Recent advances in the treatment and prevention of peripheral neuropathy after multiple myeloma treatment

Abstract

The incidence of multiple myeloma (MM) is increasing year by year, requiring chemotherapy drugs to control the condition. With the advent of new proteasome inhibitors, immunomodulators, and monoclonal antibodies, the prognosis of patients has improved significantly. However, peripheral neuropathy caused by drugs limits the dose and duration of treatment, which seriously affects patients' quality of life and treatment outcome. Although the neuropathies induced by chemotherapy drugs have attracted much attention, their mechanism and effective prevention and treatment measures are not clear. Therefore, how to alleviate peripheral neuropathy caused by drugs for treatment of MM is a key issue in improving patients' quality of life and prolonging their survival time, which have some clinical value. In this paper, we review the current research on the pathogenesis, pharmacological and nonpharmacological treatment, and prevention, which expects to present instruction for peripheral neuropathy after treatment of MM.

Keywords: chemotherapy; mechanism; multiple myeloma; peripheral neuropathy; treatment.

Figure 1

The current hypothesis for the pathogenesis of BIPN and TIPN. Bortezomib leads to glial cell activation, increased production of inflammatory factors, and release of calcium ions from the endoplasmic reticulum to activate apoptotic proteins, ultimately leading to neuronal apoptosis, as well as mitochondrial damage, leading to axonal degeneration. Thalidomide is able to induce degeneration of neuronal cells and exert direct toxic effects on DRG neurons. Further, thalidomide causes capillary damage in nerve fibers while resisting angiogenesis, an effect that reduces capillary production and leads to secondary nerve fiber ischemia and hypoxia. BIPN, bortezomib‐induced peripheral neuropathy; TIPN, thalidomide‐induced peripheral neuropathy. [Color figure can be viewed at wileyonlinelibrary.com]

Figure 2

Treatment methods for CIPN in MM patients. Pharmacological treatments are mainly nutritional nerve drugs and analgesic drugs, including duloxetine, docosahexaenoic acid and alpha‐lipoic acid, methylcobalamin, glutathione, dexanabinol, anticonvulsants, antidepressants, cannabinoids, and paeoniflorin, as well as nonpharmacological treatments such as exercise, acupuncture, nerve blocks, and electrical stimulation. BIPN, bortezomibinduced peripheral neuropathy; MM, multiple myeloma; TIPN, thalidomide‐induced peripheral neuropathy. [Color figure can be viewed at wileyonlinelibrary.com]