scholarly journals Bortezomib-Induced Perimyocarditis in a Multiple Myeloma Patient: A Case Report

2021 ◽  
pp. 1853-1859
Author(s):  
Yaman Alali ◽  
Muhamed Baljevic
Keyword(s):  
Multiple Myeloma ◽  
Pericardial Effusion ◽  
Proteasome Inhibitor ◽  
Troponin I ◽  
Acute Myocarditis ◽  
Cardiovascular Complications ◽  
Pleuritic Chest Pain ◽  
Multiple Myeloma Patient ◽  
First Case ◽  
Scoring Tools

Bortezomib (BTZ) is a proteasome inhibitor used in the treatment of multiple myeloma (MM) and other hematological malignancies. Although carfilzomib, a second-generation proteasome inhibitor, is most strongly associated with cardiotoxicity, BTZ has been associated with several cardiovascular complications including congestive heart failure, arrhythmias, and rarely myocarditis. Here, we report the first case of a BTZ-induced perimyocarditis. The patient was a 40-year-old woman with recently diagnosed MM who was admitted to the hospital with syncope at the start of her second cycle of induction therapy with BTZ, lenalidomide, and dexamethasone. She had a witnessed syncopal event in the emergency room with the telemetry showing sustained ventricular tachycardia. Laboratory workup showed elevated N-terminal pro B-type natriuretic peptide and normal troponin I. Transthoracic echocardiogram (TTE) showed a low ejection fraction of 40% with global hypokinesis of the left ventricle and trace pericardial effusion. Cardiac magnetic resonance imaging with gadolinium was consistent with acute myocarditis. The patient had recurrent pleuritic chest pain, and a repeat TTE showed worsening pericardial effusion consistent with pericarditis. Endomyocardial biopsy was done which showed nonspecific myocyte hypertrophy and foci of fibrosis, but was negative for giant cell myocarditis, hemochromatosis, and amyloidosis. Extensive infectious disease workup ruled out known infectious causes for perimyocarditis. Given the close timing between BTZ treatment (5 subcutaneous doses with a cumulative dose of 6.5 mg/m<sup>2</sup>), the absence of other iatrogenic or infectious causes, and probable or likely association with BTZ as assessed by the validated causality assessment scoring tools, it was concluded that the acute perimyocarditis was secondary to BTZ exposure. Here, we report the first case of BTZ-induced perimyocarditis and discuss the incidence and pathophysiology of BTZ-cardiovascular toxicity.

Acute Pancreatitis Associated with Ixazomib in a Multiple Myeloma Patient

2018 ◽  
Vol 139 (1) ◽  
pp. 67-70 ◽  
Author(s):  
Raphael E. Steiner ◽  
Robert Z. Orlowski ◽  
Hans C. Lee
Keyword(s):  
Multiple Myeloma ◽  
Acute Pancreatitis ◽  
Proteasome Inhibitor ◽  
Gastrointestinal Symptoms ◽  
Multiple Myeloma Patient ◽  
Case Presentation ◽  
Severe Diarrhea ◽  
First Case ◽  
To Receive ◽  
Uncommon Complication

Background: Acute pancreatitis is an uncommon complication of anti-myeloma agents. Ixazomib is a first-in-class oral proteasome inhibitor to receive regulatory approval for the treatment of multiple myeloma. This case report describes the first case of ixazomib-associated pancreatitis. Case Presentation: An 80-year-old female with relapsed multiple myeloma presented with severe diarrhea, nausea, vomiting, abdominal pain, and acute renal failure 3 weeks after starting ixazomib and dexamethasone for disease progression. An extensive workup revealed acute pancreatitis without a definitive cause. Her condition improved with supportive measures and the discontinutation of ixazomib. The latter was suspected as the probable etiology of the patient's acute pancreatitis, given no clear alternative causes and the temporal relationship between initiating ixazomib and the development of her symptoms. Conclusions: Practitioners should include acute pancreatitis as part of their differential diagnosis in patients on ixazomib treatment who present with gastrointestinal symptoms.

scholarly journals Prospective Study of Cardiac Events During Proteasome Inhibitor Therapy for Relapsed Multiple Myeloma

2019 ◽  
Vol 37 (22) ◽  
pp. 1946-1955 ◽  
Author(s):  
Robert F. Cornell ◽  
Bonnie Ky ◽  
Brendan M. Weiss ◽  
Cherie N. Dahm ◽  
Deepak K. Gupta ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Natriuretic Peptides ◽  
Odds Ratio ◽  
Proteasome Inhibitor ◽  
Troponin I ◽  
Progression Free Survival ◽  
Cardiac Biomarkers ◽  
Cardiac Events ◽  
Increased Risk ◽  
Grade 3

PURPOSE Cardiovascular adverse events (CVAEs) can occur during proteasome inhibitor (PI) therapy. We conducted a prospective, observational, multi-institutional study to define risk factors and outcomes in patients with multiple myeloma (MM) receiving PIs. PATIENTS AND METHODS Patients with relapsed MM initiating carfilzomib- or bortezomib-based therapy underwent baseline assessments and repeated assessments at regular intervals over 6 months, including cardiac biomarkers (troponin I or T, brain natriuretic peptide [BNP], and N-terminal proBNP), ECG, and echocardiography. Monitoring occurred over 18 months for development of CVAEs. RESULTS Of 95 patients enrolled, 65 received carfilzomib and 30 received bortezomib, with median 25 months of follow-up. Sixty-four CVAEs occurred, with 55% grade 3 or greater in severity. CVAEs occurred in 51% of patients treated with carfilzomib and 17% of those treated with bortezomib ( P = .002). Median time to first CVAE from treatment start was 31 days, and 86% occurred within the first 3 months. Patients receiving carfilzomib-based therapy with a baseline elevated BNP level higher than 100 pg/mL or N-terminal proBNP level higher than 125 pg/mL had increased risk for CVAE (odds ratio, 10.8; P < .001). Elevated natriuretic peptides occurring mid–first cycle of treatment with carfilzomib were associated with a substantially higher risk of CVAEs (odds ratio, 36.0; P < .001). Patients who experienced a CVAE had inferior progression-free survival (log-rank P = .01) and overall survival (log-rank P < .001). PI therapy was safely resumed in 89% of patients, although 41% required chemotherapy modifications. CONCLUSION CVAEs are common during PI therapy for relapsed MM, especially with carfilzomib, particularly within the first 3 months of therapy. CVAEs were associated with worse overall outcomes, but usually, discontinuation of therapy was not required. Natriuretic peptides were highly predictive of CVAEs; however, validation of this finding is necessary before uniform incorporation into the routine management of patients receiving carfilzomib.

scholarly journals Acute Liver Rejection in a Multiple Myeloma Patient Treated with Lenalidomide

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Iuliana Vaxman ◽  
John Eaton ◽  
Hee Eun Lee ◽  
Morie A. Gertz
Keyword(s):  
Multiple Myeloma ◽  
Mycophenolate Mofetil ◽  
Case Report ◽  
Allograft Rejection ◽  
Acute Cellular Rejection ◽  
Primary Biliary Cholangitis ◽  
Myeloma Patient ◽  
Multiple Myeloma Patient ◽  
First Case ◽  
Cellular Rejection

Herein we present a patient that underwent a liver transplant due to primary biliary cholangitis (PBC) and after 9 years developed multiple myeloma. Following the cessation of mycophenolate mofetil and 2 weeks after lenalidomide treatment was started, the patient experienced acute cellular rejection. The patient recovered after treatment with corticosteroids, resumption of mycophenolate mofetil, and cessation of lenalidomide. Lenalidomide-associated allograft rejection has been reported in other organs. However, this is the first case report of liver rejection induced by lenalidomide.

scholarly journals Case Report of a Rare Incidence of IgH Amplification Leading to Acute Kidney Injury in a Multiple Myeloma Patient

2021 ◽  
pp. 274-278
Author(s):  
Sowmya Thanikachalam ◽  
Vijay Kumar Srinivasalu ◽  
K.S. Nataraj ◽  
Sharat Damodar ◽  
Manjula Das
Keyword(s):  
Multiple Myeloma ◽  
Acute Kidney Injury ◽  
Case Report ◽  
Heavy Chain ◽  
Kidney Injury ◽  
Bone Marrow Aspiration ◽  
Structural Abnormality ◽  
Cell Transplant ◽  
Multiple Myeloma Patient ◽  
First Case

We present a case report of a 62-year-old male, treated for kappa light chain multiple myeloma with chemotherapy followed by autologous stem cell transplant (ASCT) in 2014. He has been in complete remission for 4 years. In 2018, he was evaluated for hypercreatinemia and acute kidney injury(AKI) with a suspicion of disease relapse; he underwent evaluation with bone marrow aspiration cytology which showed no evidence of relapse. However, careful cytogenetic analyses showed IgH amplification (14q32) which probably was the cause for AKI in the absence of any structural abnormality in the kidney. Heavy chain deposition leads to AKI in multiple myeloma, and its association with IgH amplification leading to AKI is reported here. Though heavy chain deposition leading to AKI is common, IgH amplification at chromosome level is the first case observed.

scholarly journals Brain abscesses caused by Nocardia paucivorans in a multiple myeloma patient treated with lenalidomide and dexamethasone: a case report and review of literature.

2014 ◽  
Vol 7 ◽  
pp. e2015011 ◽  
Author(s):  
Jacopo Monticelli ◽  
Roberto Luzzati ◽  
Cristina Maurel ◽  
Chiara Rosin ◽  
Romina Valentinotti ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Case Report ◽  
Adverse Effects ◽  
Infectious Complication ◽  
Chemotherapy Regimen ◽  
Review Of Literature ◽  
Myeloma Patient ◽  
Multiple Myeloma Patient ◽  
First Case ◽  
Brain Abscesses

We report the first case of multiple brain abscesses caused by Nocardia paucivorans in a patient suffering from multiple myeloma on treatment with lenalidomide and dexamethasone. Nocardia  paucivorans is a recently described species of the genus Nocardia, which is supposed to have a heightened neurotropism in cases of disseminated infection. Although nocardiosis itself is an uncommon infectious complication in multiple myeloma so far, nocardial brain abscess should be added to the spectrum of adverse effects due to this novel chemotherapy regimen.

scholarly journals Nocardia farcinica Brain Abscess in a Multiple Myeloma Patient Treated with Proteasome Inhibitor: A Case Report and Review of the Literature

2021 ◽  
Vol 11 (9) ◽  
pp. 1204
Author(s):  
Nengwen Xu ◽  
Linjie Li ◽  
Wen Lei ◽  
Wenbin Qian
Keyword(s):  
Multiple Myeloma ◽  
Brain Abscess ◽  
Proteasome Inhibitor ◽  
Brain Mri ◽  
Myeloma Patient ◽  
Multiple Myeloma Patient ◽  
Nocardia Farcinica ◽  
Intracranial Lesions ◽  
Brain Abscesses ◽  
The Brain

Nocardia brain abscess is relatively rare, accounting for about 1–2% of all brain abscesses, and its mortality rate is three times higher than of other types of bacterial brain abscesses; thus, early diagnosis and treatment are essential. Nocardia brain abscess generally occurs in immunodeficient patients. We report a case of Nocardia farcinica brain abscess in a multiple myeloma patient treated with proteasome inhibitor (bortezomib and ixazomib), cyclophosphamide, and corticosteroid. The patient was treated with ceftriaxone and trimethoprim-sulfamethoxazole, together with drainage of the brain abscess. Regular brain MRI follow-ups showed that intracranial lesions were gradually absorbed and improved.

scholarly journals First case of COVID-19 in a patient with multiple myeloma successfully treated with tocilizumab

2020 ◽  
Vol 4 (7) ◽  
pp. 1307-1310 ◽  
Author(s):  
Xuhan Zhang ◽  
Kaidi Song ◽  
Fei Tong ◽  
Mingming Fei ◽  
Hui Guo ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Randomized Controlled Trials ◽  
Controlled Trials ◽  
Myeloma Patient ◽  
Multiple Myeloma Patient ◽  
Randomized Controlled ◽  
First Case ◽  
Key Points

Key Points We report the first case of coronavirus disease 2019 (COVID-19) in a multiple myeloma patient successfully treated with tocilizumab. Although tocilizumab was effective in the treatment of COVID-19 in this case, randomized controlled trials are needed.

scholarly journals Left atrial appendage closure device complicated by late-onset pericardial effusion and tamponade: a case report

2021 ◽  
Vol 5 (3) ◽  
Author(s):  
Stefano Albani ◽  
Nicola Berlier ◽  
Francesco Pisano ◽  
Paolo Scacciatella
Keyword(s):  
Pericardial Effusion ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Late Onset ◽  
Oral Anticoagulants ◽  
Bleeding Risk ◽  
Atrial Appendage ◽  
Closure Device ◽  
Device Implantation ◽  
First Case

Abstract Background Late-onset complications of left atrial appendage occlusion (LAAO) device procedure are anecdotal and there are no such complications reported in literature using Cardia Ultraseal (Cardia, Inc., Eagan, MN, USA). Case summary We report the case of a 74-year-old Caucasian man affected by paroxysmal atrial fibrillation with significant bleeding risk (familiar thrombocytopenia, macroscopic haematuria episodes during therapy with direct oral anticoagulants, HAS-BLED risk score: 4) and ischaemic risk as well (CHADSVASC score: 3). The patient was treated with LAAO device implantation for high bleeding risk. Subsequently, after 26 days from LAAO procedure, he was admitted to the emergency department for haematic cardiac tamponade. The patient was successfully treated with subxyphoidal pericardiocentesis in the acute phase, unfortunately cardiac arrest occurred during the transfer to the referral hospital for urgent cardiac surgery. Permanent neurological damage was reported and the patient died on day 28. Discussion LAAO late-onset complications are very rare and the case presented is the first case described of late-onset pericardial effusion and tamponade secondary to the Cardia Ultraseal LAAO device implantation. We present a revision of the literature regarding the occurrence of similar adverse events and discuss the hypothetical mechanism of this major complication.

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