Carfilzomib-Induced Pneumotoxicity in a Lung Transplant Recipient

Razia, Deepika; Arjuna, A.; Omar, Abdelmaaboud M.M.; Buddhdev, B.; Abdelrazek, Hesham; Walia, Rajat; Tokman, Sofya

doi:10.1016/j.healun.2021.01.2052

Cited by 2 publications

(3 citation statements)

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“…Moreover, pulmonary toxicity with CFZ was not only reported in multiple myeloma patients. Razia et al 6 reported the use of CFZ in a lung-transplant patient for the treatment of probable de novo donor-specific antibody-mediated rejection (off-label use) after the failure of IVIg and plasmapheresis. Following the administration of CFZ, the patient developed hypoxemic respiratory failure along with hypertensive emergency and acute kidney injury.…”

Section: Discussionmentioning

confidence: 99%

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Carfilzomib-induced life-threatening lung injury in refractory multiple myeloma

Ghasoub,

Benkhadra,

Kassem

et al. 2023

J Oncol Pharm Pract

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Introduction Carfilzomib is a second-generation selective proteasome inhibitor that is commonly used in the treatment of relapsed or refractory multiple myeloma. Carfilzomib is associated with respiratory side effects, such as cough, dyspnea, and upper respiratory tract infection. However, severe pulmonary toxicity is rare and is only reported in a few case reports. Case report Here, we present a case of a 65-year-old male with refractory multiple myeloma who developed a life-threatening lung injury during his third cycle of carfilzomib. The patient presented with a decreased level of consciousness and was found to have Type I respiratory failure. He was admitted to the intensive care unit, where he was intubated. Blood cultures and viral panel were negative. The patient received a prolonged course of antibiotics with 2 days of hydrocortisone. Management and outcomes After discharge, repeated myeloma workup showed disease progression and carfilzomib was reintroduced. The next day, he presented with fever, vomiting, and hypoxia. Chest x-ray showed congestive lung changes with patchy airspace opacities. Repeated echocardiography showed normal ejection fraction with moderate pulmonary hypertension (RVSP 46 mm Hg). The patient was transferred again to the ICU and kept on continuous positive airway pressure. Antibiotics were started, and blood cultures and respiratory viral panels were negative for any infectious organism. The patient improved in terms of inflammatory markers and oxygen requirements. Treatment with carfilzomib was stopped permanently. Discussion Pulmonary toxicity associated with carfilzomib in patients with multiple myeloma can be potentially life-threatening. The mechanism with which carfilzomib induces lung-related AEs is still not fully understood. In our patient, carfilzomib-induced lung injury was evident after rechallenging the patient with carfilzomib, in the radiographic x-ray changes and the new onset moderate pulmonary hypertension. Healthcare providers should be encouraged to report rare adverse events in order to identify the risk factors that can predispose patients to the development of these adverse events.

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Section: Discussionmentioning

confidence: 99%

“…However, fatal pulmonary toxicity, although rare, has been reported in few case reports. [3][4][5][6] We present a case of life-threatening lung toxicity during his third cycle of carfilzomib at the National Center for Cancer Care and Research (NCCCR), Qatar.…”

Section: Introductionmentioning

confidence: 99%

Carfilzomib-induced life-threatening lung injury in refractory multiple myeloma

Ghasoub,

Benkhadra,

Kassem

et al. 2023

J Oncol Pharm Pract

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“…To our knowledge, there have been five reported cases of carfilzomib-related pulmonary toxicity, two of which resulted in fatal outcomes (table 2). 9–13…”

Section: Discussionmentioning

confidence: 99%

Severe pulmonary toxicity related to carfilzomib use: a rare but serious side effect

Sridhar¹,

Yohannan

Kachira

et al. 2022

BMJ Case Rep

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Carfilzomib is a selective proteosome inhibitor that is commonly used in the treatment of relapsed or refractory multiple myeloma. Carfilzomib has been commonly associated with respiratory side effects. It can rarely also cause fatal pulmonary toxicity. We present a case of a man in his 50s with plasma cell leukaemia who was initiated on treatment with carfilzomib and dexamethasone. He developed severe pneumonitis requiring oxygen via a high-flow nasal cannula. After an extensive workup, a temporal relationship between the carfilzomib use and exacerbation of the pulmonary symptoms was found. Carfilzomib was permanently discontinued, and the patient was started promptly on methyl prednisolone with complete resolution of his symptoms. Due to the associated risk of mortality if not detected early, we wish to highlight this rare but serious pulmonary toxicity associated with carfilzomib that was managed with high-dose glucocorticoids.

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Carfilzomib-Induced Pneumotoxicity in a Lung Transplant Recipient

Cited by 2 publications

References 0 publications

Carfilzomib-induced life-threatening lung injury in refractory multiple myeloma

Carfilzomib-induced life-threatening lung injury in refractory multiple myeloma

Severe pulmonary toxicity related to carfilzomib use: a rare but serious side effect

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