Fatal pulmonary toxicity following Carfilzomib administration

Abstract

Carfilzomib has shown excellent outcomes for relapsed Multiple Myeloma. There have been increasing reports on cardiovascular adverse events. However, reports on severe pulmonary adverse events are rare. Our patient was a 79-year-old female, undergoing fourth-line therapy with Carfilzomib. At 24h after first administration, the patient was admitted to the emergency room complaining of dyspnoea. After a full recovery, the patient was re-evaluated. Since echocardiography showed normal cardiac function, Carfilzomib was re-initiated. At 24h after administration, the patient was re-admitted to the emergency room with severe dyspnoea, meeting criteria for ARDS. Despite mechanical ventilation, the patient developed cardiac arrest. Resuscitation was unsuccessful. Although patients might fully recover from a first episode of Carfilzomib-induced pulmonary toxicity, re-initiation of Carfilzomib is not recommended.

Severe pulmonary toxicity related to carfilzomib use: a rare but serious side effect

“…To our knowledge, there have been five reported cases of carfilzomib-related pulmonary toxicity, two of which resulted in fatal outcomes (table 2). 9–13…”

“…Another case report published by Marschall et al described a similar fatal pulmonary toxicity in a patient treated with carfilzomib in the fourth-line setting for the management of multiple myeloma. The patient had a temporal respiratory decline after receiving two doses of carfilzomib that progressed to ARDS, eventually resulting in a cardiac arrest and subsequent death of the patient 10…”