Mele Giuseppe, Coppi Maria Rosaria, Melpignano Angela, Quarta Giovanni
Haematology and BMT Unit, "Antonio Perrino" Hospital, SS 7 per Mesagne, 72100, Brindisi, Italy.
Clin Exp Med. 2016 Feb;16(1):99-101. doi: 10.1007/s10238-015-0337-6. Epub 2015 Jan 20.
We retrospectively analyzed the medical history of 19 elderly myeloma patients treated with the "novel subcutaneous formulation of bortezomib." In our experience, two patients (10 %) discontinued treatment for paralytic ileus. The exact pathogenetic mechanisms of toxic megacolon and paralytic ileus due to "novel subcutaneous formulation of bortezomib" are unclear. Probably, it may be related to possible damage of the autonomic nerve fibers that control organ functions. Adequate prevention and management of the gastrointestinal (GI) toxicities with the use of fluid intake and prokinetic and laxative drugs (at least two types of agents in a suboptimal dose) especially in patients with risk factors for GI side effects (anti-myeloma novel agents, opioids or antiemetics, iron supplements, spinal and cord compression, immobility, history of constipation) can decrease the possibility of interruption of administration of drug and increase adherence to treatment. Clearly this complication must be borne in mind whenever a patient develops acute abdominal pain and distension.
我们回顾性分析了19例接受“新型皮下注射硼替佐米制剂”治疗的老年骨髓瘤患者的病史。根据我们的经验，有2例患者（10%）因麻痹性肠梗阻而停药。“新型皮下注射硼替佐米制剂”导致中毒性巨结肠和麻痹性肠梗阻的确切发病机制尚不清楚。可能与控制器官功能的自主神经纤维受损有关。通过增加液体摄入量以及使用促动力药和泻药（至少两种次优剂量的药物）对胃肠道毒性进行充分预防和管理，尤其是对于有胃肠道副作用风险因素的患者（抗骨髓瘤新型药物、阿片类药物或止吐药、铁补充剂、脊髓压迫、活动减少、便秘病史），可以降低药物给药中断的可能性并提高治疗依从性。显然，每当患者出现急性腹痛和腹胀时，都必须牢记这一并发症。
