Chalazia Development in Multiple Myeloma: A New Complication Associated with Bortezomib Therapy

Abstract

Multiple myeloma (MM) is a neoplasm of plasma cells within the bone marrow. A major impact on improving survival in MM has been the use of the boronic acid-derived proteasome inhibitor bortezomib, a first-in-class selective inhibitor of the 26S proteasome. Ocular side effects of bortezomib are rare. In this report, we present 2 patients with active MM in whom persistent chalazia became a therapy-interfering complication of treatment with bortezomib. Both patients had relapsed ISS III B kappa light chain myeloma, and they were responding to treatment with bortezomib until chalazia – which caused intolerable discomfort – started. In both patients discontinuation of bortezomib was necessary for chalazia to heal, and restarting of bortezomib was associated with relapse of chalazia.

Recurrent Chalazia Secondary to Bortezomib

“…Commencement of bortezomib after cessation causes recurrence of chalazia (Puri et al 2014). Chalazia occurring in patients on bortezomib have been known to be severe enough to cause cessation of ongoing chemotherapy cycles (Puri et al 2014;Yun et al 2015). In our patient, cessation of the chemotherapy mid-cycle due to severity of chalazia caused a repeat of his third chemotherapy cycle.…”

Chalazion in a patient with multiple myeloma treated with bortezomib

“…Chalazion is the occlusion of the duct at the base of the eyelid resulting in a painless lump. It is a rare complication of bortezomib therapy with a few case reports in the literature 1–3. The mechanism by which bortezomib induces chalazion has theoretically been associated with a systemic inflammatory process 1.…”

A Case Report on Bortezomib-Induced Bilateral Chalazion

“…Bortezomib is a boronic acid-derived proteasome inhibitor and a first-in-class selective inhibitor of the 26S proteasome, an enzyme complex involved in protein degradation. Its anti-myeloma effect is mainly due to inhibition of endoplasmic reticulum-dependent degradation of excessively synthesized abnormal myeloma proteins [2]. It is an FDA-approved medication for primary, refractory, or relapsed cases of MM when used as a single agent or in combination with other anti-myeloma agents [3].…”

“…In recent years, agents like bortezomib have been shown to impact survival in multiple myeloma (MM) significantly [2]. Bortezomib belongs to a class of medications known as proteasome inhibitors, and it has been FDA-approved for use in both MM and mantle cell lymphoma.…”