硼替佐米联合地塞米松治疗多发性骨髓瘤出现严重精神障碍一例

Severe mental disorders after bortezomib in combination with dexamethasone in treatment of multiple myeloma: one case report

硼替佐米联合地塞米松(BD)方案是目前常用的抗骨髓瘤方案,该文报道1例在应用BD方案治疗后出现严重精神障碍的多发性骨髓瘤患者。该患者在确诊多发性骨髓瘤后接受了2个疗程的BD方案治疗,于第2疗程结束2 d时突发精神异常,表现为烦躁、易怒、言行失常、应答不切题、胡乱骂人、幻听、被害妄想及有攻击行为等。请精神科会诊,诊断为急性短暂性精神障碍,给予口服奥氮平后,患者精神症状逐渐改善,查头颅MRI未见异常。因患者既往无精神病史及家族史,故考虑其精神障碍可能与使用硼替佐米或地塞米松有关,后续化学治疗改为TAD方案(表柔比星、地塞米松、沙利度胺),至完成TAD方案6个疗程后患者均无再出现精神障碍。

Bortezomib in combination with dexamethasone （BD） therapy is commonly adopted to treat myeloma.In this article,we reported one patient diagnosed with multiple myeloma presenting with severe mental disorders after BD therapy.The patient underwent two courses of BD treatment after the diagnosis of multiple myeloma was confirmed.At the end of the second cycle of therapy,the patients suddenly presented with mental disorders,manifesting with dysphoria,irritation,abnormal speech and behavior,unrelated response,verbal abuse,auditory hallucination,delusion of persecution and aggressive behavior,etc.After consultations by psychiatric department,the patient was diagnosed with acute temporary mental disorders.The mental symptoms were gradually mitigated after oral administration of olanzapine.No abnormality was observed in head MRI.Since the patient had no medical history of mental diseases,the incidence of mental disorders is probably correlated with the use of bortezomib or dexamethasone.Subsequent chemotherapy was changed to TAD therapy （epirubicin,dexamethasone and thalidomide）.The patient presented with no mental disorders after six courses of TAD therapy.