2019
DOI: 10.1016/j.clml.2019.09.449
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Unusual Carfilzomib Toxicity: Three Cases of Drug-induced Thrombotic Microangiopathy (TMA) after Treatment with High-dose weekly Carfilzomib, Cyclophosphamide, and Dexamethasone (wCCD)

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Cited by 5 publications
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“…Further details regarding TMA in this trial and with carfilzomib in general have been examined and are presented in a separate publication. 27 The majority of adverse events considered at least possibly related to protocol therapy were reversible. For three individuals reversibility could not be confirmed, including one patient with ongoing congestive heart failure at the time of data lock considered probably related to carfilzomib, one patient with suspected resolved line infection, and one patient admitted with acute renal failure, ankle fracture and delirium who died from myeloma progression shortly thereafter.…”
Section: Resultsmentioning
confidence: 98%
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“…Further details regarding TMA in this trial and with carfilzomib in general have been examined and are presented in a separate publication. 27 The majority of adverse events considered at least possibly related to protocol therapy were reversible. For three individuals reversibility could not be confirmed, including one patient with ongoing congestive heart failure at the time of data lock considered probably related to carfilzomib, one patient with suspected resolved line infection, and one patient admitted with acute renal failure, ankle fracture and delirium who died from myeloma progression shortly thereafter.…”
Section: Resultsmentioning
confidence: 98%
“…Thrombotic microangiopathy (TMA) occurred in three patients; resolving completely in all cases after cessation of protocol therapy and administration of supportive treatments including high‐dose steroids (2), plasmapheresis (2) and dialysis (1). Further details regarding TMA in this trial and with carfilzomib in general have been examined and are presented in a separate publication 27 . The majority of adverse events considered at least possibly related to protocol therapy were reversible.…”
Section: Resultsmentioning
confidence: 99%
“…Drug induced (DI)-TMA secondary to carfilzomib is a recently recognised complication, with 30 cases identified in the literature, 11,[13][14][15][16][17][18][19][20][21][22][23][24] six published as stand-alone case reports [14][15][16][17]18,20,23 and the rest described within six case series 11,13,19,21,22,24 (Table I). Most patients (28/30) were treated for RRMM having previously received 1-5 lines of therapy.…”
Section: Discussionmentioning
confidence: 99%
“…[22][23][24] Complement levels, including C3 and C4, were generally normal. However, some patients were found to be heterozygous for CFHR3-CFHR1 deletions on genetic testing 21 and one had an elevated Bb fragment level with elevation in the soluble membrane attack complex (C5b-9) on a TMA functional panel, reflecting alternate pathway complement activation. 23 These patients were treated with eculizumab in an attempt to mitigate disease progression and prevent CKD by blocking the terminal complement pathway.…”
Section: Discussionmentioning
confidence: 99%
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