Carfilzomib-induced thrombotic microangiopathy is underestimated in clinical practice: A report of five patients and literature review

Abstract

Carfilzomib (Cfz) is widely used to treat multiple myeloma. However, real-world data of the incidence of thrombotic microangiopathy (TMA) caused by Cfz is inconsistent (<1–5%). We evaluated 96 consecutive patients who received Cfz to evaluate the incidence of TMA in clinical practice. TMA developed in five patients (5.2%) who were mainly receiving high-dose Cfz (≥56 mg/m²). Based on a literature review, precaution should be taken for Cfz-induced TMA in male patients receiving high-dose Cfz irrespective of the combination therapy, Cfz administration period, and complement level. In conclusion, Cfz-induced TMA might be underestimated in clinical practice, and early intervention should be considered.

Keywords:

• Carfilzomib
• multiple myeloma
• thrombotic microangiopathy

Acknowledgments

The authors would like to thank the residents of the Department of Hematology/Oncology for their medical care of patients. We also thank Dr. Tomo Suzuki (Department of Nephrology, Kameda Medical Center) for his excellent advice regarding kidney pathology and Editage (www.editage.jp) for their English language editing services.

Author contributions

Toshiki Terao planned and designed the study, collected data, performed statistical analyses, wrote the manuscript, and provided patient care. Takafumi Tsushima, Daisuke Miura, Daisuke Ikeda, Ami Fukumoto, Ayumi Kuzume, Rikako Tabata, Kentaro Natira, Masami Takeuchi, and Kosei Matsue provided patient care. Kosei Matsue supervised the study. All authors reviewed and approved the manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the institutional review board.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.