of Chemical Engineering and Materials Sciences, Michigan State University, 428 S. Shaw Lane, Room 2100 EB, East Lansing, MI 48824 USA
| | - Paul T. Wright
- Department of Mechanical Engineering, Virginia Polytechnic Institute and State University, Blacksburg, VA USA
| | - Brett Volmert
- Department of Biomedical Engineering, Michigan State University, East Lansing, MI USA ,Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI USA
| | - Weiyang Yang
- Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI USA ,Department of Electrical and Computer Engineering, Michigan State University, East Lansing, MI USA
| | - Aitor Aguirre
- Department of Biomedical Engineering, Michigan State University, East Lansing, MI USA ,Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI USA
| | - Wen Li
- Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI USA ,Department of Electrical and Computer Engineering, Michigan State University, East Lansing, MI USA
| | - Neil T. Wright
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI USA
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Mlak R, Szudy‐Szczyrek A, Mazurek M, Szczyrek M, Homa‐Mlak I, Mielnik M, Chocholska S, Jankowska‐Łęcka O, Małecka‐Massalska T, Hus M. Polymorphisms in the promotor region of theCRBNgene as a predictive factor for peripheral neuropathy in the course of thalidomide‐based chemotherapy in multiple myeloma patients. Br J Haematol 2019; 186:695-705. [DOI: 10.1111/bjh.15972] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 03/19/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Radosław Mlak
- Department of Human Physiology Medical University of Lublin Lublin Poland
| | - Aneta Szudy‐Szczyrek
- Department of Haemato‐oncology and Bone Marrow Transplantation Medical University of Lublin Lublin Poland
| | - Marcin Mazurek
- Department of Human Physiology Medical University of Lublin Lublin Poland
| | - Michał Szczyrek
- Department of Pneumonology, Oncology and Allergology Medical University of Lublin Lublin Poland
| | - Iwona Homa‐Mlak
- Department of Human Physiology Medical University of Lublin Lublin Poland
| | - Michał Mielnik
- Department of Haemato‐oncology and Bone Marrow Transplantation Medical University of Lublin Lublin Poland
| | - Sylwia Chocholska
- Department of Haemato‐oncology and Bone Marrow Transplantation Medical University of Lublin Lublin Poland
| | - Olga Jankowska‐Łęcka
- Department of Haemato‐oncology and Bone Marrow Transplantation Medical University of Lublin Lublin Poland
| | | | - Marek Hus
- Department of Haemato‐oncology and Bone Marrow Transplantation Medical University of Lublin Lublin Poland
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Extramammary Paget's disease of the oral mucosa and perioral skin. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 124:e157-e163. [PMID: 28606832 DOI: 10.1016/j.oooo.2017.05.473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 03/13/2017] [Accepted: 05/07/2017] [Indexed: 02/05/2023]
Abstract
Extramammary Paget's disease (EMPD) is an unusual intraepidermal adenocarcinoma. Only 2 cases of EMPD in the oral mucosa have been reported previously. Here, we present the first report of a rare case of Paget's disease of the oral mucosa and perioral skin with extensive contiguous erythematous and erosive manifestations. Ultimately, the patient was treated with oral thalidomide for 8 weeks. We noticed an improvement with resolution of symptoms. A 3-year follow-up showed no relapse. Thus, this case may provide new insights to clinicians about treatment of EMPD. More importantly, we advise that dentists be vigilant about the possibility of some clinically significant conditions in patients with extensive nonspecific clinical lesions mimicking inflammatory or infectious diseases in the oral and maxillofacial regions, especially lesions that are refractory to long-term treatment. Requesting consultations with relevant clinical departments promptly and obtaining histopathologic confirmation at an early stage are crucial for early therapy and a better prognosis.
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de la Puente P, Azab AK. Nanoparticle delivery systems, general approaches, and their implementation in multiple myeloma. Eur J Haematol 2017; 98:529-541. [PMID: 28208215 DOI: 10.1111/ejh.12870] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2017] [Indexed: 12/25/2022]
Abstract
Multiple myeloma (MM) is a hematological malignancy that remains incurable, with relapse rates >90%. The main limiting factor for the effective use of chemotherapies in MM is the serious side effects caused by these drugs. The emphasis in cancer treatment has shifted from cytotoxic, non-specific chemotherapies to molecularly targeted and rationally designed therapies showing greater efficacy and fewer side effects. Traditional chemotherapy has shown several disadvantages such as lack of targeting capabilities, systemic toxicity, and side effects; low therapeutic index, as well as most anticancer drugs, has poor water solubility. Nanoparticle delivery systems (NPs) are capable of targeting large doses of chemotherapies into the target area while sparing healthy tissues, overcoming the limitations of traditional chemotherapy. Here, we review the current state of the art in nanoparticle-based strategies designed to treat MM. Many nanoparticle delivery systems have been studied for myeloma using non-targeted NPs (liposomes, polymeric NPs, and inorganic NPs), triggered NPs, as well as targeted NPs (VLA-4, ABC drug transporters, bone microenvironment targeting). The results in preclinical and clinical studies are promising; however, there remains much to be learned in the emerging field of nanomedicine in myeloma.
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Affiliation(s)
- Pilar de la Puente
- Cancer Biology Division, Department of Radiation Oncology, Washington University in Saint Louis School of Medicine, St. Louis, MO, USA
| | - Abdel Kareem Azab
- Cancer Biology Division, Department of Radiation Oncology, Washington University in Saint Louis School of Medicine, St. Louis, MO, USA
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Usnarska-Zubkiewicz L, Dębski J, Butrym A, Legieć W, Hus M, Dmoszyńska A, Stella-Hołowiecka B, Zaucha JM, Januszczyk J, Rymko M, Torosian T, Charliński G, Lech-Marańda E, Malenda A, Jurczyszyn A, Urbańska-Ryś H, Druzd-Sitek A, Błońska D, Urbanowicz A, Hołojda J, Pogrzeba J, Rzepecki P, Hałka J, Subocz E, Becht R, Zdziarska B, Dytfeld D, Nowicki A, Bołkun Ł, Kłoczko J, Knopińska-Posłuszny W, Zubkiewicz-Kucharska A, Kuliczkowski K. Efficacy and safety of lenalidomide treatment in multiple myeloma (MM) patients--Report of the Polish Myeloma Group. Leuk Res 2015; 40:90-9. [PMID: 26626207 DOI: 10.1016/j.leukres.2015.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 10/06/2015] [Accepted: 11/03/2015] [Indexed: 11/19/2022]
Abstract
UNLABELLED The aim of the multi-centre retrospective study was to evaluate the efficacy and safety of lenalidomide (LEN) therapy in patients with resistant or relapsed multiple myeloma (MM) as well as in patients with stable disease (LEN used due to neurological complications). The primary endpoint of this study was an overall response rate (ORR). The secondary endpoints were as follows: time to progression (TTP), overall survival (OS) and the safety of drug use. Data were collected in 19 centres of the Polish Multiple Myeloma Study Group. The study group consisted of 306 subjects: 153 females and 153 males. In 115 patients (38.8%, group A), a resistant myeloma was diagnosed; in 135 (44.1%, group B) a relapse, and in 56 (18.3%, group C) a stable disease were stated. In 92.8% of patients, LEN+DEX combination was used; in remaining group, LEN monotherapy or a combination therapy LEN+bortezomib or LEN+bendamustine and other were used. In the entire study group, ORR was 75.5% (including 12.4% patients achieving complete remission [CR] or stringent CR [sCR]). Median time to progression (TTP) was 20 months. Median overall survival (OS) was 33.3 months. The regression model for "treatment response" was on the borderline of statistical significance (p=0.07), however the number of LEN treatment cycles ≥ 6 (R(2)=17.2%), baseline LDH level (R(2)=1.1%) and no ASCT use (R(2)=1.7%) where the factors most affecting treatment response achievement. The regression model for dependant variable--"overall survival"--was statistically significant (p=0.0000004). Factors with the most impact on OS were as follows: number of LEN cycles treatment ≥ 6 (R(2)=16.7%), treatment response achievement (R(2)=6.9%), β-2-microglobulin (β-2-M) level (R(2)=4.8%), renal function (R(2)=3.0%) and lack of 3/4 grade adverse events (R(2)=1.4%). SUMMARY LEN is an effective and safe therapeutic option, even in intensively treated resistant and relapsed MM patients, as well as in patients with stable disease and previous treatment-induced neurological complications. In particular, the number of LEN treatment cycles ≥ 6 was the factor which affected treatment response achievement the most, together with an important impact on OS.
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Affiliation(s)
- L Usnarska-Zubkiewicz
- Department of Haematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Poland.
| | - J Dębski
- Department of Haematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Poland
| | - A Butrym
- Department of Haematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Poland; Department of Physiology, Wroclaw Medical University, Poland
| | - W Legieć
- Department of Haematology and Bone Marrow Transplantation, Medical University of Lublin, Poland
| | - M Hus
- Department of Haematology and Bone Marrow Transplantation, Medical University of Lublin, Poland
| | - A Dmoszyńska
- Department of Haematology and Bone Marrow Transplantation, Medical University of Lublin, Poland
| | - B Stella-Hołowiecka
- Department of Haematology and Bone Marrow Transplantation, Medical University of Silesia, Katowice, Poland
| | | | | | - M Rymko
- Department of Haematology, District Hospital in Torun, Poland
| | - T Torosian
- Department of Haematology, Oncology and Internal Medicine, Warsaw Medical University, Poland
| | - G Charliński
- Department of Haematology, Oncology and Internal Medicine, Warsaw Medical University, Poland
| | - E Lech-Marańda
- Department of Haematology, Institute of Haematology and Blood Transfusion, Warsaw, Poland; Centre of Postgraduate Medical Education, Warsaw, Poland
| | - A Malenda
- Department of Haematology, Institute of Haematology and Blood Transfusion, Warsaw, Poland
| | - A Jurczyszyn
- Department of Haematology, Collegium Medicum at the Jagiellonian University, Cracow, Poland
| | - H Urbańska-Ryś
- Department of Haematology, Medical University of Lodz, Poland
| | - A Druzd-Sitek
- Department of Lymphoproliferative Diseases, Maria Sklodowska-Curie Memorial Institute and Oncology Centre, Warsaw, Poland
| | - D Błońska
- Department of Haematology and Neoplasmatic Diseases of Haematopoiesis, Bydgoszcz, Poland
| | - A Urbanowicz
- Department of Clinical Oncology and Haematology, District Hospital in Suwalki, Poland
| | - J Hołojda
- Department of Haematology, District Specialist Hospital in Legnica, Poland
| | - J Pogrzeba
- Department of Haematology and Haematooncology, District Hospital in Opole, Poland
| | - P Rzepecki
- Department of Internal Diseases and Haematology, Military Institute of Medicine, Central Clinical Hospital of the Ministry of National Defence, Warsaw, Poland
| | - J Hałka
- Department of Internal Diseases and Haematology, Military Institute of Medicine, Central Clinical Hospital of the Ministry of National Defence, Warsaw, Poland
| | - E Subocz
- Department of Internal Diseases and Haematology, Military Institute of Medicine, Central Clinical Hospital of the Ministry of National Defence, Warsaw, Poland
| | - R Becht
- Department of Haematology, Pomeranian Medical University, Szczecin, Poland
| | - B Zdziarska
- Department of Haematology, Pomeranian Medical University, Szczecin, Poland
| | - D Dytfeld
- Department of Haematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poland
| | - A Nowicki
- Department of Haematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poland
| | - Ł Bołkun
- Department of Haematology, University Clinical Hospital of Białystok, Poland
| | - J Kłoczko
- Department of Haematology, University Clinical Hospital of Białystok, Poland
| | - W Knopińska-Posłuszny
- Ministry of the Interior Hospital in Olsztyn with Warmia and Masuria Oncology Center, Poland
| | - A Zubkiewicz-Kucharska
- Department of Endocrinology and Diabetology for Children and Adolescents, Wroclaw Medical University, Poland
| | - K Kuliczkowski
- Department of Haematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Poland
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Activity of 129 single-agent drugs in 228 phase I and II clinical trials in multiple myeloma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2013; 14:284-290.e5. [PMID: 24565465 DOI: 10.1016/j.clml.2013.12.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 12/17/2013] [Accepted: 12/23/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND More than 400 preclinical studies report ≥ 1 compound as cytotoxic to multiple myeloma (MM) cells; however, few of these agents became relevant in the clinic. Thus, the utility of such assays in predicting future clinical value is debatable. PATIENTS AND METHODS We examined the application of early-phase trial experiences to predict future clinical adoption. We identified 129 drugs explored as single agents in 228 trials involving 7421 patients between 1961 and 2013. RESULTS All drugs in common use in MM (melphalan, dexamethasone, prednisone, cyclophosphamide, bendamustine, thalidomide, lenalidomide, pomalidomide, bortezomib, carfilzomib, and doxorubicin) demonstrated a best reported response rate of ≥ 22%. Older agents, including teniposide, fotemustine, paclitaxel, and interferon, also appear active by this criterion; however, if mean response rates from all reported trials for an agent are considered, then only drugs with a mean response rate of 15% partial response are in clinical use. CONCLUSION Our analysis suggests that thresholds of 20% for best or 15% for mean response are highly predictive of future clinical success. Below these thresholds, no drug has yet reached regulatory approval or widespread use in the clinic. Thus, this benchmark provides 1 element of the framework for guiding choice of drugs for late-stage clinical testing.
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Subclinical pretreatment sensory deficits appear to predict the development of pain and numbness in patients with multiple myeloma undergoing chemotherapy. Cancer Chemother Pharmacol 2013; 71:1531-40. [PMID: 23543296 DOI: 10.1007/s00280-013-2152-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 03/17/2013] [Indexed: 12/15/2022]
Abstract
PURPOSE Chemotherapy-induced peripheral neuropathy is a major complication in the treatment for cancer, including multiple myeloma (MM). Patients may develop painful and non-painful (e.g., numbness) neuropathy symptoms that impair function and often persist after therapy is terminated. This study tested the hypothesis that baseline subclinical neuropathy, as assessed by sensory thresholds, is related to the development of neuropathy symptoms (e.g., pain and numbness) in patients with MM undergoing treatment with chemotherapy. METHODS Patients (n = 56) who had undergone two or fewer cycles of induction therapy and who had no evident neuropathy were assessed using quantitative sensory tests to determine multiple-modality sensory thresholds. Patient-reported pain and numbness were assessed through induction therapy (16 weeks) via the MD Anderson Symptom Inventory. A subset of participants (n = 15) continued reporting on their symptoms for an additional 16 weeks ("maintenance phase"). RESULTS Patients with sharpness detection deficits at baseline (n = 11, 20 % of sample) reported less severe pain and numbness during induction therapy and less numbness during maintenance therapy (P < 0.05). During the maintenance phase, patients with warmth detection deficits (n = 5, 38 % of sample) reported more severe pain and numbness, and those with skin temperature deficits (n = 7, 47 % of maintenance sample) reported more severe pain (P < 0.05). These deficits were related to patient reported difficulty walking, a common symptom of peripheral neuropathy. CONCLUSION Our results suggest that baseline subclinical sensory deficits may be related to a patient's risk for developing chemotherapy-induced peripheral neuropathy.
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Zamagni E, Petrucci A, Tosi P, Tacchetti P, Perrone G, Brioli A, Pantani L, Zannetti B, Terragna C, Baccarani M, Cavo M. Long-term results of thalidomide and dexamethasone (thal-dex) as therapy of first relapse in multiple myeloma. Ann Hematol 2011; 91:419-26. [PMID: 21901342 DOI: 10.1007/s00277-011-1320-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Accepted: 08/22/2011] [Indexed: 11/24/2022]
Abstract
Thal-dex (TD) is an effective therapy for advanced MM. We evaluated TD as salvage treatment of MM patients at first relapse. Thal was given at a daily dose of 100 or 200 mg until progression. Dex was administered 160 mg/month. One hundred patients were enrolled. First line therapy included ASCT (72%) and conventional CHT (28%). Fifty-nine percent received a fixed thal dose of 100 mg/day. The most frequent adverse events were constipation (42%), peripheral neuropathy (58%, 5% grade 3), bradycardia (20%), skin rash (11%), and VTE (7%). Discontinuation of thal due to adverse events was recorded in eight patients. On ITT, 46% of patients achieved at least a PR. Median DOR was 28 months, median time to next therapy was 15.5 months. Median OS, TTP, and PFS were 43, 22, and 21 months, respectively. TTP and PFS were significantly longer for patients with at least PR to TD. TD was an effective salvage treatment for MM patients at first relapse, as demonstrated by durable disease control and prolonged OS. TD was well tolerated, as reflected by the long stay on treatment without disease progression (median 25 months) and a low discontinuation rate due to toxicity (8%).
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Affiliation(s)
- Elena Zamagni
- "Seràgnoli" Institute of Hematology, Bologna University School of Medicine, Bologna, Italy.
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Mohty B, El-Cheikh J, Yakoub-Agha I, Moreau P, Harousseau JL, Mohty M. Peripheral neuropathy and new treatments for multiple myeloma: background and practical recommendations. Haematologica 2010; 95:311-9. [PMID: 20139393 DOI: 10.3324/haematol.2009.012674] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
In multiple myeloma, peripheral neuropathy has for a long time been considered as mainly secondary to the plasma cell dyscrasia itself. With the advent of new targeted drugs such as thalidomide and bortezomib, the iatrogenic neurotoxicity has become the leading cause of peripheral neuropathy. This review discusses the pathogenesis, incidence, risk factors, diagnosis, characteristics, and management of peripheral neuropathy related to new multiple myeloma drugs, mainly bortezomib and thalidomide. The current knowledge of the pathophysiology of the new forms of peripheral neuropathy is still limited. The mechanisms involved depend on the agents used, patient's medical history, and duration of exposure and/or treatment doses or sequence. Diagnosis of such peripheral neuropathy is often easier than treatment. A full anamnesis and regular clinical evaluation are necessary. Electrophysiological assessments may support the diagnosis, although their contribution remains insufficient. Complex clinical features may require a specialized neurological assessment within the context of a multi-disciplinary approach. Finally, early detection of peripheral neuropathy and the use of dose adjustment algorithms as in the case of bortezomib, should help reduce the side effects while maintaining anti-tumor efficacy.
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Affiliation(s)
- Bilal Mohty
- 1Service d'Hématologie, Hopital Universitaire de Genève, Geneva, Switzerland
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Velasco R, Bruna J. Chemotherapy-induced peripheral neuropathy: An unresolved issue. NEUROLOGÍA (ENGLISH EDITION) 2010. [DOI: 10.1016/s2173-5808(10)70022-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Abstract
Thalidomide and bortezomib are remarkably efficacious in the treatment of multiple myeloma. Unfortunately, their use can cause sensory neuropathy, a common and serious adverse event that frequently limits dose and duration of treatment. Although the relationship between peripheral neuropathy and therapeutic dose is controversial, many authors have demonstrated a positive correlation between neuropathy and cumulative dose, dose intensity, and length of therapy. Peripheral neuropathic pain is the most troublesome symptom of neuropathy. Spontaneous pain, allodynia, hyperalgesia, and hyperpathia are often associated with decreased physical activity, increased fatigue, mood, and sleep problems. Symptoms are often difficult to manage, and available treatment options rarely provide total relief. Moreover, the adverse effects of these treatments often limit their use. Several studies have demonstrated the efficacy of acupuncture, with fewer adverse effects than analgesic drugs, in the treatment of painful diabetic and human immunodeficiency virus-related neuropathy. However, the effectiveness of acupuncture in treating toxic neuropathy has not been assessed. Although its putative mechanisms remain elusive, acupuncture has strong potential as an adjunctive therapy in thalidomide- or bortezomib-induced painful neuropathy, and a better understanding might guide its use in the management of chemotherapy-induced neuropathic pain. Well-designed clinical trials with adequate sample size and power are warranted.
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Schiff D, Wen PY, van den Bent MJ. Neurological adverse effects caused by cytotoxic and targeted therapies. Nat Rev Clin Oncol 2009; 6:596-603. [DOI: 10.1038/nrclinonc.2009.128] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Affiliation(s)
- Linda Mileshkin
- Division of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.
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Cherian G, Thomas DW, Rule SAJ. The efficacy of low dose thalidomide in refractory/relapsed myeloma—a retrospective audit. Leuk Lymphoma 2009; 47:2409-11. [PMID: 17107918 DOI: 10.1080/10428190600879813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Elsea CR, Roberts DA, Druker BJ, Wood LJ. Inhibition of p38 MAPK suppresses inflammatory cytokine induction by etoposide, 5-fluorouracil, and doxorubicin without affecting tumoricidal activity. PLoS One 2008; 3:e2355. [PMID: 18523641 PMCID: PMC2396285 DOI: 10.1371/journal.pone.0002355] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2007] [Accepted: 05/01/2008] [Indexed: 02/07/2023] Open
Abstract
Cancer patients undergoing treatment with systemic cancer chemotherapy drugs often experience debilitating fatigue similar to sickness behavior, a normal response to infection or tissue damage caused by the production of the inflammatory cytokines IL-1β, TNF-α, and IL-6. The p38 mitogen activated protein kinase (p38 MAPK) plays a central role in the production of these cytokines and consequently the development of sickness behavior. Targeted inhibitors of p38 MAPK can reduce systemic inflammatory cytokine production and the development of sickness behavior. Several systemic cancer chemotherapy drugs have been shown to stimulate inflammatory cytokine production, yet whether this response is related to a common ability to activate p38 MAPK is not known and is the focus of this study. This understanding may present the possibility of using p38 MAPK inhibitors to reduce chemotherapy-induced inflammatory cytokine production and consequently treatment-related fatigue. One caveat of this approach is a potential reduction in chemotherapeutic efficacy as some believe that p38 MAPK activity is required for chemotherapy-induced cytotoxicity of tumor cells. The purpose of this study was to demonstrate proof of principal that p38 MAPK inhibition can block chemotherapy- induced inflammatory cytokine production without inhibiting drug-induced cytotoxicity using murine peritoneal macrophages and Lewis Lung Carcinoma (LLC1) cells as model cell systems. Using these cells we assessed the requirement of etoposide, doxorubicin, 5-flourouracil, and docetaxel for p38 MAPK in inflammatory cytokine production and cytotoxicity. Study findings demonstrate that clinically relevant doses of etoposide, doxorubicin, and 5-FU activated p38 MAPK in both macrophages and LLC1 cells. In contrast, docetaxel failed to activate p38 MAPK in either cell type. Activation of p38 MAPK mediated the drug's effects on inflammatory cytokine production in macrophages but not LLC1 cytotoxicity and this was confirmed with inhibitor studies.
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Affiliation(s)
- Collin R Elsea
- School of Nursing, Oregon Health & Science University, Portland, Oregon, United States of America
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El-Cheikh J, Stoppa AM, Bouabdallah R, de Lavallade H, Coso D, de Collela JMS, Auran-Schleinitz T, Gastaut JA, Blaise D, Mohty M. Features and Risk Factors of Peripheral Neuropathy During Treatment with Bortezomib for Advanced Multiple Myeloma. ACTA ACUST UNITED AC 2008; 8:146-52. [DOI: 10.3816/clm.2008.n.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Bowcock SJ, Minchom A, Yates LR, Ryali MM. Ultra low dose thalidomide in elderly patients with myeloma. Br J Haematol 2008; 141:120-2. [DOI: 10.1111/j.1365-2141.2008.06989.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Prince HM, Adena M, Smith DK, Hertel J. Efficacy of single-agent bortezomib vs. single-agent thalidomide in patients with relapsed or refractory multiple myeloma: a systematic comparison. Eur J Haematol 2007; 79:93-9. [PMID: 17608711 PMCID: PMC1974816 DOI: 10.1111/j.1600-0609.2007.00886.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2007] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To conduct a systematic review of the efficacy of single-agent bortezomib vs. single-agent thalidomide in patients with relapsed/refractory multiple. METHODS Publications in English from 1966 to June 2005 (MEDLINE, EMBASE, Cochrane library), publication reference lists, Janssen-Cilag data-on-file and abstracts from recent multiple myeloma conferences were reviewed. Prospective studies containing at least a single arm of either treatment group with n> or =30 were included. Studies adding dexamethasone for non-responders were excluded. Statistical pooling was performed for response rate and overallsurvival. RESULTS One bortezomib study (n = 333, NEJM 2005, 352; 2487-98) and 15 thalidomide (n = 1007) studies met these criteria and were included. Patient baseline characteristics including age, gender, IgG : IgA, disease duration and beta-2 microglobulin were well matched except that 48% of bortezomib patients had received prior thalidomide. Response rate, defined as serum M-protein reduction > or =50%, was 53% for patients receiving bortezomib vs. 32% for thalidomide (P < 0.001, n = 10 studies). Response rate determined by European Group for Blood and Marrow Transplantation (EBMT) criteria was 41% for patients receiving bortezomib vs. 22% for thalidomide (P < 0.001, n = 4 studies). CONCLUSION Bortezomib was associated with a significantly higher response rate and complete remission rate using both M-protein and EBMT criteria.
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Affiliation(s)
- H Miles Prince
- Department of Haematology and Medical Oncology, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Vic., Australia
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Abstract
Although hepatotoxicity is a frequent concern with all medications, chemotherapeutic agents are more often implicated in causing liver damage than most other drug classes. In many instances, these reactions are considered dose related because cytotoxic therapy directed at rapidly growing cancer cells may readily impact hepatocytes even though they are dividing more slowly. Because the stakes (remission of cancer) are high, so are the risks that the oncologist and the patient are willing to assume. The dose of many chemotherapeutic agents is limited by the toxic effects on the lungs, bone marrow, kidneys, and gastrointestinal system, including the liver. An awareness of the toxic potential of each chemotherapeutic agent is necessary before initiation of new oncologic treatments.
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Affiliation(s)
- Edmundo A Rodriguez-Frias
- Department of Internal Medicine, The University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
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Prince HM, Schenkel B, Mileshkin L. An analysis of clinical trials assessing the efficacy and safety of single-agent thalidomide in patients with relapsed or refractory multiple myeloma. Leuk Lymphoma 2007; 48:46-55. [PMID: 17325847 DOI: 10.1080/10428190601001904] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Given that the efficacy/safety of thalidomide for relapsed or refractory multiple myeloma have not been well characterized in a randomized, controlled setting, an analysis of larger, single-agent trials was conducted. Nine trials met the following inclusion criteria: primary population of multiple myeloma; all patients relapsed or refractory; single-agent thalidomide; and sample size > or =50. At median doses of 200 - 800 mg per day, the pooled overall response rate (ORR) was 28.2% (95% CI: 22.6 - 33.7%), including a complete response (CR) rate of 1.6% (95% CI: 0.3 - 2.9%) and partial response rate of 26.0% (95% CI: 20.1 - 32.0%). Response was typically based on M-protein reduction alone. Peripheral neuropathy (PN) incidence varied from 12 - 44%, possibly impacted by the short median follow-up (9 - 29 months). Pooled venous thromboembolism (VTE) incidence was 2.7% (95% CI: 1.1 - 4.3%) and discontinuation due to intolerance (DDI) rate was 14.9% (95% CI: 12.0 - 17.7%). Overall survival (OS), progression-free survival (PFS) and PN incidence were not pooled due to lack of reporting and trial heterogeneity. Prognostic factors identified included B2M (PFS) and advanced age (PFS and OS). Overall, thalidomide demonstrated an ORR approaching 30%, with low CR rate of 1.6% and VTE and DDI incidences of 3% and 15%, respectively.
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Affiliation(s)
- H Miles Prince
- Division of Haematology and Medical Oncology, Peter MacCallum Cancer Centre and University of Melbourne, Victoria, Australia.
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Abstract
Significant progress in the treatment of multiple myeloma has resulted in improvement of disease control with a trend toward overall and progression-free survival benefit. With the availability of several new therapeutic agents and combinations, a careful emphasis should be placed in the management of disease- and therapy-associated complications. Aggressive management of these complications can impact patients' quality of life as well as treatment outcome. This review highlights some of the critical supportive care measures integral to the optimal care of patients with multiple myeloma.
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Sohlbach K, Heinze S, Shiratori K, Sure U, Pagenstecher A, Neubauer A. Encephalopathy in a Patient After Long-Term Treatment With Thalidomide. J Clin Oncol 2006; 24:4942-4. [PMID: 17050881 DOI: 10.1200/jco.2006.06.5920] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Kristina Sohlbach
- University Hospital, Institute of Hematology/Oncology/Immunology, Marburg, Germany
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Mileshkin L, Stark R, Day B, Seymour JF, Zeldis JB, Prince HM. Development of neuropathy in patients with myeloma treated with thalidomide: patterns of occurrence and the role of electrophysiologic monitoring. J Clin Oncol 2006; 24:4507-14. [PMID: 16940275 DOI: 10.1200/jco.2006.05.6689] [Citation(s) in RCA: 160] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Peripheral neuropathy frequently limits the duration of treatment with thalidomide for patients with multiple myeloma. We assessed the time course of occurrence, possible predictive factors, and the utility of serial nerve electrophysiological studies (NES) for detecting onset of neuropathy. PATIENTS AND METHODS Seventy-five patients with relapsed/refractory myeloma were enrolled onto a multicenter trial of dose-escalating thalidomide with or without interferon. Patients underwent clinical assessment plus NES at baseline and every 3 months. Time to development of neuropathy according to clinical or NES criteria was compared. Patient and treatment-related factors were compared as predictors of neuropathy. RESULTS Thirty-nine percent had some NES abnormalities at baseline. Patients received thalidomide at a median dose-intensity of 373 mg/d. Thirty-one of 75 patients (41%) developed neuropathy during thalidomide treatment; 11 patients (15%) discontinued treatment with thalidomide due to neuropathy. The actuarial incidence of neuropathy increased from 38% at 6 months to 73% at 12 months, with 81% of responding patients developing this complication. Serial NES did not reliably predict the imminent development of clinical neuropathy requiring thalidomide cessation, nor were patient age, sex, or prior therapy predictive. Patients who developed neuropathy had a longer duration of thalidomide exposure (median, 268 v 89 days; P = .0001). Cumulative dose or dose-intensity received was not predictive. CONCLUSION The majority of patients will develop peripheral neuropathy given sufficient length of treatment with thalidomide. To minimize the risk of neurotoxicity, therapy should be limited to less than 6 months. Electrophysiologic monitoring provides no clear benefit versus careful clinical evaluation for the development of clinically significant neuropathy.
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Affiliation(s)
- Linda Mileshkin
- Division of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.
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Hausheer FH, Schilsky RL, Bain S, Berghorn EJ, Lieberman F. Diagnosis, management, and evaluation of chemotherapy-induced peripheral neuropathy. Semin Oncol 2006; 33:15-49. [PMID: 16473643 DOI: 10.1053/j.seminoncol.2005.12.010] [Citation(s) in RCA: 286] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Peripheral neuropathy induced by cancer chemotherapy represents a large unmet need for patients due to the absence of treatment that can prevent or mitigate this common clinical problem. Chemotherapy-induced peripheral neuropathy (CIPN) diagnosis and management is further compounded by the lack of reliable and standardized means to diagnose and monitor patients who are at risk for, or who are symptomatic from, this complication of treatment. The pathogenesis and pathophysiology of CIPN are not fully elucidated, but there is increasing evidence of damage or interference with tubulin function. The diagnosis of CIPN may present a diagnostic dilemma due to the large number of potential toxic etiologies and conditions, which may mimic some of the clinical features; the diagnosis must be approached with care in such patients. The incidence and severity of CIPN is commonly under-reported by physicians as compared with patients. The development of new and reliable methods for the assessment of CIPN as well as safe and effective treatments to prevent this complication of treatment would represent important medical advancements for cancer patients.
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Palumbo A, Bringhen S, Caravita T, Merla E, Capparella V, Callea V, Cangialosi C, Grasso M, Rossini F, Galli M, Catalano L, Zamagni E, Petrucci MT, De Stefano V, Ceccarelli M, Ambrosini MT, Avonto I, Falco P, Ciccone G, Liberati AM, Musto P, Boccadoro M. Oral melphalan and prednisone chemotherapy plus thalidomide compared with melphalan and prednisone alone in elderly patients with multiple myeloma: randomised controlled trial. Lancet 2006; 367:825-31. [PMID: 16530576 DOI: 10.1016/s0140-6736(06)68338-4] [Citation(s) in RCA: 577] [Impact Index Per Article: 32.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Since 1960, oral melphalan and prednisone (MP) has been regarded as the standard of care in elderly multiple myeloma patients. This multicentre randomised trial compared oral MP plus thalidomide (MPT) with MP alone in patients aged 60-85 years. METHODS Patients with newly diagnosed multiple myeloma were randomly assigned to receive oral MP for six 4-week cycles plus thalidomide (n=129; 100 mg per day continuously until any sign of relapse or progressive disease) or MP alone (n=126). Analysis was intention-to-treat. This study is registered at , number NCT00232934. RESULTS Patients treated with thalidomide had higher response rates and longer event-free survival (primary endpoints) than patients who were not. Combined complete or partial response rates were 76.0% for MPT and 47.6% for MP alone (absolute difference 28.3%, 95% CI 16.5-39.1), and the near-complete or complete response rates were 27.9% and 7.2%, respectively. 2-year event-free survival rates were 54% for MPT and 27% for MP (hazard ratio [HR] for MPT 0.51, 95% CI 0.35-0.75, p=0.0006). 3-year survival rates were 80% for MPT and 64% for MP (HR for MPT 0.68, 95% CI 0.38-1.22, p=0.19). Rates of grade 3 or 4 adverse events were 48% in MPT patients and 25% in MP patients (p=0.0002). Introduction of enoxaparin prophylaxis reduced rate of thromboembolism from 20% to 3% (p=0.005). CONCLUSION Oral MPT is an effective first-line treatment for elderly patients with multiple myeloma. Anticoagulant prophylaxis reduces frequency of thrombosis. Longer follow-up is needed to assess effect on overall survival.
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Affiliation(s)
- Antonio Palumbo
- Divisione di Ematologia dell'Università di Torino, Azienda Ospedaliera S Giovanni Battista, 10126 Torino, Italy.
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Abstract
Multiple myeloma is an incurable bone marrow cancer, the treatment of which is notoriously difficult. Only modest advances have been achieved using complex polychemotherapeutic regimens, transplant strategies and supportive therapy. In 1999, when new drugs for myeloma were urgently needed, thalidomide was introduced and opened up a completely new line of therapy for the disease. Although the mechanism of action is not yet completely understood, thalidomide has demonstrated efficacy in patients with refractory, relapsed myeloma, even in late-stage cases. This article reviews the current knowledge of thalidomide in myeloma treatment, focusing especially on the possible mechanisms of action, clinical results and adverse events of this drug.
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Affiliation(s)
- Ramón García-Sanz
- Department of Haematology, University Hospital of Salamanca, Paseo de San Vicente, 58-182, Salamanca, 37007, Spain.
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28
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Abstract
PURPOSE OF REVIEW This paper examines recent research on toxic neuropathy and potential therapeutic developments. It also summarizes reports of new agents reported to cause peripheral neuropathy. RECENT FINDINGS Gene therapy with vasoactive endothelial growth factor, neurotrophic substances such as nerve growth factor and neurotrophin-3 are reported to reverse or protect against neurotoxicity in animal models. The neuroprotective effects of more established therapeutic agents like vitamin E, tacrolimus (FK 506) and erythropoietin hold promise for the immediate future. Cisplatin and high-dose pyridoxine are used more frequently to produce robust models of peripheral neuropathy in animals. Statins do appear to cause peripheral neuropathy. The incidence is low, however, and compared to its benefits in terms of cardiovascular protection, relatively innocuous. The profile of thalidomide neuropathy is becoming clearer as the indications for this drug increases. The incidence of thalidomide neuropathy is high, up to three quarters in some series, and although the information on dose dependency is variable, lower cumulative doses appear to be less toxic. Like thalidomide bortezomib, a novel proteosome inhibitor, is reportedly effective in the treatment of multiple myeloma and is associated with peripheral neuropathy. Oxaliplatin and epothilone are emerging anticancer drugs with neurotoxic potential. Similarly, leflunomide, a new disease modifying-agent approved for the treatment of rheumatoid arthritis, is reported to cause neuropathy. SUMMARY The study of toxic neuropathy is not only enhancing our knowledge of the mechanisms of neurotoxicity but also the neurobiology of peripheral neuropathy in general; and is likely to reveal avenues for therapeutics.
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Affiliation(s)
- Thirugnanam Umapathi
- Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore.
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Tosi P, Zamagni E, Cellini C, Plasmati R, Cangini D, Tacchetti P, Perrone G, Pastorelli F, Tura S, Baccarani M, Cavo M. Neurological toxicity of long-term (>1 yr) thalidomide therapy in patients with multiple myeloma. Eur J Haematol 2005; 74:212-6. [PMID: 15693790 DOI: 10.1111/j.1600-0609.2004.00382.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Thalidomide is remarkably active in advanced relapsed and refractory multiple myeloma (MM), so that its use has been recently proposed either in newly diagnosed patients or as maintenance treatment after conventional or high-dose therapy. This latter therapeutic approach has risen the concern of side-effects of long-term therapy with this drug. METHODS We analysed long-term toxicity of 40 patients (27 M, 13 F, median age = 61.5 yr) who received salvage therapy with thalidomide +/- dexamethasone for longer than 12 months (median 15, range 12-44) at our centre. All the patients had achieved at least a stable disease upon treatment with thalidomide alone (200-400 mg/d, n = 20) or thalidomide (200 mg/d) and dexamethasone (40 mg/d for 4 d every 4 wk) (n = 20). RESULTS AND CONCLUSIONS Neurotoxicity was the most troublesome and frequent toxic effect that was observed after long-term treatment, the incidence averaging 75%. Among these 30 patients symptoms included paraesthesias, tremor and dizziness. Neurotoxicity was grade 1 in six patients (15%); grade 2 in 13 patients (32.5%), thus determining thalidomide dose reduction to 100 mg/d; and grade 3 in 11 patients (27.5%) who had subsequently to interrupt therapy despite their response. Electromyographic study, performed in patients with grade >/=2 neurotoxicity, revealed a symmetrical, mainly sensory peripheral neuropathy, with minor motor involvement. The severity of neurotoxicity was not related to cumulative or daily thalidomide dose, but only to the duration of the disease prior to thalidomide treatment, although no patients presented neurological symptoms at study entry. These results suggest that long-term thalidomide therapy in MM may be hampered by the remarkable neurotoxicity of the drug, and that a neurological evaluation should be mandatory prior to thalidomide treatment, in order to identify patients at risk of developing a peripheral neuropathy.
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Affiliation(s)
- Patrizia Tosi
- Institute of Hematology and Medical Oncology, Seragnoli University of Bologna, Bologna, Italy.
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