title: Neurotoxicity of stem cell mobilization chemotherapy with vinorelbine in myeloma patients after bortezomib treatment.
abstract: Vinorelbine chemotherapy with G-CSF stimulation is the standard mobilization regimen in Switzerland for multiple myeloma patients. However, with the increasing use of bortezomib during induction treatment, adding the neurotoxic compound vinorelbine for mobilization may aggravate bortezomib-induced polyneuropathy. In this retrospective single-center study, we aimed to explore vinorelbine mediated neuropathy in 106 consecutive bortezomib pretreated myeloma patients. We confirmed that vinorelbine with G-CSF represents a reliable and effective regimen for mobilization of autologous stem cells. However, the single administration of 35 mg/m(2) vinorelbine added significant neurotoxicity. We found that 24 patients (24%) reported vinorelbine mediated neurotoxicity: Aggravation of bortezomib-induced neuropathy was observed in 17 patients (17%), and vinorelbine mobilization induced first occurrence of polyneuropathy in additional 7 patients (7%). We observed that development of polyneuropathy was not associated with differing survival rates. Finally, affected patients reported polyneuropathy associated disease burden as "very high" in 13% and "high" in 50%. Our data indicate that a single administration of vinorelbine to mobilize autologous stem cells is associated with significant additional polyneuropathy in bortezomib pretreated myeloma patients. The efficacy of vinorelbine mobilization should be balanced against its neurotoxic potential.
authors.affiliation: Department of Medical Oncology, University Hospital of Berne, Berne, Switzerland.
authors.forename: Sandra
authors.initials: S
authors.lastname: Keller
authors.affiliation: Department of Clinical Research, University of Berne, Berne, Switzerland.
authors.forename: Katja
authors.initials: K
authors.lastname: Seipel
authors.affiliation: Department of Medical Oncology, University Hospital of Berne, Berne, Switzerland.
authors.forename: Urban
authors.initials: U
authors.lastname: Novak
authors.affiliation: Department of Clinical Research, University of Berne, Berne, Switzerland.
authors.forename: Beatrice U
authors.initials: BU
authors.lastname: Mueller
authors.affiliation: Department of Hematology, University Hospital of Berne, Berne, Switzerland.
authors.forename: Behrouz Mansouri
authors.initials: BM
authors.lastname: Taleghani
authors.affiliation: Department of Pediatric Hemato-Oncology, University Hospital of Berne, Berne, Switzerland.
authors.forename: Kurt
authors.initials: K
authors.lastname: Leibundgut
authors.affiliation: Department of Medical Oncology, University Hospital of Berne, Berne, Switzerland. Electronic address: thomas.pabst@insel.ch.
authors.forename: Thomas
authors.initials: T
authors.lastname: Pabst
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001897:Boronic Acids / Q000627:therapeutic use*; D000069286:Bortezomib; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy*; D009420:Nervous System / Q000187:drug effects; D011719:Pyrazines / Q000627:therapeutic use*; D014747:Vinblastine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000077235:Vinorelbine
chemical_list: D000970:Antineoplastic Agents; D001897:Boronic Acids; D011719:Pyrazines; D014747:Vinblastine; D000069286:Bortezomib; D000077235:Vinorelbine
keywords: Bortezomib; Mobilization; Myeloma; Neurotoxicity; Polyneuropathy; Stem cells; Vinorelbine