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Frequency of peripheral neuropathy and injection site reactions in patients with multiple myeloma receiving subcutaneous versus intravenous bortezomib Manchulenko, Cynthia


Multiple myeloma is an incurable hematological malignancy with patients living on average 3 to 6 years after diagnosis. Bortezomib is widely used to treat multiple myeloma. Peripheral neuropathy has been a major side effect associated with bortezomib treatment, and occurs in 47% to 64% of patients. Therefore, strategies to minimize this dose limiting toxicity have been studied and protocols have been revised accordingly. Bortezomib administered subcutaneously instead of intravenously is one strategy that has shown to decrease the incidence of peripheral neuropathy, is well-tolerated and equally as efficacious as bortezomib administered intravenously. Injection site reactions have been reported as mild. Furthermore, as far as the author is aware there is currently no published literature discussing the safety and tolerability of the back of the arm as an injection site for bortezomib. This was a retrospective, chart review of 53 subjects with multiple myeloma, conducted in two large academic medical centres in British Columbia. Incidence of peripheral neuropathy was collected and compared between those who had received bortezomib via intravenous and subcutaneous routes. Incidence of injection site reactions related to subcutaneous administration of bortezomib were also collected, and a comparison was done between the sites of injection (back of the arm, abdomen and thigh). Overall, peripheral neuropathy rates in this study were 28% (n=15/53). There was no statistically significant difference between frequencies of peripheral neuropathy for patients who received bortezomib via intravenous or subcutaneous routes (p = .490). There were a total of 861 injections, with 294 injections to the back of the arm, 487 injections to the abdomen, 130 injections to an unknown site and only one injection in the thigh. Of the 861 injections, there were eight (2%) Grade 1 injection reactions in the abdomen, and one Grade 3 injection reaction, in the thigh. None were reported in the back of the arm. In conclusion, a prospective study with a larger sample size is needed to examine if subcutaneously injected bortezomib results in less peripheral neuropathy than intravenously injected bortezomib. Furthermore, subcutaneously injected bortezomib is safe and well tolerated when injected in the back of the arm.

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