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Irene Attucci1, Sofia Pilerci1, Maria Messeri1
1Haematology Unit, Careggi University Hospital, Florence, Italy.
Cancer Reports (Hoboken, N.J.)
|October 11, 2024
Summary
Carfilzomib treatment for multiple myeloma can cause thrombotic microangiopathy (TMA). Early recognition and discontinuation of carfilzomib, along with eculizumab, can improve outcomes in patients with this serious adverse event.
Area of Science:
- Hematology
- Oncology
- Nephrology
Background:
- Thrombotic microangiopathy (TMA) is a serious condition involving anemia, low platelets, and organ damage, often affecting kidneys.
- Carfilzomib, a proteasome inhibitor used for multiple myeloma (MM), is associated with TMA development.
- Mechanisms of proteasome inhibitor-induced TMA are not fully understood, but eculizumab has shown promise in treatment.
Observation:
- Two cases of MM patients developed TMA during carfilzomib therapy.
- Eculizumab administration led to rapid improvements in renal function and platelet counts in these patients.
- Hemodialysis was discontinued within 2-4 weeks of eculizumab treatment.
Findings:
- Carfilzomib-induced TMA (DITMA) occurred in 2.2% of patients in this study (2 out of 91).
- A literature review identified 75 documented cases of carfilzomib-induced TMA.
- TMA can occur anytime during carfilzomib treatment, irrespective of combination therapies.
Implications:
- Timely recognition and discontinuation of carfilzomib are crucial for managing TMA.
- Eculizumab may expedite recovery from carfilzomib-induced TMA, warranting further investigation.
- Suspecting carfilzomib-induced TMA in MM patients with anemia, thrombocytopenia, and renal impairment is vital for prompt intervention.