Chemotherapy-induced peripheral neuropathies in hematological malignancies

Area of Science:

• Neurology
• Hematology
• Oncology

Background:

• Advancements in treating hematological malignancies, particularly plasma cell dyscrasias with proteasome inhibitors and immunomodulatory drugs, necessitate enhanced collaboration between hematologists and neurologists.
• Peripheral neuropathy is a common complication in multiple myeloma, Waldenstrom's macroglobulinemia, and light-chain amyloidosis.
• Neurologic complications in hematologic cancers can arise from direct disease involvement (compression/invasion) or as chemotherapy-induced peripheral neuropathies (CiPN).

Purpose of the Study:

• To highlight the critical need for collaboration between hematologists and neurologists in managing peripheral neuropathies associated with hematological malignancies.
• To emphasize the importance of differentiating between chemotherapy-induced peripheral neuropathies (CiPN) and disease-related neurologic complications.
• To underscore the necessity of early recognition and effective treatment of neuropathic pain in CiPN.

Main Methods:

• Review of clinical characteristics of peripheral neuropathies in hematological malignancies.
• Analysis of specific clinical phenotypes associated with CiPN caused by various chemotherapeutic agents (platinum compounds, vinca alkaloids, proteasome inhibitors, immunomodulatory drugs).
• Assessment of the role of neurologists in diagnosing and managing painful neuropathies.

Main Results:

• Hematological malignancies frequently present with peripheral neuropathy, which can be mimicked by direct tumor invasion.
• Various chemotherapy agents, including platinum compounds, vinca alkaloids, proteasome inhibitors, and immunomodulatory drugs, can cause distinct forms of CiPN.
• Early identification of CiPN's specific clinical phenotype is crucial for preventing irreversible neurological damage.
• Current evidence does not support the use of neuroprotective strategies for CiPN.
• Neurologists are best positioned to manage painful CiPN, particularly those induced by vinca alkaloids, proteasome inhibitors, and immunomodulatory drugs.

Conclusions:

• Close collaboration between hematologists and neurologists is essential for optimal patient care in hematological malignancies.
• Distinguishing CiPN from disease-related neuropathy and early recognition of CiPN are critical for preventing permanent neurological deficits.
• Neurologists play a key role in managing painful neuropathies resulting from specific cancer therapies.