Carfilzomib-Induced Thrombotic Microangiopathy Treated with Eculizumab: A Case Report and Rapid Literature Review
Background: Thrombotic microangiopathies (TMAs) can be induced by drugs. Recent works have indicated proteasome inhibitors, including carfilzomib, as a possible new causative agent. Although the physiopathology and management of carfilzomib-induced TMA are still unknown, eculizumab seems to be effic...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-12-01
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| Series: | Kidney and Dialysis |
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| Online Access: | https://www.mdpi.com/2673-8236/2/4/56 |
| _version_ | 1827638165808087040 |
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| author | Federica Pallotti Claire Queffeulou Mathieu Bellal Bastien Jean-Jacques Anne-Claire Gac Valérie Chatelet Annabel Boyer Victor Gueutin |
| author_facet | Federica Pallotti Claire Queffeulou Mathieu Bellal Bastien Jean-Jacques Anne-Claire Gac Valérie Chatelet Annabel Boyer Victor Gueutin |
| author_sort | Federica Pallotti |
| collection | DOAJ |
| description | Background: Thrombotic microangiopathies (TMAs) can be induced by drugs. Recent works have indicated proteasome inhibitors, including carfilzomib, as a possible new causative agent. Although the physiopathology and management of carfilzomib-induced TMA are still unknown, eculizumab seems to be efficient. Results: We report a clinical case of TMA during carfilzomib treatment for multiple myeloma, possibly triggered by a concomitant influenza infection, suggesting a multi-hit process. Histologic analysis of the kidney biopsy proved renal TMA. Eculizumab allowed rapid and long-lasting renal and hematologic recovery. We enriched our work with a systemic review of published cases of carfilzomib-induced TMA treated by eculizumab. Twelve patients were included, all of whom presented acute renal failure and nine of them required hemodialysis. Eculizumab led to TMA resolution in eleven patients and complete renal recovery with hemodialysis withdrawal for seven of them within a month. One patient died from multiple myeloma progression. Two patients presented inter-current viral infection. Soluble complement fragment Bb and C5b9s were found in two patients and genetic benign variant of Factor H (CFH3–CFH1) in four. Conclusion: Our results suggest that eculizumab is effective in carfilzomib-induced TMA, which could support its inclusion as a treatment option. Further studies are required to clarify its physiopathology, complement role, and management. |
| first_indexed | 2024-03-09T16:12:46Z |
| format | Article |
| id | doaj.art-3dc5ed8e5ed049ff83b633443f81c26f |
| institution | Directory Open Access Journal |
| issn | 2673-8236 |
| language | English |
| last_indexed | 2024-03-09T16:12:46Z |
| publishDate | 2022-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Kidney and Dialysis |
| spelling | doaj.art-3dc5ed8e5ed049ff83b633443f81c26f2023-11-24T16:05:11ZengMDPI AGKidney and Dialysis2673-82362022-12-012462563710.3390/kidneydial2040056Carfilzomib-Induced Thrombotic Microangiopathy Treated with Eculizumab: A Case Report and Rapid Literature ReviewFederica Pallotti0Claire Queffeulou1Mathieu Bellal2Bastien Jean-Jacques3Anne-Claire Gac4Valérie Chatelet5Annabel Boyer6Victor Gueutin7Service de Médecine Interne et Immunologie Clinique, CHU de Caen, Avenue de la Côte de Nacre, CEDEX 9, 14033 Caen, FranceService de Médecine Intensive et Réanimation, CHU de Caen, Avenue de la Côte de Nacre, CEDEX 9, 14033 Caen, FranceService de Médecine Intensive et Réanimation, CHU de Caen, Avenue de la Côte de Nacre, CEDEX 9, 14033 Caen, FranceService d’Anatomie Pathologique, CHU de Caen, Avenue de la Côte de Nacre, CEDEX 9, 14033 Caen, FranceInstitut d’hématologie de Basse-Normandie, CHU de Caen, Avenue de la Côte de Nacre, CEDEX 9, 14033 Caen, FranceCentre Universitaire des Maladies Rénales, CHU de Caen, Avenue de la Côte de Nacre, CEDEX 9, 14033 Caen, FranceService de Néphrologie-Dialyse, Centre Hospitalier Jacques Monod, rue Eugène Garnier, 61100 Flers, FranceCentre Universitaire des Maladies Rénales, CHU de Caen, Avenue de la Côte de Nacre, CEDEX 9, 14033 Caen, FranceBackground: Thrombotic microangiopathies (TMAs) can be induced by drugs. Recent works have indicated proteasome inhibitors, including carfilzomib, as a possible new causative agent. Although the physiopathology and management of carfilzomib-induced TMA are still unknown, eculizumab seems to be efficient. Results: We report a clinical case of TMA during carfilzomib treatment for multiple myeloma, possibly triggered by a concomitant influenza infection, suggesting a multi-hit process. Histologic analysis of the kidney biopsy proved renal TMA. Eculizumab allowed rapid and long-lasting renal and hematologic recovery. We enriched our work with a systemic review of published cases of carfilzomib-induced TMA treated by eculizumab. Twelve patients were included, all of whom presented acute renal failure and nine of them required hemodialysis. Eculizumab led to TMA resolution in eleven patients and complete renal recovery with hemodialysis withdrawal for seven of them within a month. One patient died from multiple myeloma progression. Two patients presented inter-current viral infection. Soluble complement fragment Bb and C5b9s were found in two patients and genetic benign variant of Factor H (CFH3–CFH1) in four. Conclusion: Our results suggest that eculizumab is effective in carfilzomib-induced TMA, which could support its inclusion as a treatment option. Further studies are required to clarify its physiopathology, complement role, and management.https://www.mdpi.com/2673-8236/2/4/56carfilzomibeculizumabTMAmultiple myelomacomplement |
| spellingShingle | Federica Pallotti Claire Queffeulou Mathieu Bellal Bastien Jean-Jacques Anne-Claire Gac Valérie Chatelet Annabel Boyer Victor Gueutin Carfilzomib-Induced Thrombotic Microangiopathy Treated with Eculizumab: A Case Report and Rapid Literature Review Kidney and Dialysis carfilzomib eculizumab TMA multiple myeloma complement |
| title | Carfilzomib-Induced Thrombotic Microangiopathy Treated with Eculizumab: A Case Report and Rapid Literature Review |
| title_full | Carfilzomib-Induced Thrombotic Microangiopathy Treated with Eculizumab: A Case Report and Rapid Literature Review |
| title_fullStr | Carfilzomib-Induced Thrombotic Microangiopathy Treated with Eculizumab: A Case Report and Rapid Literature Review |
| title_full_unstemmed | Carfilzomib-Induced Thrombotic Microangiopathy Treated with Eculizumab: A Case Report and Rapid Literature Review |
| title_short | Carfilzomib-Induced Thrombotic Microangiopathy Treated with Eculizumab: A Case Report and Rapid Literature Review |
| title_sort | carfilzomib induced thrombotic microangiopathy treated with eculizumab a case report and rapid literature review |
| topic | carfilzomib eculizumab TMA multiple myeloma complement |
| url | https://www.mdpi.com/2673-8236/2/4/56 |
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