The results of a recent retrospective study suggest that treatment with Velcade or thalidomide may increase multiple myeloma patients’ risk of developing abnormal lung function.

Specifically, patients treated with Velcade ^[1] (bortezomib)-based regimens were twice as likely to develop lung obstruction, and those treated with thalidomide ^[2] (Thalomid)-based regimens were twice as likely to develop lung restriction.

However, the study investigators note that their study did not include information about lung disease patients may have had before their myeloma therapy.  The researchers acknowledge that this could affect the interpretation of the study results.

The authors therefore conclude that a larger, prospective study is needed to confirm their results.

In the meantime, they suggest that lung function be monitored in patients before and after treatment with Velcade and thalidomide.

In recent years, newer myeloma therapies -- including thalidomide, Velcade, and, Revlimid ^[3] (lenalidomide) -- have become standard treatment options for multiple myeloma patients.   These newer therapies are often referred to as novel agents.

According to the study investigators, treatment with novel agents has been associated with lung-related side effects, such as pneumonia and high blood pressure in the arteries to the lungs. However, the investigators point out that no study has investigated the long-term effects of novel agents on lung function.

To explore the potential connection between novel agents and lung function, the authors of the current study took advantage of a common practice in the treatment of multiple myeloma.

In particular, the researchers leveraged the fact that myeloma patients being considered for a stem cell transplant typically undergo pulmonary function testing, which measures lung function.  An abnormal test result may affect a patient's eligibility for a transplant.

The pulmonary function testing is normally carried out, however, after a patient already has received initial treatment for their myeloma.  A decade ago, such treatment may, or may not, have included a novel agent.  Today, such treatment invariably involves at least one novel agent, usually in combination with dexamethasone ^[4] (Decadron).

Thus, in the current study, researchers from Ohio State University in Columbus, Ohio, reviewed the records of 343 multiple myeloma patients who had received a stem cell transplant at their institution between 2000 and 2010. The average patient age was 56 years.

All patients underwent pulmonary function testing prior to receiving a stem cell transplant.  Typical abnormalities in lung function observed during pulmonary function testing include obstruction and restriction.

Obstructive lung function is characterized by shortness of breath that occurs when a patient has difficulty exhaling air from the lungs.

Restrictive lung function, on the other hand, occurs when a patient's lungs cannot expand, resulting in incomplete inhalation.

Overall, 32 percent of patients in the study had no exposure to novel agents, 38 percent were treated with a Velcade-containing regimen, 26 percent were treated with a Revlimid-containing regimen, and 32 percent were treated with a thalidomide-containing regimen.

Results from pulmonary function testing showed that 14 percent of patients demonstrated obstructive results, and 22 percent had restrictive results.

Of the patients treated with a Velcade-containing regimen, 20 percent experienced obstruction, compared to 10 percent who had no exposure to Velcade.

Furthermore, 30 percent of thalidomide-treated patients demonstrated restriction, compared to 18 percent with no thalidomide exposure.

Revlimid-containing regimens did not increase the risk of obstruction or restriction.

The researchers also analyzed results for patients who received novel agents in combination. They found a high rate of lung obstruction among patients who were treated with a combination of Revlimid and Velcade, but the rate was not considered significantly different than the rate among patients who did not receive the combination therapy.

For more information, please see the study in Clinical Lymphoma Myeloma and Leukemia ^[5] (abstract).