Bortezomib and Thalidomide Associated with Pulmonary Function Abnormalities in Myeloma Patients
“We describe a 2-fold increased odds of PFT [pulmonary function test] abnormalities with novel agents when used before transplantation – obstruction for bortezomib-exposed patients and restriction for thalidomide-exposed patients,” reported lead author Jarrod T. Bruce, MD, a clinical assistant professor at the Division of Pulmonary, Allergy, Critical Care and Sleep Medicine at the Ohio state Medical Center in Columbus Ohio, and coauthors.
Pulmonary restriction involves reduced maximum achievable lung volume at peak inhalation. Respiratory obstruction refers to impeded airflow during inhalation or expiration.
“Our data suggest clinicians should have a low threshold of suspicion for pulmonary abnormalities in patients exposed to bortezomib and thalidomide,” Dr. Bruce and coauthors advised.
The authors reviewed medical records for 343 myeloma patients who had been administered pulmonary function tests prior to autologous stem cell transplantation. Of these patients, 234 had received bortezomib and/or lenalidomide and/or thalidomide.
Patients who were administered bortezomib were more likely to suffer obstructive PFT (19.8%) than were patients who had not received bortezomib (9.9%; P =0.015), whereas patients who had been administered thalidomide were more likely to suffer restrictive PFT (30.3%) compared with those who had not received thalidomide (18.4%; P=0.17).
After adjusting for age, sex, Durie-Salmon (DS) stage, BMI, time from diagnosis to transplantation, and smoking history, the odds of obstructive PFT among patients administered bortezomib were nearly twice as high as those seen among patients not receiving bortezomib (OR 1.96 [95% CI: 1.01-3.79]; P=0.047). Thalidomide-associated pulmonary restriction also remained statistically significant (OR 1.97 [95% CI: 1.13-3.44];P=0.017).
Lenalidomide exposure was not associated with pulmonary function abnormalities and did not modulate the associations between pulmonary function and thalidomide or bortezomib.