Bortezomib (Velcade) is a commonly used proteasome inhibitor for hematologic malignancies such as multiple myeloma. Its efficacy is well established, but peripheral neuropathy, thrombocytopenia, and infection are three major risks requiring focused prevention during treatment.

I. Peripheral Neuropathy

1. Recognition of Manifestations

Common symptoms include numbness, tingling, burning, or reduced sensation in the hands and feet.

It may be accompanied by pain and fatigue, and in severe cases affects walking and fine motor skills.

Symptoms usually begin distally and are symmetrical in distribution.

2. Monitoring and Assessment

Ask about and record changes in neurologic symptoms before each dose.

Pay attention to pain severity, extent of sensory abnormalities, and ability to perform daily activities.

Inform the doctor promptly of new or worsening symptoms.

3. Management Principles

Mild to moderate symptoms may be managed by adjusting the dosing regimen and strengthening observation.

Severe or painful neuropathy requires withholding, dose reduction, or discontinuation.

Do not self-use analgesics to mask symptoms and delay assessment.

II. Thrombocytopenia

1. Risk Characteristics

Platelets may decrease during treatment, increasing the tendency to bleed.

The decrease is often cyclical and requires regular monitoring by treatment cycle.

2. Monitoring Points

Recheck the complete blood count before each dose, focusing on the platelet count.

Observe for skin ecchymoses, gum bleeding, epistaxis, and melena.

Significantly reduced platelets require delayed dosing or dose adjustment.

3. Daily Precautions

Avoid vigorous collisions and injuries from sharp objects.

Use a soft-bristled toothbrush to reduce gum bleeding.

Seek timely medical attention for persistent bleeding or large ecchymoses.

III. Infection Risk

1. Basis of Risk

Both the disease itself and treatment can suppress immune function.

Thrombocytopenia and mucosal damage also increase the chance of infection.

2. Common Manifestations

Fever, cough, sore throat, fatigue, or local redness and swelling.

Reactivation of herpes zoster also warrants vigilance.

3. Prevention and Management

Pay attention to hand hygiene and avoid crowded places.

If fever occurs, measure body temperature promptly and seek medical attention; do not mask it with antipyretics on your own.

Evaluate antiviral prophylaxis and vaccination as directed by the doctor.

Antitumor treatment may need to be withheld or adjusted during infection.

IV. Key Points of Comprehensive Management

1. Regular Monitoring

Assess complete blood count, neurologic symptoms, and signs of infection before each cycle.

Record symptom changes to facilitate regimen adjustment by the doctor.

2. Patient Education

Understand the early signals of neuropathy, bleeding, and infection.

Seek medical attention promptly for worsening numbness, abnormal bleeding, or fever.

3. Dosing Standards

Use the subcutaneous or intravenous route as prescribed; do not change it on your own.

Do not double the dose after a missed dose; continue with the next dose as scheduled.