title: Subcutaneous bortezomib in multiple myeloma patients induces similar therapeutic response rates as intravenous application but it does not reduce the incidence of peripheral neuropathy.
abstract: OBJECTIVE
  Subcutaneous (SC) application of bortezomib has been recently introduced as a new application route in multiple myeloma (MM) patients. We performed an analysis to compare the outcomes of bortezomib-based therapy in multiple myeloma (MM) patients treated using either intravenous (IV) or subcutaneous (SC) route of administration.
  
  
  METHODS
  During January 2012 through December 2013, we performed a retrospective analysis of 446 patients with MM treated with bortezomib-based regimens (either once weekly - 63% or twice weekly - 27%) in both, the first line setting, and in relapse, with separate analysis of patients undergoing autologous stem cell transplantation. We assessed the response rates and toxicity profiles in both, IV and SC route of bortezomib administration.
  
  
  RESULTS
  The response rates in both IV and SC arm were similar with overall response rate 71.7% vs 70.7%, complete remissions in 13.9% vs 8.6%, very good partial remissions in 30.8% vs 34.5% and partial remissions in 27% vs 27.6%. The most frequent grade ≥ 3 toxicities were anemia, thrombocytopenia and neutropenia, with no significant differences between IV and SC group. There were no significant differences in the rate of peripheral neuropathy (PN). PN of any grade was present in 48% in the IV arm and in 41% in the SC arm. PN grade ≥ 2 was present in 20% vs 18% and PN grade ≥ 3 was present in 6% vs 4%.
  
  
  CONCLUSIONS
  We conclude that subcutaneous application of bortezomib has similar therapeutic outcomes and toxicity profile as intravenous route of application. In our cohort there was no difference in the incidence of PN, suggesting that PN is dose dependent and might be reduced by lower intensity schemes rather than by the route of administration.
authors: Department of Hemato-oncology, University Hospital Olomouc and Medical Faculty of Palacky University Olomouc, Olomouc, Czech Republic.
authors: Jiri
authors: J
authors: Minarik
authors: Department of Clinical Hematology, University Hospital Kralovske Vinohrady, Praha, Czech Republic.
authors: Petr
authors: P
authors: Pavlicek
authors: Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Brno, Czech Republic.
authors: Ludek
authors: L
authors: Pour
authors: Department of Hemato-oncology, University Hospital Olomouc and Medical Faculty of Palacky University Olomouc, Olomouc, Czech Republic.
authors: Tomas
authors: T
authors: Pika
authors: Department of Clinical Hematology, University Hospital, Hradec Kralove, Czech Republic.
authors: Vladimir
authors: V
authors: Maisnar
authors: Department of Internal Medicine, University Hospital, Praha, Czech Republic.
authors: Ivan
authors: I
authors: Spicka
authors: Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
authors: Jiri
authors: J
authors: Jarkovsky
authors: Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Brno, Czech Republic.
authors: Marta
authors: M
authors: Krejci
authors: Department of Hemato-oncology, University Hospital Olomouc and Medical Faculty of Palacky University Olomouc, Olomouc, Czech Republic.
authors: Jaroslav
authors: J
authors: Bacovsky
authors: Department of Clinical Hematology, University Hospital, Hradec Kralove, Czech Republic.
authors: Jakub
authors: J
authors: Radocha
authors: Department of Internal Medicine, University Hospital, Praha, Czech Republic.
authors: Jan
authors: J
authors: Straub
authors: Department of Hematology and Transfusion, General Hospital, Pelhrimov, Czech Republic.
authors: Petr
authors: P
authors: Kessler
authors: Department of Oncology, Hospital Novy Jicin, Novy Jicin, Czech Republic.
authors: Marek
authors: M
authors: Wrobel
authors: Department of Clinical Hematology, General Hospital Liberec, Liberec, Czech Republic.
authors: Lenka
authors: L
authors: Walterova
authors: Department of Clinical Hematology, General Hospital, Ceske Budejovice, Czech Republic.
authors: Michal
authors: M
authors: Sykora
authors: Department of Hematology and Transfusion, Claudian Hospital, Mlada Boleslav, Czech Republic.
authors: Jarmila
authors: J
authors: Obernauerova
authors: Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
authors: Lucie
authors: L
authors: Brozova
authors: Department of Clinical Hematology, University Hospital Kralovske Vinohrady, Praha, Czech Republic.
authors: Evzen
authors: E
authors: Gregora
authors: Department of Hematology and Transfusiology, Silesian Hospital, Opava, Czech Republic.
authors: Dagmar
authors: D
authors: Adamova
authors: Department of Haematooncology, University Hospital Ostrava and the Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.
authors: Jaromir
authors: J
authors: Gumulec
authors: Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Brno, Czech Republic.
authors: Zdenek
authors: Z
authors: Adam
authors: Department of Hemato-oncology, University Hospital Olomouc and Medical Faculty of Palacky University Olomouc, Olomouc, Czech Republic.
authors: Vlastimil
authors: V
authors: Scudla
authors: Department of Haematooncology, University Hospital Ostrava and the Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.
authors: Roman
authors: R
authors: Hajek
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000069286:Bortezomib / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D015994:Incidence; D007275:Injections, Intravenous; D007279:Injections, Subcutaneous; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy*; D010523:Peripheral Nervous System Diseases / Q000453:epidemiology / Q000209:etiology*; D012074:Remission Induction; D012189:Retrospective Studies; D012720:Severity of Illness Index
chemical_list: D000069286:Bortezomib