Recommended Dose Modifications for Velcade-related Neuropathic Pain and/or Peripheral Sensory or Motor Neuropathy

Severity of Peripheral Neuropathy Signs and Symptoms Modification of Dose and Regimen
Grade 1* (asymptomatic; loss of deep tendon reflexes or paresthesia [sensations of numbness, tingling, or prickling]) without pain or loss of function No action
Grade 1 with pain or Grade 2 (moderate symptoms; symptoms that limit instrumental activities of daily living [eg, meal preparation, shopping, using the telephone, etc.]) Reduce Velcade dose to 1.0 mg/m2
Grade 2 with pain or Grade 3 (severe symptoms; symptoms that limit self-care activities of daily living [eg, bathing, dressing, feeding self, toileting, etc.]) Withhold Velcade therapy until toxicity resolves. When toxicity resolves, reinitiate with a reduced dose of Velcade at 0.7 mg/m2 and change treatment schedule to once per week.
Grade 4 (life-threatening consequences; urgent intervention indicated) Discontinue Velcade

*The grades of severity listed here relate specifically to neuropathy