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Published on: June 29, 2015
Microangiopathy in multiple myeloma: a case of carfilzomib-induced secondary thrombotic microangiopathy successfully
Lorenzo Catanese1,2, Katharina Link1,2, Harald Rupprecht3,4,5
1Department of Medicine V (Nephrology, Hypertensiology, Angiology and Rheumatology), Klinikum Bayreuth GmbH, Medizincampus Oberfranken, Preuschwitzer Str. 101, 95445, Bayreuth, Germany.
Background:
Thrombotic microangiopathy (TMA) is a potentially organ and life-threatening condition affecting patients with multiple myeloma (MM). Cases of proteasome inhibitor-induced TMA and specifically carfilzomib-induced TMA have been rarely reported and standards for diagnostic workup and treatment are not available.
Case Presentation:
We describe a case of a male MM patient under salvage therapy including proteasome inhibitor carfilzomib following chemotherapy and autologous stem cell transplantation. The patient then developed acute kidney injury with clinical and laboratory signs of TMA. Hemodialysis became necessary and treatment with plasma exchange was initiated followed by therapy with C5 complement inhibitor eculizumab which led to amelioration of kidney function and hemolysis parameters.
Conclusion:
We report a patient with suspected proteasome inhibitor-induced secondary thrombotic microangiopathy that has been successfully treated with plasma exchange and eculizumab, a monoclonal antibody targeting complement factor C5.
Insights
Thrombotic microangiopathy (TMA) in multiple myeloma patients treated with carfilzomib is rare. This case study shows successful treatment of carfilzomib-induced TMA using plasma exchange and eculizumab.
Area of Science:
- Oncology
- Nephrology
- Hematology
Background:
- Thrombotic microangiopathy (TMA) poses a significant risk to multiple myeloma (MM) patients.
- Proteasome inhibitor-induced TMA, particularly from carfilzomib, is infrequently documented.
- Established diagnostic and treatment guidelines for this condition are lacking.
