The First Autopsy Case of Fatal Acute Cardiac Failure after Administration of Carfilzomib in a Patient with Multiple Myeloma
Carfilzomib (CFZ) improves progression-free survival for patients with relapsed or refractory multiple myeloma (MM) but has shown higher frequency of cardiovascular adverse events (CVAEs) than other proteasome inhibitors. We report the first autopsy case of acute death from cardiac failure shortly a...
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| Format: | Article |
| Language: | English |
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Wiley
2019-01-01
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| Series: | Case Reports in Hematology |
| Online Access: | http://dx.doi.org/10.1155/2019/1816287 |
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| author | Teruhito Takakuwa Ippei Otomaru Taku Araki Akiko Miura Yotaro Fujitani Yasuhide Mochizuki Yoshimi Miyagi Hideto Senzaki Ryosuke Yamamura |
| author_facet | Teruhito Takakuwa Ippei Otomaru Taku Araki Akiko Miura Yotaro Fujitani Yasuhide Mochizuki Yoshimi Miyagi Hideto Senzaki Ryosuke Yamamura |
| author_sort | Teruhito Takakuwa |
| collection | DOAJ |
| description | Carfilzomib (CFZ) improves progression-free survival for patients with relapsed or refractory multiple myeloma (MM) but has shown higher frequency of cardiovascular adverse events (CVAEs) than other proteasome inhibitors. We report the first autopsy case of acute death from cardiac failure shortly after administration of carfilzomib. A 74-year-old female was diagnosed with IgA MM after a 2-year period of smoldering MM. She was refractory to both bortezomib plus dexamethasone and lenalidomide plus dexamethasone therapies, so she subsequently received CFZ in combination with lenalidomide and dexamethasone. The day after the start of the therapy, she complained of severe dyspnea with a significant decline in left ventricular ejection fraction. Her acute cardiac failure rapidly progressed, and she died on day 7 of the start of CFZ. The autopsy showed invasion of inflammatory cells between the myocardial cells and very little myocardial necrosis. There was no obvious thrombus in the coronary artery of the heart, and no infarction or amyloid deposition was observed in the myocardium. Pathological findings of hypersensitivity myocarditis, a drug-induced cardiomyopathy, appeared to agree with this case except for absence of an eosinophilic infiltration of the myocardium. A CFZ-induced CVAE is generally considered reversible. However, rapidly progressing fatal heart failure like in our case is rare. To characterize CFZ-associated CVAE, further case collection is needed. |
| format | Article |
| id | doaj-art-c9c81c913e764061bae20db714ed1a8e |
| institution | Kabale University |
| issn | 2090-6560 2090-6579 |
| language | English |
| publishDate | 2019-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Hematology |
| spelling | doaj-art-c9c81c913e764061bae20db714ed1a8e2025-02-03T05:59:11ZengWileyCase Reports in Hematology2090-65602090-65792019-01-01201910.1155/2019/18162871816287The First Autopsy Case of Fatal Acute Cardiac Failure after Administration of Carfilzomib in a Patient with Multiple MyelomaTeruhito Takakuwa0Ippei Otomaru1Taku Araki2Akiko Miura3Yotaro Fujitani4Yasuhide Mochizuki5Yoshimi Miyagi6Hideto Senzaki7Ryosuke Yamamura8Department of Hematology, Osaka Saiseikai Nakatsu Hospital, Osaka, JapanDepartment of Hematology, Osaka Saiseikai Nakatsu Hospital, Osaka, JapanDepartment of Hematology, Osaka Saiseikai Nakatsu Hospital, Osaka, JapanDepartment of Hematology, Osaka Saiseikai Nakatsu Hospital, Osaka, JapanDepartment of Hematology, Osaka Saiseikai Nakatsu Hospital, Osaka, JapanDepartment of Cardiology, Osaka Saiseikai Nakatsu Hospital, Osaka, JapanDepartment of Pathology, Osaka Saiseikai Nakatsu Hospital, Osaka, JapanDepartment of Pathology, Osaka Saiseikai Nakatsu Hospital, Osaka, JapanDepartment of Hematology, Osaka Saiseikai Nakatsu Hospital, Osaka, JapanCarfilzomib (CFZ) improves progression-free survival for patients with relapsed or refractory multiple myeloma (MM) but has shown higher frequency of cardiovascular adverse events (CVAEs) than other proteasome inhibitors. We report the first autopsy case of acute death from cardiac failure shortly after administration of carfilzomib. A 74-year-old female was diagnosed with IgA MM after a 2-year period of smoldering MM. She was refractory to both bortezomib plus dexamethasone and lenalidomide plus dexamethasone therapies, so she subsequently received CFZ in combination with lenalidomide and dexamethasone. The day after the start of the therapy, she complained of severe dyspnea with a significant decline in left ventricular ejection fraction. Her acute cardiac failure rapidly progressed, and she died on day 7 of the start of CFZ. The autopsy showed invasion of inflammatory cells between the myocardial cells and very little myocardial necrosis. There was no obvious thrombus in the coronary artery of the heart, and no infarction or amyloid deposition was observed in the myocardium. Pathological findings of hypersensitivity myocarditis, a drug-induced cardiomyopathy, appeared to agree with this case except for absence of an eosinophilic infiltration of the myocardium. A CFZ-induced CVAE is generally considered reversible. However, rapidly progressing fatal heart failure like in our case is rare. To characterize CFZ-associated CVAE, further case collection is needed.http://dx.doi.org/10.1155/2019/1816287 |
| spellingShingle | Teruhito Takakuwa Ippei Otomaru Taku Araki Akiko Miura Yotaro Fujitani Yasuhide Mochizuki Yoshimi Miyagi Hideto Senzaki Ryosuke Yamamura The First Autopsy Case of Fatal Acute Cardiac Failure after Administration of Carfilzomib in a Patient with Multiple Myeloma Case Reports in Hematology |
| title | The First Autopsy Case of Fatal Acute Cardiac Failure after Administration of Carfilzomib in a Patient with Multiple Myeloma |
| title_full | The First Autopsy Case of Fatal Acute Cardiac Failure after Administration of Carfilzomib in a Patient with Multiple Myeloma |
| title_fullStr | The First Autopsy Case of Fatal Acute Cardiac Failure after Administration of Carfilzomib in a Patient with Multiple Myeloma |
| title_full_unstemmed | The First Autopsy Case of Fatal Acute Cardiac Failure after Administration of Carfilzomib in a Patient with Multiple Myeloma |
| title_short | The First Autopsy Case of Fatal Acute Cardiac Failure after Administration of Carfilzomib in a Patient with Multiple Myeloma |
| title_sort | first autopsy case of fatal acute cardiac failure after administration of carfilzomib in a patient with multiple myeloma |
| url | http://dx.doi.org/10.1155/2019/1816287 |
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