Home Treatment of Bortezomib: A Preliminary Exploration of a New Treatment Mode in China
Authors: Zhang Congli , Cao Xin-xin , Li Dong-zhu , Feng Jun , Zhang Lu , Zhang Yan , Duan Ming-hui , Chen Miao , Yang Chen , Wang Wei , Zhou Dao-Bin , Li Jian 
Published: November 2019

Background:Bortezomib had been used as a standard treatment in plasma cell disorders patients for years. It has been proved that subcutaneous bortezomib was locally well tolerated, had non-inferiority effect andless peripheral neuropathy compared with intravenous administration. Few studies about home treatment of bortezomib had been reported to be feasible and of benefit to patients. But in these studies, bortezomib was adminstrated by special nurse visiting home regularly.In consideration of the shortage of medical resources in China and aiming to make it easier to receive bortezomib treatment for patients, we made a preliminary exploration of home treatment of bortezomib by patients or relatives themselves in China for the first time.
Methods:234 patients provided written informed consent were enrolled in our study between March 2018 and April 2019.A clinical nurse specialist provided hands-on guidance on home-injection for patients in outpatient department. The following information including geographical and clinical data, adverse events in treatment, feedback from patients about cost and time saved than hospital injection, and difficulty degree and satisfaction with home treatment using a rating scale between 0 and 10 were collected. The higher the score, the easier the injection and more satisfied with the mode of home treatment.
Results:The median age at diagnosis was 56 (27-83) years old. 75 (32.1%) patients were diagnosed with primary light chain amyloidosis, 70 (30.0%) POEMS syndrome, 62 (26.5%) multiple myeloma, 15 (6.4%) multi-center Castleman disease, 4 (1.7%) light chain deposition disease, 4 (1.7%) Waldenstrom's macroglobulinemia, 2 (0.9%) cryoglobulinemia, 1 (0.4%) mycosis fungoides and 1 (0.4%) monoclonal gammopathy-associated scleromyxedema.Patients lived within a 3,010 kilometer radius of the city of Beijing, 46 (19.7%) patients lived in Beijing and 67 (28.6%) patients lived more than 1,000 kilometers from our hospital (Figure 1. Geographical distribution of 234 patients. The dots represent number of patients in different provinces. The blue dot represents 46 patients lived in Beijing, the city our hospital located in). As so far, patients received a median number of 20 (4-36) injections and a total of 5068 injections of bortezomib. The most common injection-site reaction was redness (24.8%) and pigmentation (20.9%). In 5068 injections, 2 (0.04%) local hematomas at injection site, 7 (0.14%) injection dose errors and 5 (0.10%) needlestick injuries occurred, respectively. Medicine bottle was broken during drug dissolution for only once (0.02%). The median cost and time saved was RMB 200 (100-6000) and 4.5 (0.5-100) hours per injection per person for home treatment. The total saving of money was RMB 3927,804, and the total time saved was 15,617.5 hours. For the score of difficulty degree of injection and satisfaction with home treatment, 201 (85.9%) and 208 (88.9%) rated 8 and higher, respectively.
Conclusion: Home treatment of bortezomib is feasible, and both cost-effective and time-saving in China, which should be promoted in other medical centers.
Figure 1

Disclosures
No relevant conflicts of interest to declare.