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Various toxicities following off-label treatment: 6 case reports In a study consisting of 34 patients treated between March 2017 and March 2018, six patients [ages and sexes not stated] were described, who developed pulmonary embolism, left ventricle thrombus, rash, liver function test elevation, fever, ileus, thrombocytopenia or lower GI haemorrhage during off-label treatment with bortezomib, dexamethasone or lenalidomide for lightchain (AL) amyloidosis [not all dosages and routes stated; time to reaction onsets and outcomes not stated]. The patients, who had AL amyloidosis, started receiving off-label treatment with VRD regimen. The VRD regimen consisted of SC bortezomib 1.3 mg/m2 on days 1, 8 and 15, lenalidomide at low doses on days 1–21 and dexamethasone 20 mg/week, every 28 days, scheduled to be administered for 8 cycles. Of the six patients, two patients were also receiving prophylaxis with unspecified low molecular weight heparins (1 patient) and unspecified novel oral anticoagulants (1 patient). Subsequently, these two patients developed VRD regimen-related adverse events consisting of pulmonary embolism (1 patient) and left ventricle thrombus (1 patient). The remaining four patients developed adverse events consisting of grade 4 rash attributed to lenalidomide (1 patient), grade 3 rash, grade 4 liver function test elevation and fever attributed to lenalidomide (1 patient), ileus attributed to bortezomib (1 patient), and thrombocytopenia and lower GI haemorrhage attributed to VRD regimen (1 patient). These four patients required hospitalisation due to their respective adverse events. The patient, who developed thrombocytopenia and lower GI haemorrhage, had discontinued lenalidomide 45 days prior to the hospital admission. The patient, who developed pulmonary embolism, continued the VRD regimen. The patient, who developed left ventricle thrombus, discontinued lenalidomide. Kastritis E, et al. Primary treatment of light-chain amyloidosis with bortezomib, lenalidomide, and dexamethasone. Blood Advances 3: 3002-3009, No. 20, 22 Oct 2019. 803500696 Available from: URL: http://doi.org/10.1182/bloodadvances.2019000147

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Reactions 12 Sep 2020 No. 1821