Clinical analysis of the development of Guillain-Barré syndrome during bortezomib treatment for multiple myeloma.

Background: The development of Guillain-Barré syndrome (GBS) during bortezomib treatment for multiple myeloma (MM) is rare. Clinical vigilance regarding this serious adverse event is imperative for timely diagnosis and management. Methods: We conducted a retrospective review of the hospital's health information system (HIS) and report three cases of GBS that occurred during bortezomib-based treatment in patients with MM. A retrospective analysis of the patients' clinical presentations, diagnostic processes, treatments, and prognoses was conducted. Additionally, a literature search was performed by using the keywords "multiple myeloma," "bortezomib," "GBS," and "polyneuropathy" in the PubMed and China National Knowledge Infrastructure (CNKI) databases, which yielded 30 relevant published cases for review. Results: A total of 33 cases were included in the analysis. The VRD regimen (bortezomib, lenalidomide, and dexamethasone) appeared to be associated with the development of GBS in patients with IgA-type MM, whereas the VTD regimen (bortezomib, thalidomide, and dexamethasone) was more commonly associated with IgG-type MM. Intravenous immunoglobulin (IVIG) and plasma exchange represented the main first-line treatments, and most of the patients achieved varying degrees of neurological recovery within a median of 4.5 months (range: 3 weeks to 21 months). Conclusion: Neurological examination, cerebrospinal fluid analysis revealing albuminocytologic dissociation, and nerve conduction studies were helpful for diagnosing GBS. Prompt treatment with IVIG and/or plasma exchange can significantly improve patient outcomes.