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Evaluation of relative thrombocytopenia, identification of neuropathy, and bleeding risk secondary to utilization of neuromodulating agents in multiple myeloma patients receiving autologous stem cell transplant treated with melphalan, bortezomib, and lenalidomide.

212 Background: Chemotherapy-induced polyneuropathy (CIPN) is a crippling manifestation in multiple myeloma (MM) patients that requires attentiveness to safety and quality of life.(2) Bortezomib, lenalidomide, and melphalan are commonly utilized chemotherapy agents that can cause both CIPN(3,4) and significant myelosuppression. Within this subset of patients we wish to insure efficacy and minimization of neuropathic pain while being mindful of bleeding risks.

METHODS: IRB approval was obtained for a retrospective study of patients with MM who received a bone marrow transplant (BMT). Criteria included those who have undergone treatment with melphalan, bortezomib, and lenalidomide who experienced CIPN and placed on gabapentin, pregabalin, or duloxetine with thrombocytopenia defined by a platelet count less than 100,000 K/ul. We identified all patients seen on the BMT service at Ochsner Medical Center who received an autologous BMT for MM and treated with melphalan, bortezumib, and lenalidomide. Demographic data included age at diagnosis, gender, height, and weight. We examined characteristics including date of diagnosis and progression free survival. Endpoints included signs of peripheral neuropathy, onset of thrombocytopenia, initiation of therapy with gabapentin, pregabalin, or duloxetine.

RESULTS: 62 patients were selected with data capture. A preliminary chart review shows of patients meeting selection criteria, 53% of patients identified had shown undocumented or undertreated neuropathy, significant bleeding risk, or low platelet function assays. Complete breakdown of individual factors to be provided graphically.

CONCLUSIONS: The standard treatment practices for MM patients with CIPN has placed patients at higher risk for development of thrombocytopenia and adverse bleeding risks, requiring more stringent institutional documentation practices.

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