ボルテゾミブ投与により惹起される自律神経障害の臨床像およびそのリスク要因

Abstract

This study examined the clinical features and risk factors of autonomic neuropathy induced by the administration of bortezomib at Social Insurance Kyoto Hospital,as well as details of an association between bortezomib and onset of autonomic neuropathy.Eleven of 32 patients (34.4%) with bortezomib-treated relapsed multiple myeloma developed autonomic neuropathy.Instances of autonomic neuropathy of more than grade 2 comprised 4 cases of paralytic ileus,1 case of hypotension,and 1 case of urinary retention.They occurred for a median of 2.5 cycles[range : 1-4],and the median cumulative dose to onset was 9.5 mg/m2[range : 3.9-18.2].In 2 patients who continued to receive bortezomib at the same doses,autonomic neuropathy developed again but in 3 patients whose dose of bortezomib was reduced,autonomic neuropathy did not recur.In addition,the onset of autonomic neuropathy was significantly higher in patients with diseases of the autonomic nervous system and those also receiving drugs affecting the autonomic nervous system.Therefore,we were able to clarify an association between the administration of bortezomib and onset of autonomic neuropathy and our findings suggested that the risk factors for bortezomib-induced autonomic neuropathy were those affecting the autonomic nervous system.