Clinical Pharmacy Department, Hamad Medical Corporation, National Center for Cancer Care and Research, Doha, Qatar.
Hematology Department, Hamad Medical Corporation, National Center for Cancer Care and Research, Doha, Qatar.
J Oncol Pharm Pract. 2023 Dec;29(8):2041-2044. doi: 10.1177/10781552231190039. Epub 2023 Jul 24.
Carfilzomib is a second-generation selective proteasome inhibitor that is commonly used in the treatment of relapsed or refractory multiple myeloma. Carfilzomib is associated with respiratory side effects, such as cough, dyspnea, and upper respiratory tract infection. However, severe pulmonary toxicity is rare and is only reported in a few case reports.
Here, we present a case of a 65-year-old male with refractory multiple myeloma who developed a life-threatening lung injury during his third cycle of carfilzomib. The patient presented with a decreased level of consciousness and was found to have Type I respiratory failure. He was admitted to the intensive care unit, where he was intubated. Blood cultures and viral panel were negative. The patient received a prolonged course of antibiotics with 2 days of hydrocortisone.
After discharge, repeated myeloma workup showed disease progression and carfilzomib was reintroduced. The next day, he presented with fever, vomiting, and hypoxia. Chest x-ray showed congestive lung changes with patchy airspace opacities. Repeated echocardiography showed normal ejection fraction with moderate pulmonary hypertension (RVSP 46 mm Hg). The patient was transferred again to the ICU and kept on continuous positive airway pressure. Antibiotics were started, and blood cultures and respiratory viral panels were negative for any infectious organism. The patient improved in terms of inflammatory markers and oxygen requirements. Treatment with carfilzomib was stopped permanently.
Pulmonary toxicity associated with carfilzomib in patients with multiple myeloma can be potentially life-threatening. The mechanism with which carfilzomib induces lung-related AEs is still not fully understood. In our patient, carfilzomib-induced lung injury was evident after rechallenging the patient with carfilzomib, in the radiographic x-ray changes and the new onset moderate pulmonary hypertension. Healthcare providers should be encouraged to report rare adverse events in order to identify the risk factors that can predispose patients to the development of these adverse events.
卡非佐米是一种第二代选择性蛋白酶体抑制剂，常用于治疗复发性或难治性多发性骨髓瘤。卡非佐米与呼吸副作用有关，如咳嗽、呼吸困难和上呼吸道感染。然而，严重的肺毒性很少见，仅在少数病例报告中有所报道。
在这里，我们报告了一例 65 岁男性难治性多发性骨髓瘤患者，在接受第三周期卡非佐米治疗时发生危及生命的肺损伤。患者表现为意识水平下降，并被发现患有 I 型呼吸衰竭。他被收入重症监护病房，并进行了气管插管。血培养和病毒检测均为阴性。患者接受了长时间的抗生素治疗，并使用了 2 天的氢化可的松。
出院后，反复进行多发性骨髓瘤检查显示疾病进展，再次引入卡非佐米。第二天，他出现发热、呕吐和缺氧。胸部 X 光显示充血性肺部改变，伴有斑片状气腔混浊。重复超声心动图显示射血分数正常，但中度肺动脉高压（RVSP 46mmHg）。患者再次被转至重症监护病房，并持续接受持续气道正压通气。开始使用抗生素，血培养和呼吸道病毒检测均未发现任何感染病原体。患者的炎症标志物和氧气需求均有所改善。卡非佐米的治疗被永久停止。
卡非佐米在多发性骨髓瘤患者中引起的肺毒性可能是危及生命的。卡非佐米引起与肺部相关的 AE 的机制仍不完全清楚。在我们的患者中，在重新开始使用卡非佐米后，患者的肺部 X 光改变和新出现的中度肺动脉高压均表明卡非佐米引起了肺损伤。应该鼓励医疗保健提供者报告罕见的不良事件，以确定可能使患者易发生这些不良事件的风险因素。
