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Matthys A, Bardel B, Le Bras F, Créange A, Nordine T, Gounot R, Ingen‐Housz‐Oro S, Carvalho M, Lefaucheur J, Haioun C, Planté‐Bordeneuve V, Gendre T. Rate and characteristics of inflammatory neuropathies associated with brentuximab vedotin therapy. Eur J Neurol 2024; 31:e16285. [PMID: 38511878 PMCID: PMC11235775 DOI: 10.1111/ene.16285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND AND PURPOSE Peripheral neuropathy is a frequent complication of brentuximab vedotin (BV), used in CD30+ lymphoma treatment. Classic BV-induced neuropathy (BV-CN) is a mild distal sensory axonal polyneuropathy. Severe BV-induced inflammatory neuropathies (BV-IN) have been described. BV-IN contribute to lymphoma-associated morbidity but might be immunotherapy-responsive. Our primary objective was to evaluate the rate of BV-IN. Our secondary objectives were to determine risk factors and warning signs. METHODS We conducted a retrospective cohort study on all patients treated with BV at our center between April 2014 and September 2021. Clinical, biological, and electrophysiological data were collected. BV-induced neuropathy was defined as the occurrence of neuropathy up to 3 months after BV discontinuation. BV-IN was defined with criteria adapted from European Academy of Neurology/Peripheral Nerve Society 2021 electrodiagnostic criteria for chronic inflammatory demyelinating polyradiculoneuropathy. Other neuropathies were classified as BV-CN. RESULTS Among 83 patients, 41 (49%) developed neuropathy: 35 BV-CN and 6 BV-IN. Thus, the rate of BV-IN was 7.2%. Compared to patients with BV-CN, no predisposing factor was identified. However, patients with BV-IN more frequently presented muscle weakness (67% vs. 5.7%, p < 0.05), gait disorders (83% vs. 20%, p < 0.05), or acute or subacute onset (67% vs. 14%, p < 0.05). BV-IN was frequently more severe (Common Terminology Criteria for Adverse Events grade ≥3; 50% vs. 0%, p < 0.05). Four patients were treated with immunotherapy. CONCLUSIONS Brentuximab vedotin-induced neuropathy is an overlooked complication. Based on four easily identifiable "red flags", we provide an algorithm to help non-neurologist physicians that care for BV-treated patients to detect BV-IN. The aim of the algorithm is to decrease the diagnostic and management delay of this disabling neuropathy.
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Affiliation(s)
- Arthur Matthys
- Department of NeurologyAP‐HP, Henri Mondor University HospitalCréteilFrance
- Center for Interdisciplinary Research in Biology, Collège de France, CNRS UMR 7241, INSERM U1050, Labex MemolifePSL Research UniversityParisFrance
| | - Benjamin Bardel
- Unit of Clinical NeurophysiologyAP‐HP, Henri Mondor University HospitalCréteilFrance
- Reference Center for Neuromuscular Diseases Nord/Est/Ile‐de‐FranceParisFrance
| | - Fabien Le Bras
- Lymphoid Malignancies UnitAP‐HP, Henri Mondor University HospitalCréteilFrance
| | - Alain Créange
- Department of NeurologyAP‐HP, Henri Mondor University HospitalCréteilFrance
- Reference Center for Neuromuscular Diseases Nord/Est/Ile‐de‐FranceParisFrance
| | - Tarik Nordine
- Unit of Clinical NeurophysiologyAP‐HP, Henri Mondor University HospitalCréteilFrance
- Reference Center for Neuromuscular Diseases Nord/Est/Ile‐de‐FranceParisFrance
| | - Romain Gounot
- Lymphoid Malignancies UnitAP‐HP, Henri Mondor University HospitalCréteilFrance
| | - Saskia Ingen‐Housz‐Oro
- Department of Dermatology, Paris‐Est Créteil University EpiDermEAP‐HP, Henri Mondor University HospitalCréteilFrance
| | - Muriel Carvalho
- Department of PharmacyAP‐HP, Henri Mondor University HospitalCréteilFrance
| | - Jean‐Pascal Lefaucheur
- Unit of Clinical NeurophysiologyAP‐HP, Henri Mondor University HospitalCréteilFrance
- Reference Center for Neuromuscular Diseases Nord/Est/Ile‐de‐FranceParisFrance
| | - Corinne Haioun
- Lymphoid Malignancies UnitAP‐HP, Henri Mondor University HospitalCréteilFrance
| | - Violaine Planté‐Bordeneuve
- Department of NeurologyAP‐HP, Henri Mondor University HospitalCréteilFrance
- Reference Center for Neuromuscular Diseases Nord/Est/Ile‐de‐FranceParisFrance
| | - Thierry Gendre
- Department of NeurologyAP‐HP, Henri Mondor University HospitalCréteilFrance
- Reference Center for Neuromuscular Diseases Nord/Est/Ile‐de‐FranceParisFrance
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Brentuximab-Induced Sensorimotor Polyneuropathy With Acquired Demyelinating Features Resembling Chronic Inflammatory Demyelinating Polyneuropathy. J Clin Neuromuscul Dis 2022; 23:166-168. [PMID: 35188920 DOI: 10.1097/cnd.0000000000000352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Velasco R, Domingo-Domenech E, Sureda A. Brentuximab-Induced Peripheral Neurotoxicity: A Multidisciplinary Approach to Manage an Emerging Challenge in Hodgkin Lymphoma Therapy. Cancers (Basel) 2021; 13:6125. [PMID: 34885234 PMCID: PMC8656789 DOI: 10.3390/cancers13236125] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/27/2021] [Accepted: 11/30/2021] [Indexed: 01/30/2023] Open
Abstract
Brentuximab vedotin (BV) is an anti-CD30 antibody-drug conjugate approved to treat classical Hodgkin lymphoma (HL). BV-induced peripheral neurotoxicity (BVIN) is one of the greatest concerns for haematologists treating HL for several reasons. First, BVIN is highly frequent. Most patients receiving BV will experience some degree of BVIN, resulting in the primary reason for dose modification or discontinuation of HL therapy. Second, BV produces sensory, motor, and/or autonomic peripheral nerve dysfunction, which can present as severe, disabling forms of BVIN-predominantly motor-in some patients. Third, although largely reversible, BVIN may persist months or years after treatment and thereby become a major issue in HL survivorship. BVIN may, therefore, negatively affect the quality of life and work-life of often young patients with HL, in whom long-term survival is expected. Currently, the only strategy for BVIN includes dose adjustments and treatment discontinuation; however, this could interfere with LH therapy efficacy. In this setting, early recognition and adequate management of BVIN are critical in improving clinical outcomes. Careful neurologic monitoring may allow accurate diagnoses and gradation of ongoing forms of BVIN presentation. This review analysed current, available data on epidemiology, pathophysiology, patient- and treatment-related risk factors, clinical and neurophysiologic phenotypes, and management in patients with HL. Furthermore, this review specifically addresses limitations posed by BVIN assessments in clinical practice and provides skills and tools to improve neurologic assessments in these patients. Integrating this neurotoxic drug in clinical practice requires a multidisciplinary approach to avoid or minimise neurotoxicity burden in survivors of HL.
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Affiliation(s)
- Roser Velasco
- Neuro-Oncology Unit, Department of Neurology, Hospital Universitari de Bellvitge-Institut Català dOncologia, 08908 Barcelona, Spain
- Department of Cell Biology, Physiology and Immunology, Institute of Neurosciences, 08193 Bellaterra, Spain
| | - Eva Domingo-Domenech
- Department of Haematology, Catalan Institute of Oncology, Hospital Duran i Reynals, IDIBELL, University of Barcelona (UB), L’Hospitalet de Llobregat, 08908 Barcelona, Spain; (E.D.-D.); (A.S.)
| | - Anna Sureda
- Department of Haematology, Catalan Institute of Oncology, Hospital Duran i Reynals, IDIBELL, University of Barcelona (UB), L’Hospitalet de Llobregat, 08908 Barcelona, Spain; (E.D.-D.); (A.S.)
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Mechanisms of Nerve Damage in Neuropathies Associated with Hematological Diseases: Lesson from Nerve Biopsies. Brain Sci 2021; 11:brainsci11020132. [PMID: 33498362 PMCID: PMC7909400 DOI: 10.3390/brainsci11020132] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/15/2021] [Accepted: 01/18/2021] [Indexed: 12/15/2022] Open
Abstract
Despite the introduction of non-invasive techniques in the study of peripheral neuropathies, sural nerve biopsy remains the gold standard for the diagnosis of several neuropathies, including vasculitic neuropathy and neurolymphomatosis. Besides its diagnostic role, sural nerve biopsy has helped to shed light on the pathogenic mechanisms of different neuropathies. In the present review, we discuss how pathological findings helped understand the mechanisms of polyneuropathies complicating hematological diseases.
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Li T, Timmins HC, Lazarus HM, Park SB. Peripheral neuropathy in hematologic malignancies – Past, present and future. Blood Rev 2020; 43:100653. [DOI: 10.1016/j.blre.2020.100653] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/13/2019] [Accepted: 01/14/2020] [Indexed: 02/06/2023]
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Fargeot G, Dupel-Pottier C, Stephant M, Lazarovici J, Thomas L, Mouthon-Reignier C, Riad B, Carde P, Berzero G, Tafani C, Nicolas W, Viala K, Maisonobe T, Lenglet T, Wang A, Magy L, Bihan K, Gaspar N, Adams D, Echaniz-Laguna A, Cauquil C, Psimaras D. Brentuximab vedotin treatment associated with acute and chronic inflammatory demyelinating polyradiculoneuropathies. J Neurol Neurosurg Psychiatry 2020; 91:786-788. [PMID: 32327451 DOI: 10.1136/jnnp-2020-323124] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/06/2020] [Accepted: 04/08/2020] [Indexed: 01/20/2023]
Affiliation(s)
- Guillaume Fargeot
- Department of Neurology, French National Reference Center for Rare Neuropathies, Bicêtre Hospital, AP-HP, Le Kremlin-Bicetre, France
| | | | - Maeva Stephant
- Department of Neurology, French National Reference Center for Rare Neuropathies, Bicêtre Hospital, AP-HP, Le Kremlin-Bicetre, France
| | - Julien Lazarovici
- Department of Hematology, Gustave Roussy Institute, Villejuif, France
| | - Laure Thomas
- Regional Pharmacovigilance Center, Henri Mondor Hospital, Créteil, France
| | - Capucine Mouthon-Reignier
- Department of Neurology, Centre Hospitalier Sud Francilien Site Gilles de Corbeil, Corbeil-Essonnes, France
| | - Benramdane Riad
- Department of Hematology, Rene Dubos Hospital, Pontoise, Île-de-France, France
| | - Patrice Carde
- Department of Hematology, Gustave Roussy institute, Paris-Saclay University, Villejuif, France
| | - Giulia Berzero
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Neurologie 2-Mazarin et Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle Epinière (CRICM), UMRS 975, Paris 75013, France; Inserm U 975, CNRS, UMR 7225, Paris, France
| | - Camille Tafani
- Department of Neurology, Military Training Hospital Percy, Service de Santé des Armées, Paris, France, Military Health Service Academy of Val-de-Grâce, Service de Santé des Armées, Paris, France
| | - Weiss Nicolas
- Département de Neurologie, Unité de Médecine Intensive Réanimation neurologique, Sorbonne Université, Brain Liver Pitié-Salpêtrière (BLIPS) Study Group, INSERM UMR_S 938, Centre de recherche Saint-Antoine, Maladies métaboliques, biliaires et fibro-inflammatoire du foie, Institute of Cardiometabolism and Nutrition (ICAN), AP-HP. Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Karine Viala
- Department of Clinical Neurophysiology, Hôpitaux universitaires Pitié-Salpêtrière-Charles Foix. Assistance Publique Hôpitaux de Paris (APHP), Paris, France
| | - Thierry Maisonobe
- Department of Clinical Neurophysiology, Hôpitaux universitaires Pitié-Salpêtrière-Charles Foix. Assistance Publique Hôpitaux de Paris (APHP), Paris, France
| | - Timothée Lenglet
- Department of Clinical Neurophysiology, Hôpitaux universitaires Pitié-Salpêtrière-Charles Foix. Assistance Publique Hôpitaux de Paris (APHP), Paris, France
| | - Adrien Wang
- Department of Neurology, Foch Hospital, Suresnes, France
| | - Laurent Magy
- Department of Neurology, National Reference Center for Rare Peripheral Neuropathies, University Hospital, Limoges, France
| | - Kevin Bihan
- Regional Pharmacovigilance Center, Department of Pharmacology, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Nathalie Gaspar
- Department of Pediatric and Adolescent Oncology, Gustave Roussy institute, Villejuif, France
| | - David Adams
- Department of Neurology, French National Reference Center for Rare Neuropathies, Bicêtre Hospital, AP-HP, INSERM U1195 & Paris-Saclay University, Le Kremlin-Bicetre, France
| | - Andoni Echaniz-Laguna
- Department of Neurology, French National Reference Center for Rare Neuropathies, Bicêtre Hospital, AP-HP, INSERM U1195 & Paris-Saclay University, Le Kremlin-Bicetre, France
| | - Cecile Cauquil
- Department of Neurology, French National Reference Center for Rare Neuropathies, Bicêtre Hospital, AP-HP, Le Kremlin-Bicetre, France
| | - Dimitri Psimaras
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Neurologie 2-Mazarin et Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle Epinière (CRICM), UMRS 975, Paris 75013, France; Inserm U 975, CNRS, UMR 7225, Paris 75013, France, Paris, France
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Briani C, Visentin A, Campagnolo M, Salvalaggio A, Ferrari S, Cavallaro T, Manara R, Gasparotti R, Piazza F. Peripheral nervous system involvement in lymphomas. J Peripher Nerv Syst 2019; 24:5-18. [PMID: 30556258 DOI: 10.1111/jns.12295] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 12/01/2018] [Accepted: 12/08/2018] [Indexed: 12/11/2022]
Abstract
The peripheral nervous system may be involved at any stage in the course of lymphoproliferative diseases. The different underlying mechanisms include neurotoxicity secondary to chemotherapy, direct nerve infiltration (neurolymphomatosis), infections, immune-mediated, paraneoplastic or metabolic processes and nutritional deficiencies. Accordingly, the clinical features are heterogeneous and depend on the localization of the damage (ganglia, roots, plexi, and peripheral nerves) and on the involved structures (myelin, axon, and cell body). Some clinical findings, such a focal or diffuse involvement, symmetric or asymmetric pattern, presence of pain may point to the correct diagnosis. Besides a thorough medical history and neurological examination, neurophysiological studies, cerebrospinal fluid analysis, nerve biopsy (in selected patients with suspected lymphomatous infiltration) and neuroimaging techniques (magnetic resonance neurography and nerve ultrasound) may be crucial for a proper diagnostic workup.
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Affiliation(s)
- Chiara Briani
- Department of Neuroscience, University of Padova, Padova, Italy
| | - Andrea Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, Padova, Italy
| | | | | | - Sergio Ferrari
- Department of Neurology, Azienda Ospedaliera Universitaria Integrata, University Hospital G.B. Rossi, Verona, Italy
| | - Tiziana Cavallaro
- Department of Neurology, Azienda Ospedaliera Universitaria Integrata, University Hospital G.B. Rossi, Verona, Italy
| | - Renzo Manara
- Neuroradiology, Department of Medicine and Surgery, University of Salerno, Fisciano, Italy
| | - Roberto Gasparotti
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Francesco Piazza
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, Padova, Italy
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Cavaletti G, Alberti P, Marmiroli P. Chemotherapy-induced peripheral neurotoxicity in cancer survivors: an underdiagnosed clinical entity? Am Soc Clin Oncol Educ Book 2016:e553-60. [PMID: 25993222 DOI: 10.14694/edbook_am.2015.35.e553] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Systemic chemotherapy is a cornerstone of the modern medical management of cancer, although its use is limited by toxicity on normal tissues and organs, including the nervous system. Long-surviving or cured people strongly require a high level of wellness in addition to prolongation of life (the concept of the quality of survival), but neurologic dysfunction can severely affect daily life activities. Chemotherapy-related peripheral neurotoxicity is becoming one of the most worrisome long-term side effects in patients affected by a neoplasm. The central nervous system has a limited capacity to recover from injuries, and it is not surprising that severe damage can determine long-term or permanent neurologic dysfunction. However, the peripheral nervous system also can be permanently damaged by anticancer treatments despite its better regeneration capacities, and the effect on patients' daily life activities might be extremely severe. However, only recently, the paradigms of peripheral neurotoxicity reversibility have been scientifically challenged, and studies have been performed to capture the patients' perspectives on this issue and to measure the effect of peripheral neurotoxicity on their daily life activities. Despite these efforts, knowledge about this problem is still largely incomplete, and further studies are necessary to clarify the several still-unsettled aspects of long-term peripheral neurotoxicity of conventional and targeted anticancer chemotherapy.
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Affiliation(s)
- Guido Cavaletti
- From the Experimental Neurology Unit and Milan Center for Neuroscience, Department of Surgery and Translational Medicine, University of Milano-Bicocca, Monza, Italy
| | - Paola Alberti
- From the Experimental Neurology Unit and Milan Center for Neuroscience, Department of Surgery and Translational Medicine, University of Milano-Bicocca, Monza, Italy
| | - Paola Marmiroli
- From the Experimental Neurology Unit and Milan Center for Neuroscience, Department of Surgery and Translational Medicine, University of Milano-Bicocca, Monza, Italy
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Zinzani P, Sasse S, Radford J, Shonukan O, Bonthapally V. Experience of brentuximab vedotin in relapsed/refractory Hodgkin lymphoma and relapsed/refractory systemic anaplastic large-cell lymphoma in the Named Patient Program: Review of the literature. Crit Rev Oncol Hematol 2015; 95:359-69. [DOI: 10.1016/j.critrevonc.2015.03.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 03/09/2015] [Accepted: 03/26/2015] [Indexed: 02/06/2023] Open
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Cavaletti G. Chemotherapy-induced peripheral neurotoxicity (CIPN): what we need and what we know. J Peripher Nerv Syst 2015; 19:66-76. [PMID: 24976572 DOI: 10.1111/jns5.12073] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 03/19/2014] [Indexed: 12/16/2022]
Abstract
Chemotherapy-induced peripheral neurotoxicity (CIPN) is one of the most frequent and severe long-term side effects of cancer chemotherapy. Preclinical and clinical studies have extensively investigated CIPN searching for effective strategies to limit its severity or to treat CIPN-related impairment, but the results have been disappointing. Among the reasons for this failure are methodological flaws in both preclinical and clinical investigations. Their successful resolution might provide a brighter perspective for future studies. Among the several neurotoxic chemotherapy drugs, oxaliplatin may offer a clear example of a methodological approach eventually leading to successful clinical trials. However, the same considerations apply to the other neurotoxic agents and, although frequently neglected, also to the new "targeted" agents.
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Affiliation(s)
- Guido Cavaletti
- Experimental Neurology Unit and Milan Center for Neuroscience, Department of Surgery and Translational Medicine, University of Milano-Bicocca, Monza, Italy
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