Abstract
Purpose: Confocal laser scanning microscopy (CLSM) is a non-invasive technique for cellular in vivo imaging of the human cornea. CLSM screening was evaluated for early detection of corneal nerve morphology changes and neuropathogenic events in different stage multiple myeloma (MM) patients. As MM patients show disease as well as therapy-related neuropathological symptoms, CLSM potentially provides a tool for non-invasive early detection of neuropathogenic events. CLSM findings were compared with the severity of peripheral neuropathic (PNP) symptoms.Methods: The study enrolled 25 MM patients in which bilateral ophthalmologic examination was performed including unilateral CLSM. Further peripheral nerve function was clinically evaluated using the conventional neuropathy symptom and neuropathy deficit scores (NDSs).Results: In 18/25 MM patients, CLSM detected atypical morphological appearance of bulb-like enlarged nerve endings in the corneal sub-basal nerve plexus. These neuromas were only found in patients showing moderate to severe PNP, in patients with mild or lacking PNP neuromas were absent.Conclusions: CLSM provides a novel non-invasive diagnostic tool for identification of neuromas in cancer patients affected by therapy or disease-related neuropathologies, perspectival allowing early neuronal degenerative process detection and monitoring.
Highlights
Multiple myeloma (MM) is a hematologic malignancy with an incidence of approximately 5 per 100000 people per year [1]
The study was designed as a cross-sectional study to investigate changes in corneal nerve morphology and changes of peripheral neuropathy symptoms at different stages of the disease
Approval of the applicable Ethics Committee of the University of Rostock in accordance with applicable laws, rules and regulations was obtained in January 2015
Summary
Multiple myeloma (MM) is a hematologic malignancy with an incidence of approximately 5 per 100000 people per year [1]. Hypercalcemia, renal failure, anemia and sometimes nerve damage are observed. Among these symptoms, peripheral neuropathy (PNP) can cause considerable loss of quality-of-life. PNP of MM patients has been in focus over the last 10 years. Several studies have shown that up to 54% of MM patients develop PNP either as effect of MM itself (reported frequencies of 1% up to 20%) or as a result of therapeutic intervention [2,3]. Bortezomib, the first and until now most widely used proteasome inhibitor, is associated with a high frequency of PNP (38% all grades and 6% grade 3/4 according to CTCAEv3) [3]. PNP is a pronounced and often treatment-limiting side effect of thalidomide, the License 4.0 (CC BY)
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