ارزیابی اثر تیامین در کاهش علایم عارضه‌ی نوروپاتی حاصل از داروی بورتزوماب در بیماران مبتلا به Multiple Myeloma

نوع مقاله : مقاله های پژوهشی

نویسندگان

1 استاد، گروه داخلی، دانشکده‌‌ی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

2 دستیار، گروه داخلی، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

چکیده

مقدمه: نوروپاتی محیطی، یکی از شایع‌ترین عوارض جانبی شیمی‌درمانی با داروی بورتزوماب می‌باشد که این دارو، امروزه نقش بسیار مهمی در درمان بیماران مبتلا به Multiple myeloma ایفا می‌کند. تاکنون، عوامل مختلفی نظیر انواع گروه ویتامین B به منظور پیش‌گیری و درمان نوروپاتی محیطی مورد تحقیق قرار گرفته‌اند، اما هیچ کدام از موارد آزمایش به طور قطعی به مرحله‌ی اثبات و توصیه‌های بالینی نرسیده‌اند. هدف از انجام مطالعه‌ی حاضر، بررسی نقش تیامین در کاهش علایم نوروپاتی محیطی حاصل از داروی بورتزوماب در بیماران مبتلا Multiple myeloma بود.روش‌ها: این مطالعه، یک مطالعه‌ی کارآزمایی بالینی تصادفی مورد- شاهدی بود. بیماران مبتلا به Multiple myeloma که بر اساس برنامه‌ی شیمی‌درمانی کاندیدای دریافت درمان چهار ماهه‌ی بورتزوماب بودند، در این مطالعه وارد شدند. این بیماران، به 2 گروه تقسیم شدند. گروه مورد مطالعه که تیامین را از ابتدای شروع شیمی‌درمانی با دز300 میلی‌گرم در روز دریافت نمودند و گروه شاهد که تنها رژیم استاندارد شیمی‌درمانی بورتزوماب را دریافت کردند. جهت ارزیابی بیماران، از پرسش‌نامه‌ی تجربی مبتنی بر علایم استفاده گردید.یافته‌ها: 29 بیمار درگروه مورد (مصرف کننده‌ی تیامین) و 29 بیمار در گروه شاهد قرار گرفتند. شدت علایم نوروپاتی محیطی به طور مشخص بعد از مصرف تیامین در گروه مورد در مقایسه با گروه شاهد کاهش یافت (001/0 > P).نتیجه‌گیری: تیامین نقش مؤثری در کاهش علایم نوروپاتی محیطی در بیماران تحت درمان با بورتزوماب دارد.

کلیدواژه‌ها


عنوان مقاله [English]

The Effect of Thiamine in Reducing the Symptoms of Bortezomib-Induced Peripheral Neuropathy in Patients with Multiple Myeloma

نویسندگان [English]

  • Valiollah Mehrzad 1
  • Ghazal Rafiaei 2
1 Assistant Professor, Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
2 Resident, Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
چکیده [English]

Background: Peripheral neuropathy is one of the most frequent side effects of bortezomib-based chemotherapy, which has the most important role in treatment of multiple myeloma. Various supplements including vitamin B group complex have been examined to prevent and treat bortezomib-induced peripheral neuropathy (BIPN), but there is no definite recommendation yet. We aimed to evaluate the role of vitamin B1 (thiamine) in prevention of BIPN in patients with multiple myeloma.Methods: This was a randomized controlled clinical trial study. Patients with multiple myeloma who were supposed to receive 4 months of bortezomib-based chemotherapy were enrolled the study and divided into two groups. The intervention group received thiamine at a dose of 300 mg per day from the beginning of treatment schedules, and the control group were observed during treatment. For assessment, we used symptoms experience questionnaire that was completed after 4 months.Findings: 29 patients were enrolled in vitamin B1 group and 29 others in control group. Peripheral neuropathy score significantly decreased after intervention with vitamin B1 in comparison with control group (P < 0.0001).Conclusion: The findings demonstrate that vitamin B1 has a significant effect on preventing and reducing the severity of peripheral neuropathy in BIPN.

کلیدواژه‌ها [English]

  • Bortezomib
  • Vitamin B1
  • Neuropathy
  • Multiple myeloma
  1. Palumbo A, Anderson K. Multiple myeloma. N Engl J Med 2011; 364(11): 1046-60.
  2. Petrucci MT, Finsinger P, Chisini M, Gentilini F. Subcutaneous bortezomib for multiple myeloma treatment: Patients' benefits. Patient Prefer Adherence 2014; 8: 939-46.
  3. Kyle RA, Rajkumar SV. Multiple myeloma. N Engl J Med 2004; 351(18): 1860-73.
  4. Delforge M, Blade J, Dimopoulos MA, Facon T, Kropff M, Ludwig H, et al. Treatment-related peripheral neuropathy in multiple myeloma: the challenge continues. Lancet Oncol 2010; 11(11): 1086-95.
  5. Durie BG, Kyle RA, Belch A, Bensinger W, Blade J, Boccadoro M, et al. Myeloma management guidelines: A consensus report from the Scientific Advisors of the International Myeloma Foundation. Hematol J 2003; 4(6): 379-98.
  6. Kyle RA, Rajkumar SV. Criteria for diagnosis, staging, risk stratification and response assessment of multiple myeloma. Leukemia 2009; 23(1): 3-9.
  7. Kyle RA, Remstein ED, Therneau TM, Dispenzieri A, Kurtin PJ, Hodnefield JM, et al. Clinical course and prognosis of smoldering (asymptomatic) multiple myeloma. N Engl J Med 2007; 356(25): 2582-90.
  8. Kyle RA, Durie BG, Rajkumar SV, Landgren O, Blade J, Merlini G, et al. Monoclonal gammopathy of undetermined significance (MGUS) and smoldering (asymptomatic) multiple myeloma: IMWG consensus perspectives risk factors for progression and guidelines for monitoring and management. Leukemia 2010; 24(6): 1121-7.
  9. Grammatico S, Cesini L, Petrucci MT. Managing treatment-related peripheral neuropathy in patients with multiple myeloma. Blood Lymphat Cancer 2016; 6: 37-47.
  10. Dispenzieri A, Kyle RA. Neurological aspects of multiple myeloma and related disorders. Best Pract Res Clin Haematol 2005; 18(4): 673-88.
  11. Drappatz J, Batchelor T. Neurologic complications of plasma cell disorders. Clin Lymphoma 2004; 5(3): 163-71.
  12. Mohty B, El-Cheikh J, Yakoub-Agha I, Moreau P, Harousseau JL, Mohty M. Peripheral neuropathy and new treatments for multiple myeloma: Background and practical recommendations. Haematologica 2010; 95(2): 311-9.
  13. Velasco R, Petit J, Clapes V, Verdu E, Navarro X, Bruna J. Neurological monitoring reduces the incidence of bortezomib-induced peripheral neuropathy in multiple myeloma patients. J Peripher Nerv Syst 2010; 15(1): 17-25.
  14. Tariman JD, Love G, McCullagh E, Sandifer S. Peripheral neuropathy associated with novel therapies in patients with multiple myeloma: Consensus statement of the IMF Nurse Leadership Board. Clin J Oncol Nurs 2008; 12(3 Suppl): 29-36.
  15. Richardson PG, Sonneveld P, Schuster MW, Irwin D, Stadtmauer EA, Facon T, et al. Bortezomib or high-dose dexamethasone for relapsed multiple myeloma. N Engl J Med 2005; 352(24): 2487-98.
  16. Dimopoulos MA, Mateos MV, Richardson PG, Schlag R, Khuageva NK, Shpilberg O, et al. Risk factors for, and reversibility of, peripheral neuropathy associated with bortezomib-melphalan-prednisone in newly diagnosed patients with multiple myeloma: Subanalysis of the phase 3 VISTA study. Eur J Haematol 2011; 86(1): 23-31.
  17. Cavaletti G, Tredici G, Marmiroli P, Petruccioli MG, Barajon I, Fabbrica D. Morphometric study of the sensory neuron and peripheral nerve changes induced by chronic cisplatin (DDP) administration in rats. Acta Neuropathol 1992; 84(4): 364-71.
  18. Landowski TH, Megli CJ, Nullmeyer KD, Lynch RM, Dorr RT. Mitochondrial-mediated disregulation of Ca2+ is a critical determinant of Velcade (PS-341/bortezomib) cytotoxicity in myeloma cell lines. Cancer Res 2005; 65(9): 3828-36.
  19. Poruchynsky MS, Sackett DL, Robey RW, Ward Y, Annunziata C, Fojo T. Proteasome inhibitors increase tubulin polymerization and stabilization in tissue culture cells: A possible mechanism contributing to peripheral neuropathy and cellular toxicity following proteasome inhibition. Cell Cycle 2008; 7(7): 940-9.
  20. Cata JP, Weng HR, Burton AW, Villareal H, Giralt S, Dougherty PM. Quantitative sensory findings in patients with bortezomib-induced pain. J Pain 2007; 8(4): 296-306.
  21. Argyriou AA, Iconomou G, Kalofonos HP. Bortezomib-induced peripheral neuropathy in multiple myeloma: A comprehensive review of the literature. Blood 2008; 112(5): 1593-9.
  22. Visovsky C, Collins M, Abbott L, Aschenbrenner J, Hart C. Putting evidence into practice: evidence-based interventions for chemotherapy-induced peripheral neuropathy. Clin J Oncol Nurs 2007; 11(6): 901-13.
  23. Rostock M, Jaroslawski K, Guethlin C, Ludtke R, Schroder S, Bartsch HH. Chemotherapy-induced peripheral neuropathy in cancer patients: A four-arm randomized trial on the effectiveness of electroacupuncture. Evid Based Complement Alternat Med 2013; 2013: 349653.
  24. Albers JW, Chaudhry V, Cavaletti G, Donehower RC. Interventions for preventing neuropathy caused by cisplatin and related compounds. Cochrane Database Syst Rev 2014; (3): CD005228.
  25. Pachman DR, Barton DL, Watson JC, Loprinzi CL. Chemotherapy-induced peripheral neuropathy: prevention and treatment. Clin Pharmacol Ther 2011; 90(3): 377-87.
  26. Ocean AJ, Vahdat LT. Chemotherapy-induced peripheral neuropathy: Pathogenesis and emerging therapies. Support Care Cancer 2004; 12(9): 619-25.
  27. Schloss J, Colosimo M. B Vitamin Complex and Chemotherapy-Induced Peripheral Neuropathy. Curr Oncol Rep 2017; 19(12): 76.
  28. Richardson PG, Sonneveld P, Schuster MW, Irwin D, Stadtmauer EA, Facon T, et al. Safety and efficacy of bortezomib in high-risk and elderly patients with relapsed multiple myeloma. Br J Haematol 2007; 137(5): 429-35.
  29. Richardson PG, Briemberg H, Jagannath S, Wen PY, Barlogie B, Berenson J, et al. Frequency, characteristics, and reversibility of peripheral neuropathy during treatment of advanced multiple myeloma with bortezomib. J Clin Oncol 2006; 24(19): 3113-20.
  30. Bertolotti P, Pierre A, Rome S, Faiman B. Evidence-Based Guidelines for Preventing and Managing Side Effects of Multiple Myeloma. Semin Oncol Nurs 2017; 33(3): 332-47.
  31. Onk D, Mammadov R, Suleyman B, Cimen FK, Cankaya M, Gul V, et al. The effect of thiamine and its metabolites on peripheral neuropathic pain induced by cisplatin in rats. Exp Anim 2018; 67(2): 259-69.
  32. Tsukaguchi M, Shibano M, Matsuura A, Mukai S. The protective effects of lafutidine for bortezomib induced peripheral neuropathy. J Blood Med 2013; 4: 81-5.
  33. Han X, Wang L, Shi H, Zheng G, He J, Wu W, et al. Acupuncture combined with methylcobalamin for the treatment of chemotherapy-induced peripheral neuropathy in patients with multiple myeloma. BMC Cancer 2017; 17(1): 40.