Electroacupuncture for thalidomide/bortezomib-induced peripheral neuropathy in multiple myeloma: a feasibility study

M Kay Garcia, Lorenzo Cohen, Ying Guo, Yuhong Zhou, Bing You, Joseph Chiang, Robert Z Orlowski, Donna Weber, Jatin Shah, Raymond Alexanian, Sheeba Thomas, Jorge Romaguera, Liang Zhang, Maria Badillo, Yiming Chen, Qi Wei, Richard Lee, Kay Delasalle, Vivian Green, Michael Wang, M Kay Garcia, Lorenzo Cohen, Ying Guo, Yuhong Zhou, Bing You, Joseph Chiang, Robert Z Orlowski, Donna Weber, Jatin Shah, Raymond Alexanian, Sheeba Thomas, Jorge Romaguera, Liang Zhang, Maria Badillo, Yiming Chen, Qi Wei, Richard Lee, Kay Delasalle, Vivian Green, Michael Wang

Abstract

Background: This single-arm study evaluated feasibility, safety, and initial efficacy of electroacupuncture for thalidomide/bortezomib-induced peripheral neuropathy (PN) in cancer patients with multiple myeloma.

Methods: Patients with neuropathy ≥ grade 2 received 20 acupuncture treatments over 9 weeks.

Results: For the 19 evaluable patients, Functional Assessment of Cancer Therapy/Gynecological Oncology Group-Neurotoxicity (FACT/GOG/NTX) mean (SD) scores improved significantly between baseline and week 13 (20.8 [9.6] vs 13.2 [8.5], p = 0.0002). Moderate effect size differences began on week 4, with the largest effect size differences found at week 9 for FACT/GOG/NTX scores, worst pain in the last 24 hours, and pain severity (Cohen's d = 1.43, 1.19, and 1.08, respectively) and continuing through week 13 (Cohen's d = 0.86, 0.88, and 0.90, respectively). From baseline to week 13, additional significant improvements were seen as follows: postural stability (1.0 [0.6] vs 0.8 [0.4], p = 0.02); coin test (10.0 [7.4] vs 5.6 [1.9], p < 0.0001); button test (96.1 [144.4] vs 54.9 [47.3], p < 0.0001); and walking test (21.6 [10.0] vs 17.2 [7.7], p = 0.0003). No significant changes were seen with NCS.

Conclusions: Acupuncture may help patients experiencing thalidomide- or bortezomib-induced PN. Larger, randomized, clinical trials are needed.

Trial registration: ClinicalTrials.gov Identifier: NCT00891618.

Figures

Figure 1
Figure 1
Study flow diagram.

References

    1. Richardson PG, Delforge M, Beksac M, Wen P, Jongen JL, Sezer O, Terpos E, Munshi N, Palumbo A, Rajkumar SV, Harousseau JL, Moreau P, Avet-Loiseau H, Lee JH, Cavo M, Merlini G, Voorhees P, Chng WJ, Mazumder A, Usmani S, Einsele H, Comenzo R, Orlowski R, Vesole D, Lahuerta JJ, Niesvizky R, Siegel D, Mateos MV, Dimopoulos M, Lonial S. et al.Management of treatment-emergent peripheral neuropathy in multiple myeloma. Leukemia. 2012;26(4):595–608. doi: 10.1038/leu.2011.346.
    1. Richardson PG, Weller E, Lonial S, Jakubowiak AJ, Jagannath S, Raje NS, Avigan DE, Xie W, Ghobrial IM, Schlossman RL, Mazumder A, Munshi NC, Vesole DH, Joyce R, Kaufman JL, Doss D, Warren DL, Lunde LE, Kaster S, Delaney C, Hideshima T, Mitsiades CS, Knight R, Esseltine DL, Anderson KC. Lenalidomide, bortezomib, and dexamethasone combination therapy in patients with newly diagnosed multiple myeloma. Blood. 2010;116(5):679–686. doi: 10.1182/blood-2010-02-268862.
    1. Velasco R, Petit J, Clapes V, Verdu E, Navarro X, Bruna J. Neurological monitoring reduces the incidence of bortezomib-induced peripheral neuropathy in multiple myeloma patients. J Peripher Nerv Syst. 2010;15(1):17–25. doi: 10.1111/j.1529-8027.2010.00248.x.
    1. Raab MS, Podar K, Breitkreutz I, Richardson PG, Anderson KC. Multiple myeloma. Lancet. 2009;374(9686):324–339. doi: 10.1016/S0140-6736(09)60221-X.
    1. Kaufmann H, Raderer M, Wohrer S, Puspok A, Bankier A, Zielinski C, Chott A, Drach J. Antitumor activity of rituximab plus thalidomide in patients with relapsed/refractory mantle cell lymphoma. Blood. 2004;104(8):2269–2271. doi: 10.1182/blood-2004-03-1091.
    1. Cavo M, Pantani L, Petrucci MT, Patriarca F, Zamagni E, Donnarumma D, Crippa C, Boccadoro M, Perrone G, Falcone A, Nozzoli C, Zambello R, Masini L, Furlan A, Brioli A, Derudas D, Ballanti S, Dessanti ML, De Stefano V, Carella AM, Marcatti M, Nozza A, Ferrara F, Callea V, Califano C, Pezzi A, Baraldi A, Grasso M, Musto P, Palumbo A. Bortezomib-thalidomide-dexamethasone is superior to thalidomide-dexamethasone as consolidation therapy after autologous hematopoietic stem cell transplantation in patients with newly diagnosed multiple myeloma. Blood. 2012;120(1):9–19. doi: 10.1182/blood-2012-02-408898.
    1. Umapathi T, Chaudhry V. Toxic neuropathy. Curr Opin Neurol. 2005;18(5):574–580. doi: 10.1097/01.wco.0000180158.34713.aa.
    1. Argyriou AA, Bruna J, Marmiroli P, Cavaletti G. Chemotherapy-induced peripheral neurotoxicity (CIPN): an update. Crit Rev Oncol Hematol. 2012;82(1):51–77. doi: 10.1016/j.critrevonc.2011.04.012.
    1. Grisold W, Cavaletti G, Windebank AJ. Peripheral neuropathies from chemotherapeutics and targeted agents: diagnosis, treatment, and prevention. Neuro Oncol. 2012;14(Suppl 4):iv45–iv54.
    1. Argyriou AA, Iconomou G, Kalofonos HP. Bortezomib-induced peripheral neuropathy in multiple myeloma: a comprehensive review of the literature. Blood. 2008;112(5):1593–1599. doi: 10.1182/blood-2008-04-149385.
    1. Johnson DC, Corthals SL, Walker BA, Ross FM, Gregory WM, Dickens NJ, Lokhorst HM, Goldschmidt H, Davies FE, Durie BG, Van Ness B, Child JA, Sonneveld P, Morgan GJ. Genetic factors underlying the risk of thalidomide-related neuropathy in patients with multiple myeloma. J Clin Oncol. 2011;29(7):797–804. doi: 10.1200/JCO.2010.28.0792.
    1. Lao L, Hamilton GR, Fu J, Berman BM. Is acupuncture safe? A systematic review of case reports. Altern Ther Health Med. 2003;9(1):72–83.
    1. Ernst E, White AR. Prospective studies of the safety of acupuncture: a systematic review. Am J Med. 2001;110(6):481–485. doi: 10.1016/S0002-9343(01)00651-9.
    1. Macpherson H, Scullion A, Thomas KJ, Walters S. Patient reports of adverse events associated with acupuncture treatment: a prospective national survey. Qual Saf Health Care. 2004;13(5):349–355. doi: 10.1136/qshc.2003.009134.
    1. Su JW, Lim CH, Chua YL. Bilateral pneumothoraces as a complication of acupuncture. Singapore Med J. 2007;48(1):e32–e33.
    1. Peuker E, Gronemeyer D. Rare but serious complications of acupuncture: traumatic lesions. Acupunct Med. 2001;19(2):103–108. doi: 10.1136/aim.19.2.103.
    1. Chang SA, Kim YJ, Sohn DW, Park YB, Choi YS. Aortoduodenal fistula complicated by acupuncture. Int J Cardiol. 2005;104(2):241–242. doi: 10.1016/j.ijcard.2004.12.035.
    1. Shiflett SC, Schwartz GE. Effects of acupuncture in reducing attrition and mortality in HIV-infected men with peripheral neuropathy. Explore (NY) 2011;7(3):148–154. doi: 10.1016/j.explore.2011.02.004.
    1. Phillips KD, Skelton WD, Hand GA. Effect of acupuncture administered in a group setting on pain and subjective peripheral neuropathy in persons with human immunodeficiency virus disease. J Altern Complement Med. 2004;10(3):449–455. doi: 10.1089/1075553041323678.
    1. Zhang C, Ma YX, Yan Y. Clinical effects of acupuncture for diabetic peripheral neuropathy. J Tradit Chin Med. 2010;30(1):13–14. doi: 10.1016/S0254-6272(10)60003-9.
    1. Tong Y, Guo H, Han B. Fifteen-day acupuncture treatment relieves diabetic peripheral neuropathy. J Acupunct Meridian Stud. 2010;3(2):95–103. doi: 10.1016/S2005-2901(10)60018-0.
    1. Wang YP, Ji L, Li JT, Pu JQ, Liu FJ. Effects of acupuncture on diabetic peripheral neuropathies. Zhongguo Zhen Jiu. 2005;25(8):542–544.
    1. Abuaisha BB, Costanzi JB, Boulton AJ. Acupuncture for the treatment of chronic painful peripheral diabetic neuropathy: a long-term study. Diabetes Res Clin Pract. 1998;39(2):115–121. doi: 10.1016/S0168-8227(97)00123-X.
    1. Jiang H, Shi K, Li X, Zhou W, Cao Y. Clinical study on the wrist-ankle acupuncture treatment for 30 cases of diabetic peripheral neuritis. J Tradit Chin Med. 2006;26(1):8–12.
    1. Wong R, Sagar S. Acupuncture treatment for chemotherapy-induced peripheral neuropathy–a case series. Acupunct Med. 2006;24(2):87–91. doi: 10.1136/aim.24.2.87.
    1. Donald GK, Tobin I, Stringer J. Evaluation of acupuncture in the management of chemotherapy-induced peripheral neuropathy. Acupunct Med. 2011;29(3):230–233. doi: 10.1136/acupmed.2011.010025.
    1. Schroeder S, Meyer-Hamme G, Epplee S. Acupuncture for chemotherapy-induced peripheral neuropathy (CIPN): a pilot study using neurography. Acupunct Med. 2012;30(1):4–7. doi: 10.1136/acupmed-2011-010034.
    1. Xu WR, Hua BJ, Hou W, Bao YJ. Clinical randomized controlled study on acupuncture for treatment of peripheral neuropathy induced by chemotherapeutic drugs. Zhongguo Zhen Jiu. 2010;30(6):457–460.
    1. Zhao ZQ. Neural mechanism underlying acupuncture analgesia. Prog Neurobiol. 2008;85(4):355–375. doi: 10.1016/j.pneurobio.2008.05.004.
    1. Han JS. Acupuncture and endorphins. Neurosci Lett. 2004;361(1–3):258–261.
    1. Mittleman E, Gaynor JS. A brief overview of the analgesic and immunologic effects of acupuncture in domestic animals. J Am Vet Med Assoc. 2000;217(8):1201–1205. doi: 10.2460/javma.2000.217.1201.
    1. Schroder S, Liepert J, Remppis A, Greten JH. Acupuncture treatment improves nerve conduction in peripheral neuropathy. Eur J Neurol. 2007;14(3):276–281.
    1. Atkinson TM, Mendoza TR, Sit L, Passik S, Scher HI, Cleeland C, Basch E. The Brief Pain Inventory and its “pain at its worst in the last 24 hours” item: clinical trial endpoint considerations. Pain Med. 2010;11(3):337–346. doi: 10.1111/j.1526-4637.2009.00774.x.
    1. Kaptchuk TJ. Placebo studies and ritual theory: a comparative analysis of Navajo, acupuncture and biomedical healing. Philos Trans R Soc Lond B Biol Sci. 2011;366(1572):1849–1858. doi: 10.1098/rstb.2010.0385.
    1. Kaptchuk TJ, Kelley JM, Conboy LA, Davis RB, Kerr CE, Jacobson EE, Kirsch I, Schyner RN, Nam BH, Nguyen LT, Park M, Rivers AL, McManus C, Kokkotou E, Drossman DA, Goldman P, Lembo AJ. Components of placebo effect: randomised controlled trial in patients with irritable bowel syndrome. BMJ. 2008;336(7651):999–1003. doi: 10.1136/bmj.39524.439618.25.
    1. Kaptchuk TJ, Stason WB, Davis RB, Legedza AR, Schnyer RN, Kerr CE, Stone DA, Nam BH, Kirsch I, Goldman RH. Sham device v inert pill: randomised controlled trial of two placebo treatments. BMJ. 2006;332(7538):391–397. doi: 10.1136/bmj.38726.603310.55.
    1. Trotti A, Colevas AD, Setser A, Rusch V, Jaques D, Budach V, Langer C, Murphy B, Cumberlin R, Coleman CN, Rubin P. CTCAE v3.0: development of a comprehensive grading system for the adverse effects of cancer treatment. Semin Radiat Oncol. 2003;13(3):176–181. doi: 10.1016/S1053-4296(03)00031-6.
    1. Dedman P, Al-Khafaji M, Baker K. A Manual of Acupuncture. East Sussex, UK: Journal of Chinese Medicine Publications; 1998.
    1. Deng LY. Chinese Acupuncture and Moxibustion. Beijing: Foreign Languages Press; 1997.
    1. Buschbacher RM, Prahlow ND. Manual of Nerve Conduction Studies. 2. New York: Demos Medical Publishing; 2005.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe