Department of Hematology, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China.
Ann Palliat Med. 2021 Dec;10(12):12335-12346. doi: 10.21037/apm-21-3313.
This study sought to examine the use of glutathione combined with mecobalamin in the prevention and treatment peripheral neuropathy (PN) in multiple myeloma (MM) patients, observe its effectiveness and safety, and explore the risk factors and prognostic factors of chemotherapy-induced peripheral neuropathy (CIPN).
Patients in the study group were administered 2.4 g of glutathione intravenously once daily 2-3 days before chemotherapy, combined with 500 µg of mecobalamin administered intravenously once every other day until the end of the chemotherapy cycle. Patients who did not use this regimen were selected as a control group. Differences in adverse reactions, treatment efficiency, progression-free survival (PFS), and overall survival (OS) between the two groups were retrospectively analyzed. PFS and OS curves were plotted using the Kaplan-Meier method. The univariate analysis rates were compared using the χ2 test. The multivariate analysis was performed by a logistic regression analysis. The proportional hazard regression model was used for the univariate and multivariate proportional hazards model analyses.
The incidence of PN, especially grade 2 and 3 PN, was more decreased in the study group than the control group. The history of diabetes (P=0.032) and the method of bortezomib injection (P=0.043) was found to affect the PN grade. The multivariate logistic regression analysis showed that diabetes was an independent risk factor of PN in MM patients [odds ratio (OR) =3.484, P=0.020]. The Proportional hazards model multivariate analysis showed that extramedullary disease (EMD) [hazard ratio (HR) =2.373, P=0.006] and elevated lactic dehydrogenase (LDH) (HR =1.934, P=0.009) were independent prognostic factors for MM patients.
Glutathione combined with mecobalamin significantly reduced the incidence and severity of CIPN in MM patients, and did not increase the adverse reactions of patients with MM. Diabetes and bortezomib intravenously increased the incidence and severity of PN in patients with MM.
本研究旨在探讨谷胱甘肽联合甲钴胺在预防和治疗多发性骨髓瘤（MM）患者周围神经病变（PN）中的作用，观察其疗效和安全性，并探讨化疗诱导的周围神经病变（CIPN）的危险因素和预后因素。
研究组患者在化疗前 2-3 天每天静脉注射 2.4g 谷胱甘肽，联合每两天静脉注射一次 500μg 甲钴胺，直至化疗周期结束。选择未使用该方案的患者作为对照组。回顾性分析两组患者不良反应、治疗效果、无进展生存期（PFS）和总生存期（OS）的差异。采用 Kaplan-Meier 法绘制 PFS 和 OS 曲线。采用 χ2 检验比较单因素分析率。采用 logistic 回归分析进行多因素分析。采用比例风险回归模型进行单因素和多因素比例风险模型分析。
研究组 PN 的发生率，尤其是 2 级和 3 级 PN 的发生率，明显低于对照组。糖尿病史（P=0.032）和硼替佐米注射方式（P=0.043）是影响 PN 分级的因素。多因素 logistic 回归分析显示，糖尿病是 MM 患者发生 PN 的独立危险因素（OR=3.484，P=0.020）。比例风险模型多因素分析显示，髓外疾病（EMD）（HR=2.373，P=0.006）和乳酸脱氢酶（LDH）升高（HR=1.934，P=0.009）是 MM 患者的独立预后因素。
谷胱甘肽联合甲钴胺可显著降低 MM 患者 CIPN 的发生率和严重程度，且不增加 MM 患者的不良反应。糖尿病和硼替佐米静脉注射增加了 MM 患者 PN 的发生率和严重程度。
