Bortezomib is a proteasome inhibitor that has proven to be a very effective treatment for multiple myeloma. The investigators hypothesis is that the proteasome inhibition will lead to reduced antibody titers and improved clinical outcome. One patient experienced lymphocytic leptomeningitis resulting in unilateral optic neuritis. Different schedules may be used for patients who are receiving treatment for the first time and those who are receiving treatment for relapsed disease, as well as patients who are receiving Velcade in combination with other drugs. His radiologic findings, clinical course and subsequent recovery supported a diagnosis of RPLS. Accessed November 21, 2011. In addition, 10 patients experienced at least a 50% improvement in their symptoms.
We summarize the impact of these therapies on pathogenesis and spectrum of infection complicating their usage. CONCLUSIONS: Bortezomib alone or in combination with other agents can be recommended for both previously untreated or relapsed/refractory patients with multiple myeloma. The incidence of peripheral neuropathy (PN) in PTD group was significantly higher than other three groups, especially grade 2–3 PN. Three patients developed grade 2 neuropathy, which required a bortezomib dose reduction to 1.0 mg/mq. The mechanism of action of bortezomib, a reversible proteasome inhibitor, is partly mediated through the nuclear factor-kappa B (NF-kB) inhibition, leading to myeloma cell apoptosis, decreased angiogenic cytokine expression, and inhibition of tumor cell adhesion to stroma.4 However, bortezomib barely affected the unstimulated T cells in vitro5 and had little, if any, impact on the function or number of the mature lymphocytes in animal models.6 Similar studies in humans failed to show consistent alterations in CD4+, CD8+ or CD56+ NK cell populations with the use of bortezomib. Blood. The twice-monthly bortezomib infusion appeared to reduce the incidence of grade 3 and 4 neuropathies in comparison to similar experiences in other settings.