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Abstracts
P009
'Carfilzomib Induced Thrombotic Microangiopathy In Multiple Myeloma Treated With Eculizumab'
Introduction:
Carfilzomib (CFZ) is a proteasome inhibitor indicated in Multiple Myeloma patients who have relapsed after subsequent lines of treatment or have become refractory to first-line therapy. The most common toxicities associated are cardiotoxicity and severe infections. Although, a less common side effect of Thrombotic Microangiopathy (TMA) has been recently described in the literature via case reports with emphasis on Eculizumab as a treatment modality by terminal complement pathway inhibition. The following case will describe a patient with IgG lambda Multiple Myeloma presenting with CFZ-induced TMA and successfully treated with Eculizumab and brief hemodialysis.
Case description:
An 80-year-old male with relapsed IgG lambda Multiple Myeloma on Carfilzomib presented with lethargy, weakness, and decreased urine output. The last Carfilzomib infusion was five days before admission. On arrival, he was afebrile at 98.6 F, BP 136/78‚Äâmm Hg, HR 96, Sp02 97% on room air. He was lethargic and endorsed decreased urine output. Labs were notable for Cr 7.61 mg/dl, BUN 78 mg/dl, Hgb 10.8, PLTs 21, schistocytes present, haptoglobin Discussion:
In recent years, Carfilzomib-associated TMA has been described in several case reports, with the presentation being notable for microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure. In each case, secondary causes of TMA were ruled out, with ADAMTS13, complement levels, Direct Coombs test, and Atypical HUS labs being unremarkable. Kidney biopsy is the definitive method of diagnosis of this drug-induced process, but it can be deferred in cases that improve rapidly with the complement inhibitor eculizumab.
Carfilzomib (CFZ) is a proteasome inhibitor indicated in Multiple Myeloma patients who have relapsed after subsequent lines of treatment or have become refractory to first-line therapy. The most common toxicities associated are cardiotoxicity and severe infections. Although, a less common side effect of Thrombotic Microangiopathy (TMA) has been recently described in the literature via case reports with emphasis on Eculizumab as a treatment modality by terminal complement pathway inhibition. The following case will describe a patient with IgG lambda Multiple Myeloma presenting with CFZ-induced TMA and successfully treated with Eculizumab and brief hemodialysis.
Case description:
An 80-year-old male with relapsed IgG lambda Multiple Myeloma on Carfilzomib presented with lethargy, weakness, and decreased urine output. The last Carfilzomib infusion was five days before admission. On arrival, he was afebrile at 98.6 F, BP 136/78‚Äâmm Hg, HR 96, Sp02 97% on room air. He was lethargic and endorsed decreased urine output. Labs were notable for Cr 7.61 mg/dl, BUN 78 mg/dl, Hgb 10.8, PLTs 21, schistocytes present, haptoglobin Discussion:
In recent years, Carfilzomib-associated TMA has been described in several case reports, with the presentation being notable for microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure. In each case, secondary causes of TMA were ruled out, with ADAMTS13, complement levels, Direct Coombs test, and Atypical HUS labs being unremarkable. Kidney biopsy is the definitive method of diagnosis of this drug-induced process, but it can be deferred in cases that improve rapidly with the complement inhibitor eculizumab.
Publisher
John Wiley & Sons; Hoboken, USA
Source Journal
American Journal of Hematology
2022 Wiley Periodicals LLC.
