Myeloma is characterized by the neoplastic proliferation of a clone of plasma cells that invades the bone, causes destruction of the skeleton, and causes bone pain and fractures. In addition, other important features are anemia, hypercalcemia and renal failure. The standard treatment in Spain for autologous stem cell transplant (ASCT)-eligible patients is VTD (bortezomib, thalidomide, dexamethasone). Both bortezomib and thalidomide can cause or exacerbate an existing neuropathy. The mechanism by which they produce it is different in the two drugs.1 A 52-year-old white male was referred to our hospital for the evaluation of anemia (12 g/dL) and serum monoclonal protein (>4 g/dL). The diagnosis was a high cytogenetic risk MM stage R-ISS IIIA, without bone lesions. He only presented mild anemia. He started treatment with standard doses and in accordance to the usual protocol in a candidate patient for autologous stem cell transplant, based on a thalidomide and bortezomib scheme. On the 15th day of the 2nd cycle, the patient showed an autonomic neuropathy and an affectation of the deep sensibility, predominantly the vibratory and proprioceptive with generalized muscle weakness predominant in the lower limbs. He had no pain. He was totally dependent for the basic activities of daily life. Regarding the MM response, the patient showed a strict complete response. This case illustrates a young man with a high cytogenetic risk MM who developed an acute and early polyneuropathy grade IV after 1.5 cycles of standard treatment and with myeloma in strict complete response. The remarkable aspect about this case is the severe and early neuropathy, and an early, deep and persistent myeloma response. On some occasions this relationship has been reported, and we report an example of it.
Few side effects of cancer treatment are more fearsome for patients than nausea and vomiting. Although both can result from surgery or radiation therapy, chemotherapy-induced nausea and vomiting (CINV) are potentially the most severe and the most distressing ones. Despite recent advances in the prevention of emesis induced by chemotherapy, its control remains to be insufficient in 20-25%.1s of patients, with the ensuing negative impact on their quality of life. In this small review, we intend to analyze some critical aspects related to the approach of antiemetic therapy in the clinical practice in haematological patients.
Few side effects of cancer treatment are more fearsome for patients than nausea and vomiting. Although both can result from surgery or radiation therapy, chemotherapy-induced nausea and vomiting (CINV) are potentially the most severe and the most distressing ones. Despite recent advances in the prevention of emesis induced by chemotherapy, its control remains to be insufficient in 20-25%. 1 of patients, with the ensuing negative impact on their quality of life. In this small review, we intend to analyze some critical aspects related to the approach of antiemetic therapy in the clinical practice in haematological patients.
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