Carfilzomib-induced tumor lysis syndrome in relapsed multiple myeloma: a report of two cases

Abstract

Background: Tumor lysis syndrome (TLS) is a potentially fatal complication of cancer therapy characterized by severe electrolyte and metabolic abnormalities such as hyperphosphatemia, hyperkalemia, and hypocalcaemia. TLS usually occurs in aggressive hematologic malignancies such as Burkitt lymphoma and acute leukemia. TLS has rarely been observed in multiple myeloma (MM). Case report: We present 2 patients with relapsed MM who developed TLS after the first cycle of carfilzomib treatment. Conclusion: Carfilzomib is a next-generation proteasome inhibitor with proven efficacy in relapsed/refractory MM. Recently, increasing frequency of TLS has been reported in MM, especially after treatment with proteasome inhibitors. The potential complications of TLS should be considered especially during the first cycle of carfilzomib treatment.

Laboratory features of tumour lysis syndrome following daratumumab monotherapy in relapsed/refractory multiple myeloma

“…The authors postulate that an abrupt increase in serum‐free light chain (SFLC) concentration in the setting of abrupt MM cell death may contribute significantly to the acute kidney injury seen in TLS [ 1 ]. TLS is rarely seen in multiple myeloma (MM) but has been reported following treatment with the proteasome inhibitors (PI) bortezomib and carfilzomib [ 2 , 3 ]. However, less is known about the risk of TLS with other anti‐myeloma agents including immunomodulatory drugs (iMIDS) and monoclonal antibodies.…”

Prevention and Treatment of Tumor Lysis Syndrome in the Era of Onco-Nephrology Progress

“…Generally, the risk of TLS in multiple myeloma is low, given the disease's low proliferation rate. However, after the introduction of proteasome inhibitors, an increasing frequency of TLS has been reported, with an incidence of 1.4-5% for bortezomib, 0.4-4.3% for carfilzomib, and 2.4% for oprozomib [9,[56][57][58].…”