多发性骨髓瘤中的微血管病：一例因卡非佐米引起的继发性血栓性微血管病，经血浆置换和补体抑制成功治疗。
Microangiopathy in multiple myeloma: a case of carfilzomib-induced secondary thrombotic microangiopathy successfully treated with plasma exchange and complement inhibition.
机构信息
Department of Medicine V (Nephrology, Hypertensiology, Angiology and Rheumatology), Klinikum Bayreuth GmbH, Medizincampus Oberfranken, Preuschwitzer Str. 101, 95445, Bayreuth, Germany.
Friedrich-Alexander-University Erlangen-Nürnberg, Schloßplatz 4, 91054, Erlangen, Germany.
出版信息
BMC Nephrol. 2023 Jun 19;24(1):179. doi: 10.1186/s12882-023-03228-9.
BACKGROUND
Thrombotic microangiopathy (TMA) is a potentially organ and life-threatening condition affecting patients with multiple myeloma (MM). Cases of proteasome inhibitor-induced TMA and specifically carfilzomib-induced TMA have been rarely reported and standards for diagnostic workup and treatment are not available.
CASE PRESENTATION
We describe a case of a male MM patient under salvage therapy including proteasome inhibitor carfilzomib following chemotherapy and autologous stem cell transplantation. The patient then developed acute kidney injury with clinical and laboratory signs of TMA. Hemodialysis became necessary and treatment with plasma exchange was initiated followed by therapy with C5 complement inhibitor eculizumab which led to amelioration of kidney function and hemolysis parameters.
CONCLUSION
We report a patient with suspected proteasome inhibitor-induced secondary thrombotic microangiopathy that has been successfully treated with plasma exchange and eculizumab, a monoclonal antibody targeting complement factor C5.
背景
血栓性微血管病（TMA）是一种潜在的多器官和危及生命的疾病，影响多发性骨髓瘤（MM）患者。蛋白酶体抑制剂诱导的 TMA，特别是卡非佐米诱导的 TMA 病例很少见，也没有诊断性检查和治疗的标准。
病例介绍
我们描述了一名男性 MM 患者的病例，该患者在化疗和自体干细胞移植后接受了包括蛋白酶体抑制剂卡非佐米在内的挽救性治疗。随后，该患者发生急性肾损伤，伴有 TMA 的临床和实验室表现。需要进行血液透析，随后开始进行血浆置换治疗，接着是 C5 补体抑制剂依库珠单抗治疗，这导致肾功能和溶血参数得到改善。
结论
我们报告了一例疑似蛋白酶体抑制剂诱导的继发性血栓性微血管病的患者，该患者通过血浆置换和依库珠单抗（一种针对补体因子 C5 的单克隆抗体）成功治疗。
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