title: Bortezomib-associated demyelinating neuropathy--clinical and pathologic features.
abstract: OBJECTIVE
  Bortezomib is a proteasome inhibitor that is frequently used for multiple myeloma and lymphoma. A sensory predominant axonal neuropathy is associated with bortezomib treatment but a demyelinating neuropathy is also described primarily based on electrodiagnostic findings. We report a series of patients treated with bortezomib who developed peripheral neuropathy and were found to have demyelinating features on electrodiagnostic testing.
  
  
  METHODS
  Four patients who developed a bortezomib-induced peripheral neuropathy underwent electrophysiological testing, and 1 patient had a nerve biopsy.
  
  
  RESULTS
  The four patients with bortezomib-induced peripheral neuropathy had demyelinating features on their electrophysiological testing. The nerve biopsy performed in 1 patient demonstrated a demyelinating component in a background of axonal degeneration.
  
  
  CONCLUSIONS
  Although most toxic neuropathies are symmetrical axonal neuropathies, bortezomib is part of a small list of agents that may cause a demyelinating polyneuropathy and axonal degeneration. These findings have been confirmed by nerve biopsy.
authors.affiliation: *Department of Neurology, Columbia Neuropathy Research Center, The Neurological Institute of New York, Columbia University Medical Center, New York, NY; †Division of Neuropathology, Department of Pathology and Cell Biology, Neuromuscular Pathology Laboratory, Columbia University College of Physicians and Surgeons, New York, NY; ‡Division of Neuromuscular Medicine, Department of Neurology, The University of Oklahoma Health Sciences Center, Oklahoma, OK.
authors.forename: Sujata P
authors.initials: SP
authors.lastname: Thawani
authors.forename: Kurenai
authors.initials: K
authors.lastname: Tanji
authors.forename: Eduardo A
authors.initials: EA
authors.lastname: De Sousa
authors.forename: Louis H
authors.initials: LH
authors.lastname: Weimer
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Brannagan
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000069286:Bortezomib / Q000009:adverse effects* / Q000627:therapeutic use; D003711:Demyelinating Diseases / Q000139:chemically induced* / Q000473:pathology / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology; D009431:Neural Conduction / Q000502:physiology*; D011115:Polyneuropathies / Q000139:chemically induced* / Q000473:pathology / Q000503:physiopathology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology
chemical_list: D000970:Antineoplastic Agents; D000069286:Bortezomib