Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China; College of Pharmacy, Changsha Medical University, Changsha, Hunan 410219, China.
Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China.
Int Immunopharmacol. 2024 Jun 15;134:112178. doi: 10.1016/j.intimp.2024.112178. Epub 2024 May 9.
Thrombotic microangiopathy (TMA) is associated with carfilzomib, and knowledge of carfilzomib-induced TMA is based mainly on case reports. This study investigated the clinical characteristics of patients with carfilzomib-induced TMA and provided a reference for the rational use of carfilzomib.
Reports of carfilzomib-induced TMA were collected for retrospective analysis by searching the Chinese and English databases from inception to January 31, 2024.
Sixty-six patients were included, with a median age of 63 years (range 39, 85). The median time to onset of TMA was 42 days (range 1, 1825) from initial administration, and the median number of cycles was 3 cycles (range 1, 15). Hemolytic anemia was recorded in 64 patients, with a median of 8.3 g/dL (range 4.6, 13). Sixty-three patients had thrombocytopenia with a median of 18 × 10/L (range 1, 139). The median value of increased LDH was 1192 IU/L (range 141, 5378). ADAMTS13 activity was normal in 41 (62.1 %) of the 42 patients. Mutations were found in 9 (13.6 %) of the 15 patients. Fifty-seven patients achieved a clinical response after discontinuing carfilzomib and receiving therapeutic plasma exchange (53.0 %), eculizumab (24.2 %), or hemodialysis (39.4 %).
Carfilzomib-induced TMA is an important adverse event that should be considered in patients receiving carfilzomib for multiple myeloma with anemia, thrombocytopenia, and acute kidney injury. Withdrawal of carfilzomib and treatment with eculizumab have proven successful in some patients.
血栓性微血管病（TMA）与卡非佐米相关，对卡非佐米诱导的 TMA 的认识主要基于病例报告。本研究调查了卡非佐米诱导的 TMA 患者的临床特征，为卡非佐米的合理应用提供了参考。
通过检索中文和英文数据库，收集截至 2024 年 1 月 31 日卡非佐米诱导的 TMA 的报告进行回顾性分析。
共纳入 66 例患者，中位年龄 63 岁（范围 39，85）。TMA 发病中位时间为初始给药后 42 天（范围 1，1825），中位周期数为 3 个周期（范围 1，15）。64 例患者记录有溶血性贫血，中位血红蛋白 8.3 g/dL（范围 4.6，13）。63 例患者血小板减少，中位血小板计数 18×10/L（范围 1，139）。中位升高的 LDH 值为 1192 IU/L（范围 141，5378）。42 例患者中的 41 例（62.1%）ADAMTS13 活性正常。15 例患者中有 9 例（13.6%）发现突变。57 例患者在停用卡非佐米并接受治疗性血浆置换（53.0%）、依库珠单抗（24.2%）或血液透析（39.4%）后获得临床缓解。
卡非佐米诱导的 TMA 是接受卡非佐米治疗多发性骨髓瘤伴贫血、血小板减少和急性肾损伤患者的重要不良事件。在某些患者中，停用卡非佐米和使用依库珠单抗治疗已被证明是成功的。
