12th Congress of the European Hematology ... - Haematologica

12 th Congress of the European Hematology Association
0685
NERVE CONDUCTION STUDY IN MULTIPLE MYELOMA PATIENTS PRESENTING
BORTEZOMIB INDUCED PERIPHERAL NEUROPATHY
G.A. Pangalis, 1 C. Zaroulis, 2 M.C. Kyrtsonis, 1 E. Koutra, 2 S. Sachanas, 1
K. Anargyrou, 1 S. Masouridis, 1 Z. Galanis, 1 M. Dimou, 1
T.P. Vassilakopoulos, 1 E.M. Dimitriadou, 1 M.N. Dimopoulou, 1
S.I. Kokoris, 1 M.P. Siakantaris, 1 M.A. Angelopoulou, 1
P. Panayiotidis, 1 N. Matikas, 2 G.A. Pangalis1
1 University of Athens Medical School, ATHENS; 2 Neurologic Clinic, Evangelismos
Hospital, ATHENS, Greece
Introduction. Bortezomib produces high response rates in patients with
relapsed or refractory MM. However, Bortezomib induced neuropathy
influence negatively patients’ quality of life. Although there is an increasing
experience on the use of Bortezomib, its associated neuropathy has
not been studied extensively. Aims. To evaluate the neurotoxicity of bortezomib
in relapsed/ refractory MM patients by physical examination and
nerve conduction velocities. Patients and Methods. 75 refractory/relapsed
MM patients (21 F, 54 M) were treated with Bortezomib at standard doses
and schedule, in our Department. Patients’ median age was 70 years
(32-83). 59% had IgG MM., 26% IgA, 4% IgD, 11% BJ. 38 patients
received Bortezomib as second line treatment while the others had
received multiple prior therapies (median 3 lines). 81% of patients
responded (12% CR, 20% nCR, 32% PR,16% MR). 32% had prior treatment
with thalidomide. No patient had neuropathy greater than grade 1
at bortezomib initiation. 45 (60%) patients presented neuropathy (1 grade
4, 17 grade 3, 17 grade 2, 9 grade 1). Of these patients, 20 underwent complete
neurological examination including nerve conduction study. 8 were
evaluated between third and fourth cycle of Bortezomib administration
(at presentation of neuropathy), 6 immediately after the end of therapy
and 6, more than 5 months from the end of therapy. 2 patients were
reevaluated when neuropathy improved. Results. The most common
symptoms revealed by physical neurological examination were numbness,
tingling, paresthesias, dysaesthesias, pain and weakness. Eight out
of 20 patients (40%) had neuropathy of grade 3, 9/20 (45%) grade 2 and
3/20 (15%) grade 1. Nerve conduction velocities (NCV) findings are shown
in Table 1. Four out of 6 patients (66%) that were far from Bortezomib
treatment still had abnormal findings in NCV Although 7 patients had resolution
of pain they still had impaired velocities in NCV. The pain assessment
by the neurologist and the hematologist were in agreement but the
sensory neuropathy was underestimated by the hematologist. The differing
evaluation was more pronounced for patients evaluated far from Bortezomib
treatment for who the hematologist considered that the neuropathy
resolved. Conclusions. Bortezomib induces either axonal or demyelinated
type of neuropathy. Lower extremities are more frequently affected.
Resolution of pain does not necessarily mean normal nerve conduction
velocities - this should be taken in account in case other neurotoxic
modalities are going to be used. Further studies are needed for a better
understanding of the pathogenesis of bortezomib neurotoxicity and of its
management
Table 1.
0686
SECOND AUTOLOGOUS STEM CELL TRANSPLANTATION FOR MULTIPLE MYELOMA IN FIRST
RELAPSE
A. Chaidos, C. Giles, I. Gabriel, J.F. Apperley, E. Kanfer, E. Olavarria,
M. Bua, D. Samson, A. Rahemtulla
Hammersmith Hospital, LONDON, United Kingdom
Background. Induction chemotherapy to maximum response followed
by autologous stem cell transplantation (ASCT) has become standard
practice for eligible, newly diagnosed patients with multiple myeloma
(MM). This approach is well supported by evidence obtained from large
256 | haematologica/the hematology journal | 2007; 92(s1)
randomised trials. However, ASCT is not curative and virtually all patients
relapse. Re-induction and a second ASCT is usually offered, although
there are limited data on the outcome of this approach. Aims. We retrospectively
analysed the results of second ASCT after re-induction
chemotherapy for MM patients in first relapse and identified parameters
of prognostic value. Methods. From July 1994 to September 2005, 228
patients with MM aged 26.7 to 72.5 years (median 56.2 years) received
ASCT using melphalan (200 patients) or melphalan/TBI (28 patients). Thirty-five
(15.4%) patients achieved complete response (CR) and 153 patients
(67.1%) partial response (PR). The transplant related mortality (TRM) of
the first ASCT was 1.3%. Patients treated by elective tandem autologous
or a subsequent allogeneic SCT and patients who died in remission were
excluded from the current study. Relapse post-transplant occurred in 141
(61.8%) patients. Re-induction chemotherapy and a second ASCT with
melphalan 100-200 mg/m 2 conditioning was performed in 42 (29.8%)
patients, while 99 (70.2%) patients had other salvage treatments.
Response was defined by EBMT criteria. Results. Twenty-nine patients
(69%) responded to second ASCT. Three patients (7.1%) achieved CR and
26 (61.9%) PR. Eight patients (19%) had minimal or no response to the
second transplant procedure. The median time to neutrophil recovery
(>0.5×10 9 /L) was 13.5 days (range 7-19) and for platelets (>50×10 9 /L) was
17 days (range 13-56). Four patients had primary graft failure (9.5%). Five
patients died of TRM (11.9%) 11 to 70 days post transplant. The median
event-free survival (EFS) after the second transplant was 10.8 months. The
patients with a first remission period of