Early-Onset Severe Diffuse Alveolar Hemorrhage after Bortezomib Administration Suggestive of Pulmonary Involvement of Myeloma Cells

Sugita, Yoshiaki; Ohwada, Chikako; Nagao, Yuhei; Kawajiri, Chika; Shimizu, Ryoh; Togasaki, Emi; Yamazaki, Atsuko; Muto, Tomoya; Sakai, Shio; Takeda, Yusuke; Mimura, Naoya; Takeuchi, Masahiro; Sakaida, Emiko; Iseki, Tohru; Yokote, Koutaro; Nakaseko, Chiaki

doi:10.3960/jslrt.55.163

Cited by 8 publications

(4 citation statements)

References 18 publications

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“…Alternatively, it has been proposed that metabolites of bortezomib may cause direct injury to the lung [ [13] , [14] , [15] ]. Further, Sugita et al [ 11 ] hypothesized that the alveolar hemorrhage observed in their patient resulted from the rapid disintegration of multiple myeloma cells in the lung following the first dose of bortezomib, and Miyakoshi et al [ 14 ] proposed the same mechanism in one of their patients. However, this mechanism is unlikely to be applicable in our case because, unlike Sugita et al’s patient who had patchy ground glass opacities on CT prior to the initiation of treatment, our patient's initial CT scan had no abnormalities suggestive of leukemic infiltration of the lung parenchyma.…”

Section: Discussionmentioning

confidence: 99%

Bortezomib-induced diffuse alveolar hemorrhage in a patient with plasma cell leukemia

Wirth¹,

Peters²

2020

Respiratory Medicine Case Reports

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Bortezomib, a chemotherapeutic agent used in the treatment of hematologic malignancies, has been associated with multiple forms of lung injury including diffuse alveolar hemorrhage (DAH). We present the first reported case of bortezomib-induced DAH in a patient with plasma cell leukemia. This 59-year-old female developed hemoptysis, severe cough, and diffuse bilateral ground glass opacities on CT scan of the chest after receiving one dose of bortezomib, with DAH subsequently confirmed on bronchoalveolar lavage. Unlike most previously reported cases, she did not develop respiratory failure requiring high dose corticosteroids, and in fact did not require any supplemental oxygen. We also provide a comparative summary of all reports of bortezomib-induced DAH in the literature to date. This case provides additional insight into the spectrum of disease severity observed in DAH secondary to bortezomib therapy.

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Section: Discussionmentioning

confidence: 99%

Bortezomib-induced diffuse alveolar hemorrhage in a patient with plasma cell leukemia

Wirth¹,

Peters²

2020

Respiratory Medicine Case Reports

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“…Although there are reports about bortezomib associated pulmonary complications, the mechanism is unclear. 31–34 Diarrhea and mucositis of any grade were more frequently reported in the Bor-HDM conditioning regimen. Like previous reports with the Bor-HDM conditioning regimen mucositis and diarrhea were the most commonly reported toxicities.…”

Section: Discussionmentioning

confidence: 99%

Comparison of conditioning regimen toxicities among autologous stem cell transplantation eligible multiple myeloma patients: High-dose melphalan versus high-dose melphalan and bortezomib

Aypar

İzzettin

Akı

et al. 2017

J Oncol Pharm Pract

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Background Autologous hematopoietic stem cell transplantation (AHSCT) remains the standard of care for younger patients with multiple myeloma (MM). Currently, high-dose melphalan (HDM) is recommended as conditioning regimen before AHSCT. Preclinical data suggest that combining bortezomib and melphalan has synergistic effect against multiple myeloma cells. Bortezomib and HDM (Bor-HDM) combination as conditioning regimen has been investigated by many other investigators. Objective In this retrospective study, we aimed to compare transplant-related toxicities and hematologic recovery of HDM and Bor-HDM conditioning regimens. Method We retrospectively evaluated hematologic recovery and toxicity profile in patients with MM who received AHSCT with either HDM ( n = 114) or Bor-HDM ( n = 53) conditioning regimen. Results Nonhematologic toxicities were comparable between HDM and Bor-HDM conditioning regimen, except mucositis and diarrhea being more frequent in the Bor-HDM group. Neutrophil and platelet engraftment time and duration of hospital stay were significantly shorter for HDM regimen. Conclusions In this retrospective analysis, we observed engraftment kinetics and duration of hospitalization were significantly worse in Bor-HDM conditioning regimen with manageable toxicities. Randomized studies are needed to further compare Bor- HDM regimen to HDM in terms of response rates, toxicities, and transplant-related mortality.

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“…Diffuse alveolar hemorrhage: In patients presenting with acute onset hypoxia, pulmonary opacities, and fevers, especially in the setting of thrombocytopenia and anemia, pulmonary hemorrhage is a possibility. Diffuse alveolar hemorrhage (DAH) has been rarely reported in MM patients, but there have been cases associated with bortezomib and in the posttransplant setting [2,7,8,120]. Though rare, this is potentially a fatal event.…”

Section: Pulmonarymentioning

confidence: 99%

What the Intensivists Need to Know About Critically Ill Myeloma Patients

Nair¹,

Patel²

2018

Oncologic Critical Care

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Multiple myeloma (MM) is a hematological malignancy characterized by an increase in aberrant plasma cells in the bone marrow leading to rising monoclonal protein in serum and urine. With the introduction of novel therapies with manageable side effects, this incurable disease has evolved into a chronic disease with an acceptable quality of life for the majority of patients. Accordingly, management of acute complications is fundamental in reducing the morbidity and mortality in MM. MM emergencies include symptoms and signs related directly to the disease and/or to the treatment; many organs may be involved including, but not limited to, renal, cardiovascular, neurologic, hematologic, and infectious complications. This review will focus on the numerous approaches that are aimed at managing these complications.

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Early-Onset Severe Diffuse Alveolar Hemorrhage after Bortezomib Administration Suggestive of Pulmonary Involvement of Myeloma Cells

Cited by 8 publications

References 18 publications

Bortezomib-induced diffuse alveolar hemorrhage in a patient with plasma cell leukemia

Bortezomib-induced diffuse alveolar hemorrhage in a patient with plasma cell leukemia

Comparison of conditioning regimen toxicities among autologous stem cell transplantation eligible multiple myeloma patients: High-dose melphalan versus high-dose melphalan and bortezomib

What the Intensivists Need to Know About Critically Ill Myeloma Patients

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