多发性骨髓瘤患者治疗相关周围神经病变的管理。

IF 3.9 Q2 ONCOLOGY
Blood and Lymphatic Cancer-Targets and Therapy Pub Date : 2016-06-29 eCollection Date: 2016-01-01 DOI:10.2147/BLCTT.S91251
Sara Grammatico, Laura Cesini, Maria Teresa Petrucci
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引用次数: 0

摘要

周围神经病变是多发性骨髓瘤治疗中最重要的并发症之一。由于单克隆蛋白或神经根压迫的影响,在疾病发作时可以观察到神经损伤,但更多情况下与治疗有关。Vinca生物碱在过去的时代,以及最近的沙利度胺和硼替佐米是主要原因。背根神经节的退化是常见的,在沙利度胺的情况下普遍与血管生成抑制和细胞因子调节有关,在硼替佐米的情况下则与泛素-蛋白酶体系统的抑制有关。感觉神经病变和神经性疼痛更为常见;较少观察到运动神经病和自主神经损伤。神经毒性通常会影响患者的生活质量,需要调整剂量或停止治疗,可能会对整体反应产生影响。通过适当量表的定期神经评估,及时识别易感因素(如糖尿病、酗酒、维生素缺乏或病毒感染)以及体征和症状的出现,这一点极为重要。周围神经病变出现时的有效治疗可以最大限度地降低并发症的发生率和严重程度,并保持治疗效果。治疗期间可能需要调整剂量;此外,根据疼痛的严重程度,建议使用加巴喷丁或普瑞巴林、三环类抗抑郁药、血清素和去甲肾上腺素再摄取抑制剂、卡马西平和阿片类止痛药。一些作者报告说,在多发性骨髓瘤治疗期间发生周围神经病变的患者表现出特定的基因表达谱;因此,未来的研究可能有助于更好地了解神经毒性潜在的生物学途径。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Managing treatment-related peripheral neuropathy in patients with multiple myeloma.

Managing treatment-related peripheral neuropathy in patients with multiple myeloma.

Peripheral neuropathy is one of the most important complications of multiple myeloma treatment. Neurological damage can be observed at the onset of the disease, due to the effect of monoclonal protein or radicular compression, but more often is treatment related. Vinca alkaloids in the past era, and more recently, thalidomide and bortezomib are mainly responsible. Degeneration of dorsal root ganglion is common, prevalently related to angiogenesis inhibition and cytokine modulation in the case of thalidomide and inhibition of the ubiquitin proteasome system in the case of bortezomib. Sensory neuropathy and neuropathic pain are more common; motor neuropathy and autonomic damage are less frequently observed. Neurotoxicity often affects patient's quality of life and requires dose modification or withdrawal of therapy, with a possible effect on the overall response. A prompt recognition of predisposing factors (such as diabetes mellitus, alcohol abuse, vitamin deficiencies, or viral infections) and appearance of signs and symptoms, through a periodic neurological assessment with appropriate scales, is extremely important. Effective management of treatment at the emergence of peripheral neuropathy can minimize the incidence and severity of this complication and preserve therapeutic efficacy. Dose adjustment could be necessary during treatment; moreover, gabapentin or pregabalin, tricyclic antidepressants, serotonin and norepinephrine reuptake inhibitors, carbamazepine, and opioid-type analgesics are suggested according to the pain severity. Some authors reported that patients who develop peripheral neuropathy during their multiple myeloma treatments presented a particular gene expression profile; therefore, future studies could be helpful for a better understanding of possible biological pathways underlying neurotoxicity.

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来源期刊
自引率
7.10%
发文量
16
审稿时长
16 weeks
期刊介绍: Blood and Lymphatic Cancer: Targets and Therapy is an international, peer reviewed, open access journal focusing on blood and lymphatic cancer research, identification of therapeutic targets, and the optimal use of preventative and integrated treatment interventions to achieve improved outcomes, enhanced survival, and quality of life for the cancer patient. Specific topics covered in the journal include: Epidemiology, detection and screening Cellular research and biomarkers Identification of biotargets and agents with novel mechanisms of action Optimal clinical use of existing anticancer agents, including combination therapies Radiation, surgery, bone marrow transplantation Palliative care Patient adherence, quality of life, satisfaction Health economic evaluations.
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