Thrombotic microangiopathy after treatment with bortezomib and dexamethasone in a patient with multiple myeloma

Morita, Rena; Hashino, Satoshi; Shirai, Shinichi; Fujita, N; Onozawa, Masahiro; Kahata, Kaoru; Kondo, Takeshi; Imamura, Masahiro; Asaka, Masahiro

doi:10.1007/s12185-008-0140-1

Cited by 29 publications

(30 citation statements)

References 6 publications

(6 reference statements)

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“…Several days after the initial dose of bortezomib, the patient developed haematological, biochemical and morphological evidence of microangiopathic haemolytic anaemia, consistent with a diagnosis of TTP. There has been only one other case reported in the literature of thrombotic microangiopathy (TMA) following bortezomib and dexamethasone in a 54‐year‐old man with refractory MM 1 . This patient had already undergone both autologous and allogeneic bone marrow transplantation, had chronic Graft versus Host Disease (GvHD) and received bortezomib and dexamethasone for disease progression.…”

Section: Discussionmentioning

confidence: 99%

Multiple myeloma presenting with a fever of unknown origin and development of thrombotic thrombocytopenic purpura post‐bortezomib

Moore

Romeril

2011

Internal Medicine Journal

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Multiple myeloma rarely presents with a fever of unknown origin and diagnosis may be delayed. We describe a case of myeloma presenting in this way with raised serum-free light chains and TP53 deletion on cytogenetics. The patient developed thrombotic thrombocytopenia purpura (TTP) following bortezomib therapy but recovered spontaneously and was successfully re-challenged. We believe this is only the second case to describe this phenomenon post-bortezomib and the first to rechallenge the patient successfully without further recurrence of TTP. Possible mechanisms for this successful rechallenge are discussed.

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Section: Discussionmentioning

confidence: 99%

Multiple myeloma presenting with a fever of unknown origin and development of thrombotic thrombocytopenic purpura post‐bortezomib

Moore

Romeril

2011

Internal Medicine Journal

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“…Both prior cases were seen in patients after their first dose of bortezomib 4 5. The first reported case occurred 8 days after introduction of bortezomib and the second occurred 2 days after the introduction of bortezomib.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore drug-induced TTP is often treated by holding the offending agent 8. In the first described case of bortezomib-induced TTP, the patient was treated with fresh frozen plasma and haptoglobin 4. In the second case, TTP resolved as bortezomib was withheld 5.…”

Section: Discussionmentioning

confidence: 99%

Bortezomib-induced thrombotic thrombocytopaenic purpura: Figure 1

2012

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Thrombotic thrombocytopaenic purpura (TTP) is a thrombotic microangiopathy characterised by haemolytic anaemia, schistocytes on peripheral blood smear and thrombocytopaenia that can additionally present with fever, renal insufficiency and/or neurological abnormalities. While our understanding of idiopathic TTP has significantly advanced, there are still many unanswered questions regarding the pathophysiology of secondary TTP, which can be associated with malignancy, pregnancy, HIV infection, bone marrow transplantation and exposure to certain drugs including several chemotherapeutic agents. Here we present a case of bortezomib-associated TTP. Our patient developed microangiopathic haemolytic anaemia, thrombocytopaenia and altered mental status after her ninth dose of bortezomib. The drug was subsequently discontinued and the patient underwent one session of plasma exchange with clinical improvement and recovery of her platelet counts, disappearance of schistocytes and resolution of both neurological symptoms and haemolysis in 2 days.

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“…7 Bortezomib is increasingly used in the treatment of multiple myeloma and clinicians should be aware of this association in patients with anemia and unexpectedly severe thrombocytopenia.…”

Section: Discussionmentioning

confidence: 99%

Thrombotic Microangiopathy Associated with Bortezomib Treatment in a Patient with Relapsed Multiple Myeloma

Salmenniemi

Remes

2012

Hematology Reports

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Thrombotic microangiopathy after treatment with bortezomib and dexamethasone in a patient with multiple myeloma

Cited by 29 publications

References 6 publications

Multiple myeloma presenting with a fever of unknown origin and development of thrombotic thrombocytopenic purpura post‐bortezomib

Multiple myeloma presenting with a fever of unknown origin and development of thrombotic thrombocytopenic purpura post‐bortezomib

Bortezomib-induced thrombotic thrombocytopaenic purpura: Figure 1

Thrombotic Microangiopathy Associated with Bortezomib Treatment in a Patient with Relapsed Multiple Myeloma

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