title: The magnitude of neurotoxicity in patients with multiple myeloma and the impact of dose modifications: results from the population-based PROFILES registry.
abstract: The aim of this analysis is to assess (1) self-reported chemotherapy-induced peripheral neuropathy (CIPN) symptoms; (2) its association with sociodemographic and clinical characteristics; and (3) treatment dose modifications and its influence on the magnitude of neurotoxicity in a population-based cohort of patients with multiple myeloma (MM). MM patients (n = 156), diagnosed between 2000 and 2014, filled out the EORTC QLQ-CIPN20 (65% response). Data on treatment, outcomes, and dose modifications were extracted from the medical files. Fifty-three percent of patients reported at least one and on average three neuropathy symptoms that bothered them the most during the past week, with tingling toes/feet as most reported. In multivariate analysis, thalidomide, especially higher cumulative dose, was associated with neuropathy (β = 0.26, CI 95% 0.27-15.34, p = 0.04) and CIPN was not associated with age, sex, time since last course of therapy, number of prior therapies, osteoarthritis, or diabetes. Dose modifications were often applied (65%). Although not statistically significant, a trend towards higher sensory (22 vs. 15 vs. 12, p = 0.22) and motor neuropathy scores (21 vs. 15 vs. 11, p = 0.36) was observed among patients receiving dose modification because of CIPN (31%) compared to those receiving a dose modification for another reason or no dose modification, without altering treatment response. CIPN is a common dose limiting side effect in patients with MM. Severity of CIPN was mainly affected by treatment with thalidomide. In spite of dose modifications, patients still reported somewhat higher neuropathy scores without altered response rates. Early dose modification based on a more reliable tool for CIPN measurements may prove value.
authors.affiliation: Department of Internal Medicine, Máxima Medical Center, Eindhoven and Veldhoven, De Run 4600, Veldhoven, PO Box 7777, 5500, MB, the Netherlands. t.beijers@mmc.nl.
authors.forename: Antoinetta J M
authors.initials: AJ
authors.lastname: Beijers
authors.affiliation: Netherlands Comprehensive Cancer Organisation (IKNL), Netherlands Cancer Registry, Eindhoven, the Netherlands.
authors.forename: Simone
authors.initials: S
authors.lastname: Oerlemans
authors.affiliation: Netherlands Comprehensive Cancer Organisation (IKNL), Netherlands Cancer Registry, Eindhoven, the Netherlands.|CoRPS - Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands.
authors.forename: Floortje
authors.initials: F
authors.lastname: Mols
authors.affiliation: Department of Neurology, Spaarne Hospital, Hoofddorp, The Netherlands.
authors.forename: Marijke
authors.initials: M
authors.lastname: Eurelings
authors.affiliation: Department of Hematology, UMC Utrecht Cancer Center, Utrecht, the Netherlands.
authors.forename: Monique C
authors.initials: MC
authors.lastname: Minnema
authors.affiliation: Department of Internal Medicine, Máxima Medical Center, Eindhoven and Veldhoven, De Run 4600, Veldhoven, PO Box 7777, 5500, MB, the Netherlands.|Department of Medical Oncology, Maastricht University Medical Center+, Maastricht, the Netherlands.
authors.forename: Art
authors.initials: A
authors.lastname: Vreugdenhil
authors.affiliation: Netherlands Comprehensive Cancer Organisation (IKNL), Netherlands Cancer Registry, Eindhoven, the Netherlands.|CoRPS - Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands.|Division of Psychosocial Oncology and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
authors.forename: Lonneke V
authors.initials: LV
authors.lastname: van de Poll-Franse
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D009426:Netherlands / Q000453:epidemiology; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology; D011159:Population Surveillance / Q000379:methods; D011446:Prospective Studies; D012042:Registries; D013792:Thalidomide / Q000008:administration & dosage / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D013792:Thalidomide
keywords: Chemotherapy-induced peripheral neuropathy; Dose modification; Multiple myeloma; Neuropathy; Treatment