Table 4 Comparisons between BiPN and GBS

Antecedent events

Bortezomib therapy

Infections, vaccinations, immune checkpoint inhibitor therapy and surgery

Time of onset

Typically within the first courses of bortezomib [34].

Within 4 weeks of antecedent infections,6 weeks of surgery

Clinical features

Mild to moderate distal sensory loss;

Mild to very severe pain, mainly at fingertips and toes;

Mild motor weakness in distal muscles of the lower limbs;

Rare autonomic dysfunction

Bilateral and flaccid weakness of limbs;

Decreased or absent deep tendon reflexes;

Mild sensory symptoms or signs;

Cranial nerve involvement;

Autonomic dysfunction

CSF analysis

Normal

CSF white cell count < 50 /µl (usually < 10);

CSF protein raised (after week 1)

NCS

Mild distal slowing of sensory and motor conduction velocities and increase in distal motor latencies.

Slow nerve conduction velocities, prolonged distal latencies, and temporal dispersion in AIDP;

Decreased CMAP amplitude in AMAN

Locations of lesion

Schwann cells and dorsal root ganglion neurons [35]

Axonal injury in AMAN

Inflammatory infiltrates and demyelination in AIDP

Management

Prevention first(subcutaneous injection, dose reduction, prolonged administration of bortezomib);

Medical therapy(Opioids, Tricyclic antidepressants, Anticonvulsants, SNRIs, NSAIDs, Vitamins)

IVIG;

plasma exchange

Outcome

Improve or completely resolve in most patients after a median interval of 3 months after discontinuation of bortezomib treatment

Following immunotherapy, most patients have a good recovery, with 81% able to walk independently at 12 months

Mortality

Cases report [36]

3-7% [37]