The Clinical Spectrum of Bortezomib-Induced Peripheral Neuropathy (P06.140)

Abstract

Objective: We sought to investigate the incidence, risk factors for development and phenotype of peripheral neuropathy in patient9s treated with bortezomib. Background Bortezomib (Velcade®) is the first member of a new class of chemotherapeutic agents that inhibit the proteasome-ubiquitination pathway. It is FDA-approved for use in multiple myeloma and mantle cell lymphoma. Bortezomib causes a painful axonal sensory-predominant length-dependent peripheral neuropathy in 30-40% of patients. A small subgroup of patients treated with bortezomib develop a severe neuropathy soon after commencing bortezomib, the mechanism of which is unclear. Design/Methods: We searched the Mayo Clinic Hematology Chemotherapy database for patients treated with bortezomib. We reviewed the clinical information to determine if neuropathy occurred in relation to the initiation of bortezomib. We reviewed the clinical and electrophysiological features and long-term followup of patients evaluated by a neurologist. Subjects were included if they received bortezomib and had follow-up for at least one cycle of chemotherapy. Results: 589 patients were identified. 378 patients met inclusion criteria. 138 (36.5%) were determined to have treatment-emergent peripheral neuropathy. The typical pattern was a painful, sensory-predominant peripheral neuropathy involving the hands and feet. Three patients had evidence of a plexopathy or polyradiculoneuropathy. Two patients had nerve biopsies suggesting microvasculitis. A prior history of peripheral neuropathy was more common in patients with treatment-emergent peripheral neuropathy (22% vs 14%, p Conclusions: In our series the incidence of bortezomib-induced peripheral neuropathy is 36.5%, similar to previous reports. A prior history of peripheral neuropathy appears to be a risk factor for the development of bortezomib-induced peripheral neuropathy. The pattern is most commonly a painful, sensory-predominant length-dependent neuropathy. An inflammatory neuropathy or polyradiculoneuropathy can occur with bortezomib with biopsy features suggesting microvasculitis. Disclosure: Dr. Mauermann has nothing to disclose. Dr. Dispenzieri has received research support from Millennium. Dr. Staff has nothing to disclose.