A pilot study of acupuncture in treating bortezomib-induced peripheral neuropathy in patients with multiple myeloma

Abstract

Background: Peripheral neuropathy is the dose limiting toxicity of bortezomib in patients with multiple myeloma (MM).

Objectives: To examine the safety, feasibility and efficacy of acupuncture in reducing bortezomib-induced peripheral neuropathy (BIPN) symptoms.

Methods: Patients with MM experiencing persistent BIPN ≥grade 2 despite adequate medical intervention and discontinuation of bortezomib received 10 acupuncture treatments for 10 weeks (2×/week for 2 weeks, 1×/week for 4 weeks, and then biweekly for 4 weeks). Responses were assessed by the Clinical Total Neuropathy Score (TNSc), Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity (FACT/GOG-Ntx) questionnaire, and the Neuropathy Pain Scale (NPS). Repeated-measures analysis of variance was used to test for monotonic decline in scores on each of the measures. Serial serum levels of proinflammatory and neurotrophic cytokines were obtained at baseline and weeks 1, 2, 4, 8, and 14.

Results: Twenty-seven patients with MM were enrolled in the trial. There were no adverse events associated with the acupuncture treatments. TNSc data were deemed invalid and therefore were not reported. At weeks 10 and 14, FACT/GOG-Ntx and NPS showed significant reduction suggesting decreased pain, and improved function (P values were <.0001 for both FACT/GOG-Ntx and NPS at weeks 10 and 14). However, nerve conduction studies did not significantly change between baseline assessment and end of study. There was no correlation in serum cytokines for responders versus none responders.

Conclusions: Acupuncture is safe, feasible and produces subjective improvements in patients' symptoms. A follow-up randomized controlled trial is warranted.

Keywords: acupuncture; bortezomib; multiple myeloma; peripheral neuropathy.

Figure 1

Acupuncture point location map. Acupuncture needles were inserted 0.5 to 2 inches into the skin to reach de qi sensation and remained in the skin for 20 minutes.

Figure 2

Trial schema.

Figure 3

(A) Change in FACT/GOG-Ntx scores over 14 weeks. FACT/GOG-Ntx scores at each time point (means and 95% confidence intervals). (B) Change in NPS scores over 14 weeks. NPS scores at each time point (means and 95% confidence intervals). Abbreviations: FACT/GOG-Ntx, Functional Assessment of Cancer Therapy/Gynecologic Oncology Group–Neurotoxicity; NPS, Neuropathy Pain Scale.