Jongen Joost Louis Marie, Broijl Annemiek, Sonneveld Pieter
Department of Neurology, Erasmus MC, 's Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands,
J Neurooncol. 2015 Jan;121(2):229-37. doi: 10.1007/s11060-014-1632-x. Epub 2014 Oct 19.
Recent developments in the treatment of hematological malignancies, especially with the advent of proteasome inhibitors and immunomodulatory drugs in plasma cell dyscrasias, call for an increased collaboration between hematologists and neurologists. This collaboration involves differentiating chemotherapy-induced peripheral neuropathies (CiPN) from disease-related neurologic complications, early recognition of CiPN and treatment of neuropathic pain. Multiple myeloma, Waldenstrom's macroglobulinemia and light-chain amyloidosis frequently present with peripheral neuropathy. In addition, multiple myeloma, non-Hodgkin lymphomas and leukemia's may mimic peripheral neuropathy by compression or invasion of the extra/intradural space. Platinum compounds, vinca alkaloids, proteasome inhibitors and immunomodulatory drugs may all cause CiPN, each with different and often specific clinical characteristics. Early recognition, by identifying the distinct clinical phenotype of CiPN, is of crucial importance to prevent irreversible neurological damage. No recommendations can be given on the use of neuroprotective strategies because of a lack of convincing clinical evidence. Finally, CiPN caused by vinca-alkaloids, proteasome inhibitors and immunomodulatory drugs is often painful and neurologists are best equipped to treat this kind of painful neuropathy.
血液系统恶性肿瘤治疗领域的最新进展，尤其是蛋白酶体抑制剂和免疫调节药物在浆细胞异常增殖性疾病中的出现，要求血液科医生和神经科医生加强合作。这种合作包括区分化疗引起的周围神经病变（CiPN）与疾病相关的神经并发症、早期识别CiPN以及治疗神经性疼痛。多发性骨髓瘤、华氏巨球蛋白血症和轻链淀粉样变性常伴有周围神经病变。此外，多发性骨髓瘤、非霍奇金淋巴瘤和白血病可能通过压迫或侵犯硬膜外/硬膜内间隙而酷似周围神经病变。铂类化合物、长春花生物碱、蛋白酶体抑制剂和免疫调节药物都可能导致CiPN，每种药物都有不同且往往特定的临床特征。通过识别CiPN独特的临床表型进行早期识别，对于预防不可逆的神经损伤至关重要。由于缺乏令人信服的临床证据，无法就神经保护策略的使用给出建议。最后，由长春花生物碱、蛋白酶体抑制剂和免疫调节药物引起的CiPN通常会引起疼痛，神经科医生最有能力治疗这种疼痛性神经病变。
