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DOI: 10.1055/s-0029-1246079
© Georg Thieme Verlag KG Stuttgart · New York
Management der Polyneuropathie beim Multiplen Myelom unter der Therapie mit Bortezomib: Empfehlungen aus klinischen Erfahrungen
Management of polyneuropathy in patients with multiple myeloma treated with bortezomib: Recommendations based on clinical experiencePublikationsverlauf
Publikationsdatum:
16. Juni 2011 (online)
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Zusammenfassung
Die bortezomibinduzierte periphere Neuropathie (PNP) beim Multiplen Myelom (MM) kann sich schnell entwickeln und fortschreiten. Durch rasches therapeutisches Eingreifen kann das Auftreten neuropathischer Schmerzen und die Weiterentwicklung zu höhergradigen Formen der PNP möglicherweise vermieden werden. Eine Expertenrunde aus Hämatologen und Neurologen gibt diesbezüglich Empfehlungen basierend auf ihren Erfahrungen. Als Basisuntersuchung für eine Verlaufsbeurteilung des Schweregrades einer PNP sind Erhebungen des neurologischen Ausgangsbefundes und neurologische Untersuchungen während der Bortezomibtherapie erforderlich. Diese können vom Hämatologen selbst durchgeführt werden, wobei ein Selbstauskunftsbogen des Patienten als wichtiges Instrument angesehen werden kann. Tritt eine bortezomibassoziierte PNP auf, ist die Therapie zu modifizieren. Internationale Experten benutzen hierzu unterschiedliche Schemata, evidenz-basierte Daten sind spärlich. Bei Polyneuropathien, die durch Komorbiditäten verursacht werden, kann schon vor Therapiebeginn eine Reduktion der Dosis überlegt werden. Die Behandlung der PNP selbst wird in diesem Manuskript erörtert. Medikamentöse und nicht medikamentöse Optionen können häufig zu einer deutlichen Symptomerleichterung oder -kupierung der PNP-Beschwerden führen.
Abstract
Bortezomib-induced peripheral neuropathy (PNP) in multiple myeloma (MM) can develop and progress rapidly. Rapid therapeutic intervention can possibly avoid the occurrence of neuropathic pain and the progression to higher grades of PNP. A group of experts consisting of haematologists and neurologists is issuing practice recommendations based on their experiences. The initial neurological assessment and neurological examinations during Bortezomib-therapy provide a basis for monitoring the patient. These examinations can be carried out by the haematologist. An important instrument is a questionnaire for the patients. If additional diagnostic workup is needed, consultation of a neurologist may be advantageous to fully evaluate the severity and type of PNP. If PNP develops, the therapy with Bortezomib has to be modified. International experts use different schemes, however, evidence based studies comparing these schemes are rare. In case of polyneuropathies caused by comorbidities, the possibility of dose reduction should be checked already prior to treatment initiation. Treatment of the PNP itself is discussed in the manuscript. Drug based as well as non-drug based therapies can often lead to significant improvement or even resolution of PNP symptoms.
Schlüsselwörter
Bortezomib - multiples Myelom - periphere Neuropathie - Polyneuropathie - PNP - Nerven - Prävention
Key words
Bortezomib - multiple myeloma - nerve damage - peripheral neuropathy - polyneuropathy
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Prof. Dr. Orhan Sezer
Onkologie, Hämatologie und Knochenmarktransplantation, Universitätsklinikum Hamburg-Eppendorf
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