Home administration of bortezomib: Making a difference to myeloma patients' lives

Abstract

Multiple myeloma is a clonal malignancy of plasma cells, characterized by anaemia, renal dysfunction, lytic bone lesions and the presence of excess monoclonal immunoglobulin. It is the second most common hematological disorder (Devenney and Erickson, 2004). It remains a complex disease to diagnose and treat. However, our understanding of the biology of myeloma continues to develop, and hence a number of new potential therapies have been identified, with improved outcomes and survival (Kumar et al., 2008).

The introduction of novel agents, such as immunomodulatory drugs or proteasome inhibitors, either alone or in combination with traditional agents for the treatment of myeloma has led to a major improvement in patient outcomes, including survival, in the past decade. Based on significant improvements in response rates and overall survival in elderly patients when combined with melphalan in elderly patients (San Miguel et al., 2008), Bortezomib, a proteasome inhibitor, is now licensed as front line treatment for myeloma. Bortezomib combined with dexamethasone has also proven to be a very effective induction therapy in younger patients prior to autologous stem cell transplant (Harousseau et al., 2006) and is now viewed by some as the new standard for initial therapy of younger patients. Younger patients are those less than 65 years of age and eligible for stem cell transplant. However, they must also have good performance status and without other co-morbidities.

Initiatives in the home administration of chemotherapy are evident internationally (e.g. Lashlee and O'Hanlon Curry, 2007). With regard to the home administration of bortezomib, a pilot feasibility project of home administration of bortezomib to patients with myeloma has recently been reported from Bournmouth Hospital in England (McCarthy et al., 2009). However, that pilot program only included patients with relapsed disease and patients had to live within a 12 mile radius of the hospital. In addition, Day 1 and Day 4 doses were administered in the hospital, and blood samples were taken on each visit. Three of our patient group were newly diagnosed, receiving initial treatment for their myeloma. Furthermore, all patients on our program received first doses of bortezomib safely at home. In addition, bloods on our program are only taken on Day 8; the platelet nadir is day 11 so checking on day 8 detects any significant drop prior to this. Finally, our patients live as far away as 100 miles from the hospital.