Peripheral neuropathy in hematologic malignancies – Past, present and future

Li, Tiffany; Timmins, Hannah C.; Lazarus, Hillard M.; Park, Susanna B.

doi:10.1016/j.blre.2020.100653

Cited by 21 publications

(21 citation statements)

References 161 publications

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“…VIPN can be observed in 20-40% of DLBCL patients leading to an increase in morbidity and a decrease in quality of life [6][7][8][9]. However, the clinical features and symptoms are variable and range from mild neurologic signs like numbness, which may disappear with discontinuation of vincristine, to severe permanent neurological long-term sequela such as gross and fine motoric deficits, e.g., impaired handwriting [10,11].…”

Section: Introductionmentioning

confidence: 99%

Vinorelbine as substitute for vincristine in patients with diffuse large B cell lymphoma and vincristine-induced neuropathy

Hatzl

Posch

Rezai

et al. 2021

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Background A combination of rituximab with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) is the standard first-line therapy for diffuse large B cell lymphoma (DLBCL), the most common aggressive lymphoma in adults. One of the major adverse effects of this regimen is vincristine-induced polyneuropathy which leads to discontinuation of vincristine in up to 30% of DLBCL-patients. Dose reduction of vincristine might worsen treatment outcomes of DLBCL but identification of treatment alternatives for patients exhibiting peripheral neuropathy during R-CHOP is an unmet need in hematology. Methods In this retrospective cohort study, comprising 987 patients with de novo DLBCL, we delineated the role of vinorelbine as a substitute for vincristine in R-CHOP by measuring improvements in neuropathy and outcome variables. Results Five-year overall survival (OS) and progression-free survival (PFS) were 72.6% and 63.1% in patients who received regular doses of vincristine, as compared to 60.6% and 51.7% in patients who received reduced doses of vincristine (p = 0.022 and p = 0.003, respectively). Of 199 patients who switched to vinorelbine, the majority experienced an improvement of neuropathy Furthermore, vinorelbine-switched patients showed favorable oncologic outcomes. Conclusion Replacement of vincristine by vinorelbine due to neuropathy is effective and safe, and results in a significant improvement in neuropathy as compared to treatment with R-CHOP.

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Section: Introductionmentioning

confidence: 99%

Vinorelbine as substitute for vincristine in patients with diffuse large B cell lymphoma and vincristine-induced neuropathy

Hatzl

Posch

Rezai

et al. 2021

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“…This discrepancy can be explained by the effects of aging and HM treatment on physical problems. In particular, patients with HMs, especially lymphoma and multiple myeloma, frequently experience tingling due to neurotoxic treatments (e.g., bortezomib, thalidomide, brentuximab vedotin, vinca alkaloid) [37]. Moreover, our prevalence of memory impairment and di culty in getting around was comparable to other elderly patients with cancer that was measured using a different diagnostic tool (e.g., Mini-Mental State Examination) [38].…”

Section: Discussionmentioning

confidence: 54%

Patient-reported distress and problems among elderly patients with hematological malignancy in Korea

Park

Kim

Hong

2022

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Purpose: Treatment for hematological malignancies (HMs) and functional decline associated with age can cause distress in elderly patients with HMs. However, information about the nature and effects of distress in this population is scarce. Therefore, this study examined the level of distress, its source, and the practical/familial/physical/emotional problems among elderly patients with HMs.Methods: We conducted a cross-sectional study of patients with HMs aged ≥ 65 years who visited an outpatient clinic at a tertiary medical center in Korea between November 2019 and March 2020. Patientreported distress and problems were measured using the Distress Thermometer (DT) and 39-item Problem List by the National Comprehensive Cancer Network. Descriptive statistics, χ2 test or Fisher's exact test, and multivariate logistic regression analyses were conducted (N = 132).Results: In total, 62.1% of patients were had moderate to severe distress (DT score ≥ 4), experiencing an average of nine problems. Signi cant sources of distress on multivariate logistic analysis included problems with transportation, depression, and constipation, accounting for 47% of distress variance.Most patients had physical (97.0%) or emotional problems (79.5%). Among these, fatigue (60.6%), worry (59.8%), tingling (59.8%), getting around (47.0%), and memory/concentration (40.2%) were the most frequently reported problems.Conclusions: Elderly patients with HMs have a high burden of distress, which is affected by different sources, compared with patients with general cancer. Thus, in this population, assessment and management of distress need to be conducted considering the unique features of their source and burden. Further research on distress should consider the cancer type and population age.

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“…All of these regimens contain vinca-alkaloid or platinum agents known to produce PN to some degree. For example, the classical ABVD schedule can be associated with neuropathy in overall and grade 2-3 PN, up to 56% and 12%, respectively [ 64 , 65 , 66 ]. In addition, novel therapies such as immune checkpoint inhibitors such as anti-PD1 antibodies (i.e., nivolumab and pembrolizumab), which received recent approval for relapsed/refractory HL [ 67 , 68 ], can induce immune-mediated PN amongst other neurologic complications [ 69 ].…”

Section: Epidemiology Of Bvinmentioning

confidence: 99%

“…Currently, the majority of patients with HL have been previously treated with prior chemotherapy regimens before BV therapy [ 26 ], frequently including neurotoxic agents [ 64 ]. In a series of 36 patients with MF, a logistic regression analysis showed that the likelihood of developing clinically significant BVIN increased 13-fold (95% CI 2.59–65.20) in those patients who received treatments in the previous year [ 79 ].…”

Section: Risk Factors For Bvinmentioning

confidence: 99%

“…BV treatment had a manageable neurotoxicity in patients with HL participating in clinical trials and studies within a real-world setting ( Table 1 ). Dose modification is a successful, preventative strategy in managing patients with BVIN, with supporting evidence by pharmacokinetic analyses demonstrating that the probability of PN onset is associated with BV exposure [ 64 , 118 ]. Reducing doses thus lowers peak plasma concentration and minimises toxicity [ 71 ].…”

Section: Early Diagnosis and Management Of Bvinmentioning

confidence: 99%

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Brentuximab-Induced Peripheral Neurotoxicity: A Multidisciplinary Approach to Manage an Emerging Challenge in Hodgkin Lymphoma Therapy

Velasco

Domingo‐Domenech

Sureda

2021

Cancers

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Brentuximab vedotin (BV) is an anti-CD30 antibody–drug conjugate approved to treat classical Hodgkin lymphoma (HL). BV-induced peripheral neurotoxicity (BVIN) is one of the greatest concerns for haematologists treating HL for several reasons. First, BVIN is highly frequent. Most patients receiving BV will experience some degree of BVIN, resulting in the primary reason for dose modification or discontinuation of HL therapy. Second, BV produces sensory, motor, and/or autonomic peripheral nerve dysfunction, which can present as severe, disabling forms of BVIN—predominantly motor—in some patients. Third, although largely reversible, BVIN may persist months or years after treatment and thereby become a major issue in HL survivorship. BVIN may, therefore, negatively affect the quality of life and work-life of often young patients with HL, in whom long-term survival is expected. Currently, the only strategy for BVIN includes dose adjustments and treatment discontinuation; however, this could interfere with LH therapy efficacy. In this setting, early recognition and adequate management of BVIN are critical in improving clinical outcomes. Careful neurologic monitoring may allow accurate diagnoses and gradation of ongoing forms of BVIN presentation. This review analysed current, available data on epidemiology, pathophysiology, patient- and treatment-related risk factors, clinical and neurophysiologic phenotypes, and management in patients with HL. Furthermore, this review specifically addresses limitations posed by BVIN assessments in clinical practice and provides skills and tools to improve neurologic assessments in these patients. Integrating this neurotoxic drug in clinical practice requires a multidisciplinary approach to avoid or minimise neurotoxicity burden in survivors of HL.

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Peripheral neuropathy in hematologic malignancies – Past, present and future

Cited by 21 publications

References 161 publications

Vinorelbine as substitute for vincristine in patients with diffuse large B cell lymphoma and vincristine-induced neuropathy

Vinorelbine as substitute for vincristine in patients with diffuse large B cell lymphoma and vincristine-induced neuropathy

Patient-reported distress and problems among elderly patients with hematological malignancy in Korea

Brentuximab-Induced Peripheral Neurotoxicity: A Multidisciplinary Approach to Manage an Emerging Challenge in Hodgkin Lymphoma Therapy

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