Lanzani Francesca, Mattavelli Laura, Frigeni Barbara, Rossini Fausto, Cammarota Sara, Petrò Daniela, Jann Stefano, Cavaletti Guido
Dipartimento di Neuroscienze e Tecnologie Biomediche, Università di Milano Bicocca, Monza, Italy.
J Peripher Nerv Syst. 2008 Dec;13(4):267-74. doi: 10.1111/j.1529-8027.2008.00192.x.
We investigated a series of bortezomib-treated patients and correlated the course of bortezomib-induced peripheral neurotoxicity with the presence or absence of peripheral neuropathy at baseline. Forty-eight patients were examined with the total neuropathy score reduced version (TNSr), visual analogue score (VAS) for pain, and nerve conduction studies at baseline and after two and four cycles of chemotherapy. Twenty-three patients had a baseline TNSr = 0-2, and 25 patients had a baseline TNSr >2 (median = 6, range 3-13). The course of bortezomib-induced peripheral neurotoxicity was generally more severe in those patients with the highest baseline TNSr. However, among those subjects with a normal baseline TNSr, two patients developed a clinically relevant peripheral neuropathy with a marked increase in TNSr as early as after two cycles of bortezomib treatment (TNSr = 10 and 15, respectively), while after four cycles, three other patients with normal baseline TNSr had a TNSr of 11, 12, and 13. VAS reporting confirmed that painful neuropathy is frequent after bortezomib administration. Our results indicate that the course of bortezomib-induced peripheral neurotoxicity can be severe in subjects with normal neurological examination at baseline, and therefore, careful monitoring during treatment is suggested in these patients.
我们研究了一系列接受硼替佐米治疗的患者，并将硼替佐米诱导的周围神经毒性病程与基线时周围神经病变的有无进行关联。48例患者在基线时以及化疗两个周期和四个周期后，接受了简化版总神经病变评分（TNSr）、疼痛视觉模拟评分（VAS）以及神经传导研究检查。23例患者基线TNSr = 0 - 2，25例患者基线TNSr > 2（中位数 = 6，范围3 - 13）。硼替佐米诱导的周围神经毒性病程在基线TNSr最高的那些患者中通常更为严重。然而，在那些基线TNSr正常的受试者中，两名患者早在硼替佐米治疗两个周期后就出现了具有临床意义的周围神经病变，TNSr显著增加（分别为TNSr = 10和15），而在四个周期后，另外三名基线TNSr正常的患者TNSr分别为11、12和13。VAS报告证实，硼替佐米给药后疼痛性神经病变很常见。我们的结果表明，在基线时神经系统检查正常的受试者中，硼替佐米诱导的周围神经毒性病程可能很严重，因此，建议对这些患者在治疗期间进行仔细监测。
