title: Carfilzomib: A cause of drug associated thrombotic microangiopathy.
abstract: Carfilzomib is a selective proteosome inhibitor approved for treatment of relapsed and refractory multiple myeloma. Recent reports have linked exposure to carfilzomib with development of thrombotic microangiopathy (TMA). We describe two cases of biopsy proven thrombotic microangiopathy that occurred after the initiation of carfilzomib (dosed at 32 mg/m(2) and 23 mg/m(2), respectively) for relapsed multiple myeloma. Both patients were managed with discontinuation of the drug, therapeutic plasma exchange (TPE) and supportive care. Hemoglobin, platelets and renal function did not improve with TPE. TMA resolved with creatinine returning to baseline several weeks after discontinuation of the drug. The outcomes suggest that TPE is not beneficial for treating carfilzomib-induced TMA.
authors.affiliation: Department of Nephrology, Mayo Clinic Arizona, 5777 East Mayo Blvd, Phoenix, AZ 85054, USA.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Qaqish
authors.affiliation: Department of Internal Medicine, Mayo Clinic Arizona, 5777 East Mayo Blvd, Phoenix, AZ 85054, USA.
authors.forename: Ilana M
authors.initials: IM
authors.lastname: Schlam
authors.affiliation: Department of Nephrology, Mayo Clinic Arizona, 5777 East Mayo Blvd, Phoenix, AZ 85054, USA.
authors.forename: Harini A
authors.initials: HA
authors.lastname: Chakkera
authors.affiliation: Department of Internal Medicine, Mayo Clinic Arizona, 5777 East Mayo Blvd, Phoenix, AZ 85054, USA.
authors.forename: Rafael
authors.initials: R
authors.lastname: Fonseca
authors.affiliation: Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, 5777 East Mayo Blvd, Phoenix, AZ 85054, USA. Electronic address: adamski.jill@mayo.edu.
authors.forename: Jill
authors.initials: J
authors.lastname: Adamski
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D009101:Multiple Myeloma / Q000188:drug therapy*; D009842:Oligopeptides / Q000008:administration & dosage* / Q000009:adverse effects*; D010951:Plasma Exchange; D057049:Thrombotic Microangiopathies / Q000139:chemically induced* / Q000628:therapy*
chemical_list: D009842:Oligopeptides; C524865:carfilzomib
keywords: Apheresis; Therapeutic plasma exchange; Thrombotic microangiopathy