title: Fatal pulmonary toxicity due to carfilzomib (Kyprolis™).
abstract: BACKGROUND
  Carfilzomib (Kyprolis™) is a second-generation proteasome inhibitor for the treatment of relapsing multiple myeloma (MM). In 2012, carfilzomib was approved by Food and Drug Administration for the treatment of patients with relapsed MM who had received at least two prior therapies. We present a case of fatal pulmonary toxicity presumed secondary to carfilzomib.
  
  
  METHODS
  A 61-year-old male was initially diagnosed with MM in 2003 for which he received multiple treatments. In 2013, he was started on carfilzomib for relapsing MM. After 24 h, the patient developed an acute respiratory distress syndrome for which he needed mechanical ventilation. One week later, patient developed diffuse alveolar hemorrhage and despite aggressive supportive care, the patient died after three weeks.
  
  
  CONCLUSIONS
  The temporal relationship between the first exposure to carfilzomib and development of symptoms, and the exclusion of other possible etiologies, leads us to believe that our patient's lung toxicity is a possible adverse reaction to carfilzomib. To the best of our knowledge, there are no previous reports of deaths due to carfilzomib-related pulmonary toxicity.
authors.affiliation: Department of Pulmonary and Critical care, University of Arkansas for Medical sciences, UAMS, Little Rock, AR, USA arlataifeh@uams.edu.
authors.forename: Abdel Rahman
authors.initials: AR
authors.lastname: Lataifeh
authors.affiliation: Department of Infectious disease, Marshall University, Huntington, WV, USA.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Nusair
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use / Q000633:toxicity*; D017809:Fatal Outcome; D006801:Humans; D008168:Lung / Q000187:drug effects / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy; D009842:Oligopeptides / Q000627:therapeutic use / Q000633:toxicity*; D061988:Proteasome Inhibitors / Q000627:therapeutic use / Q000633:toxicity*; D012128:Respiratory Distress Syndrome / Q000139:chemically induced*
chemical_list: D000970:Antineoplastic Agents; D009842:Oligopeptides; D061988:Proteasome Inhibitors; C524865:carfilzomib
keywords: Carfilzomib; multiple myeloma; proteasome inhibitor; pulmonary toxicity