Department of Pharmacy, Winship Cancer Institute of Emory University, Atlanta, GA.
Department of Biostatistics and Bioinformatics, Winship Cancer Institute of Emory University, Atlanta, GA.
JCO Oncol Pract. 2023 Sep;19(9):793-798. doi: 10.1200/OP.22.00781. Epub 2023 Jul 7.
The incidence of multiple myeloma (MM) is two to three times higher in Black patients compared with other races, making it the most common hematologic malignancy in this patient population. Current treatment guidelines recommend the combination of a proteasome inhibitor, an immunomodulatory agent, and a corticosteroid as preferred induction therapy. Bortezomib use comes with the risk of peripheral neuropathy (PN) and potential need for dose reduction, therapy interruption, and additional supportive medications. Known risk factors for bortezomib-induced peripheral neuropathy (BIPN) include diabetes mellitus, previous thalidomide, advanced age, and obesity. We aimed to determine the potential association between Black race and incidence of BIPN.
We identified a cohort of 748 patients with newly diagnosed MM who received induction with bortezomib, lenalidomide, and dexamethasone from 2007 to 2016. One hundred forty Black patients were matched with 140 non-Black patients on age, sex, BMI, and route of bortezomib administration. Incidence of BIPN was a binary event defined as new use of a neuropathy medication, bortezomib dose reduction, dose omission, or discontinuation because of PN.
The incidence of BIPN was higher in Black patients (46%) compared with non-Black patients (34%; = .05) in both univariate (odds ratio [OR], 1.61; 95% CI, 1.00 to 2.61; = .052) and multivariable analyses (OR, 1.64; 95% CI, 1.01 to 2.67; = .047). No significant differences in BIPN were seen when stratified by route of administration.
These data indicate that Black race is an independent risk factor for the development of BIPN. Additional prevention strategies, close monitoring, and appropriate supportive care measures are warranted for these patients.
多发性骨髓瘤（MM）在黑人患者中的发病率比其他种族高 2 至 3 倍，使其成为该患者群体中最常见的血液系统恶性肿瘤。目前的治疗指南建议将蛋白酶体抑制剂、免疫调节剂和皮质类固醇联合作为首选诱导治疗。硼替佐米的使用存在周围神经病变（PN）的风险，并且可能需要减少剂量、中断治疗和额外的支持性药物。硼替佐米诱导的周围神经病变（BIPN）的已知危险因素包括糖尿病、先前使用沙利度胺、年龄较大和肥胖。我们旨在确定黑种人与 BIPN 发生率之间的潜在关联。
我们确定了一个队列，其中包括 748 名在 2007 年至 2016 年间接受硼替佐米、来那度胺和地塞米松诱导治疗的新诊断 MM 患者。将 140 名黑人患者与 140 名非黑人患者在年龄、性别、BMI 和硼替佐米给药途径上进行匹配。BIPN 的发生率为新使用神经病变药物、硼替佐米剂量减少、剂量遗漏或因 PN 而停止的二元事件。
黑人患者（46%）BIPN 的发生率高于非黑人患者（34%； =.05），无论是在单变量（优势比 [OR]，1.61；95%置信区间，1.00 至 2.61； =.052）还是多变量分析中（OR，1.64；95%置信区间，1.01 至 2.67； =.047）。给药途径分层时，BIPN 无显著差异。
这些数据表明，黑种人是发生 BIPN 的独立危险因素。这些患者需要额外的预防策略、密切监测和适当的支持性护理措施。
