Takikawa Kaito, Sota Mana, Nakashima Shiori, Imai Yui, Nakano Hirofumi, Uchida Tomoyuki, Inoue Morihiro, Hagihara Masao, Torii Akiko
Department of Hematology, Eiju General Hospital, 2-23-16 Higashiueno, Taito-ku, Tokyo, 110-8645, Japan.
Department of Nephrology, Eiju General Hospital, Tokyo, Japan.
Int J Hematol. 2025 May 5. doi: 10.1007/s12185-025-03996-0.
A 62-year-old woman experienced severe renal insufficiency and significant thrombocytopenia during the 7th cycle of carfilzomib and dexamethasone therapy for relapsed multiple myeloma. She was diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection from a routine check upon admission. She was subsequently diagnosed with thrombotic microangiopathy (TMA) as well, and platelet fragments were detected in her blood. Treatment with plasma exchange, hemodialysis, and antiviral medications was successful. Although coronavirus disease 2019 (COVID-19) was identified as the primary trigger of TMA, carfilzomib was probably a predisposing factor that contributed to endothelial damage. Even though severe cases of COVID-19 have been less frequent since the Omicron variant became dominant, patients with MM, especially those under treatment with carfilzomib, should be given repeated booster vaccinations. Antiviral medication should also be considered in patients infected with COVID-19, even if symptoms are mild.
一名62岁女性在接受卡非佐米和地塞米松治疗复发多发性骨髓瘤的第7个疗程时，出现了严重肾功能不全和显著血小板减少。入院时常规检查发现她感染了严重急性呼吸综合征冠状病毒2（SARS-CoV-2）。随后她也被诊断为血栓性微血管病（TMA），血液中检测到血小板碎片。血浆置换、血液透析和抗病毒药物治疗取得成功。尽管2019冠状病毒病（COVID-19）被确定为TMA的主要触发因素，但卡非佐米可能是导致内皮损伤的一个易感因素。自奥密克戎变种成为优势毒株以来，尽管重症COVID-19病例已不那么常见，但多发性骨髓瘤患者，尤其是正在接受卡非佐米治疗的患者，应反复接种加强疫苗。即使症状轻微，感染COVID-19的患者也应考虑使用抗病毒药物。
