Carfilzomib
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Carfilzomib Congestive heart failure due to drug toxicity: case report
A 60-year-old woman developed congestive heart failure due to drug toxicity during treatment with carfilzomib for multiple myeloma. The woman, who was diagnosed with multiple myeloma in 2016, presented to the hospital in December 2019. She also had nonnephrotic proteinuria, chronic kidney disease and chronic anaemia. She had received 8 cycles of (CyBorD) bortezomib, cyclophosphamide and dexamethasone in April 2016. Thereafter, she underwent autologous stem cell transplantation in March 2018 and then started receiving dexamethasone and lenalidomide as maintenance therapy. However, she had disease progression thereafter. Hence, chemotherapy with carfilzomib [route and dosage not stated], leflunomide and dexamethasone was initiated. Prior to the initiation of the chemotherapy, her transthoracic echocardiogram showed a preserved ventricular systolic function with left ventricular ejection fraction (LVEF) of 58% and global longitudinal strain (GLS) of –17%. Subsequently, her functional status of the heart decreased rapidly form class I to II in 2 weeks as per New York Heart Association’s functional classification, orthopnoea and paroxysmal nocturnal dyspnoea after 5 cyles of the chemotherapy. Therefore, the woman was hospitalised and her diagnostic studies showed troponin-I of 0.006 pg/ml (cut-off point 0–0.017 pg/ ml) and N-terminal pro brain natriuretic peptide of 17570 pg/mL (cut-off point ≥900 pg/mL).Her transthoracic echocardiogram revealed 182 g/m2 of ventricular mass, diffuse hypokinaesia, left ventricular concentric hypertrophy, decreased LVEF to 45% and decreased GLS to –11.7%. Based on these laboratory results, severe congestive heart failure due to carfilzomib toxicity was considered [duration of treatment to reaction onset not stated]. The heart failure was classified as high-grade cardiovascular adverse events. Hence, carfilzomib was discontinued, and she started receiving treatment with enalapril, carvedilol, spironolactone and furosemide that led to good partial response. Her bone marrow investigation did not show plasmocytes. Due to progression of the disease, she started receiving lenalidomide, daratumumab and dexamethasone as a third line therapy. Forty-five days after the discontinuation of carfilzomib, she reported improvement in the orthopnoea and dyspnoea. At the follow-up, no change in the LVEF; but, significant improvement in the GLS was noted upon echocardiogram. Mendez-Toro A, et al. Carfilzomib induced cardiotoxicity in a multiple myeloma patient. Cardio-Oncology 6: 17, 2020. Available from: URL: http://doi.org/10.1186/ s40959-020-00074-8
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Reactions 10 Oct 2020 No. 1825
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