Subclinical Peripheral Neuropathy in Patients With Multiple Myeloma Before Chemotherapy Is Correlated With Decreased Fingertip Innervation Density

1. Alyssa K. Kosturakis, 
2. Zijing He, 
3. Yan Li, 
4. Jessica A. Boyette-Davis, 
5. Nina Shah,
6. Sheeba K. Thomas, 
7. Haijun Zhang, 
8. Elisabeth G. Vichaya, 
9. Xin Shelley Wang,
10. Gwen Wendelschafer-Crabb, 
11. William R. Kennedy, 
12. Donald A. Simone,
13. Charles S. Cleeland and 
14. Patrick M. Dougherty⇑

+Author Affiliations

1. Alyssa K. Kosturakis, Zijing He, Yan Li, Nina Shah, Sheeba K. Thomas, Haijun Zhang, Elisabeth G. Vichaya, Xin Shelley Wang, Charles S. Cleeland, and Patrick M. Dougherty, University of Texas MD Anderson Cancer Center, Houston, TX; Jessica A. Boyette-Davis, York College, York, PA; Gwen Wendelschafer-Crabb and William R. Kennedy, University of Minnesota School of Medicine; and Donald A. Simone, University of Minnesota School of Dentistry, Minneapolis, MN.

1. Corresponding author: Patrick M. Dougherty, PhD, Department of Anesthesia and Pain Medicine, University of Texas MD Anderson Cancer Center, Houston, TX 77030; e-mail: pdougherty@mdanderson.org.

1. A.K.K. and Z.H. contributed equally to this work.

Abstract

Purpose The goal in this study was to determine the incidence of subclinical neuropathy in treatment-naive patients with multiple myeloma (MM) with no history of peripheral neuropathy using quantitative sensory tests (QSTs) and its correlation with innervation density of the extremities using noninvasive laser reflectance confocal microscopy.

Patients and Methods QST results were collected for 27 patients with a diagnosis of MM and compared with data collected from 30 age- and sex-matched healthy volunteers. Skin temperature, sensorimotor function (grooved pegboard test), and detection thresholds for temperature, sharpness, and low-threshold mechanical stimuli (von Frey monofilaments and bumps detection test) were measured. Meissner's corpuscle (MC) density in the fingertips was assessed using in vivo laser reflectance confocal microscopy.

Results Patients showed a high incidence (> 80%) of ≥ one subclinical QST deficit. These included increased von Frey, bumps, and warmth detection thresholds as compared with healthy volunteers. Patients also showed increases in cold pain, sensorimotor deficits (grooved pegboard test), and higher overall neuropathy scores. MC density was significantly lower in patients than controls and showed significant inverse correlation with bumps detection threshold.

Conclusion Patients with MM commonly present with sensory and sensorimotor deficits before undergoing treatment, and these deficits seem to result from disease-related decreases in peripheral innervation density.