A 47-year-old woman developed a rare complication after taking the drug for 11 months, and the doctor saved her life 

Wang is confused recently. His aunt was diagnosed with multiple myeloma last year and is currently receiving treatment with carfilzomib. He has heard that this drug may cause thrombotic microangiopathy, which worries him. Let’s talk about this topic today.

A warning from a real case

In the spring of 2019, 47-year-old Ms. Li sought medical attention for persistent back pain and paresthesia in her lower limbs. Examination revealed a thoracic spine tumor, and after surgery she was diagnosed with multiple myeloma. After several adjustments to the treatment plan, she began treatment with carfilzomib in July 2022.

Everything went well at the beginning of the treatment, and the condition was well controlled. But in May 2023, nearly a year after taking carfilzomib, Ms. Li suddenly developed symptoms such as fatigue, dizziness, drowsiness, ecchymosis, oliguria and jaundice, and was urgently hospitalized for treatment.

After a detailed examination, the doctor found that this was a rare but serious complication – thrombotic microangiopathy (TMA).

What is Thrombotic Microangiopathy?

Thrombotic microangiopathy is a group of diseases characterized by microvascular thrombosis, mainly manifested by:

To put it simply, hemolytic anemia , thrombocytopenia and impaired organ function means that many tiny blood clots are formed in the blood vessels, causing red blood cells to break and platelet consumption, which in turn affects the blood supply to various organs.

Why does carfilzomib cause this complication?

Carfilzomib is a proteasome inhibitor that kills myeloma cells by blocking the protein degradation system within cancer cells. However, studies have found that it may:

Direct damage to vascular endothelial cells leads to excessive activation of the complement system , triggering the coagulation cascade reaction . These factors work together to ultimately lead to microvascular thrombosis.

It is worth noting that this complication usually occurs in the early stages of medication. It is rare for a situation like Ms. Li’s to occur after nearly a year of use.

How to detect and treat it in time?

The key is to be alert for the following symptoms:

If you experience sudden fatigue, dizziness, skin bruises , decreased urine output, jaundice , or changes in consciousness , seek medical attention immediately. Timely detection and treatment are crucial.

The lesson that Ms. Li’s example brings to our mind is:

Carfilzomib was immediately discontinued and plasma exchange treatment was promptly initiated, and various indicators were closely monitored. After 18 plasma exchange treatments, Ms. Li’s symptoms were completely relieved.

Expert advice

During medication, it is necessary to regularly monitor blood routine, renal function and other indicators. If any abnormality is found, seek medical attention in time, and do not be afraid to seek medical treatment . Doctors should be vigilant and pay special attention to the possible late complications of patients taking long-term medication. Develop individualized treatment plans, weigh the pros and cons, and give advice to patients and their families.

Maintain an optimistic and positive attitude, cooperate with treatment and keep good medication records, have regular checkups to understand possible complications, and promptly communicate with doctors about changes in physical condition . Although carfilzomib is an important drug for the treatment of multiple myeloma, it does carry the risk of thrombotic microangiopathy. The key is:

Both doctors and patients should be vigilant and have regular check-ups, detect symptoms early, seek medical attention promptly, and develop individualized treatment plans. With this understanding, I believe we can better cope with the challenges that may arise during the treatment process.

Back to Xiao Wang’s confusion at the beginning: After learning this information, it is recommended that he accompany his aunt:

Check up on time, record physical changes and maintain good communication with your doctor. This will not only help detect problems in a timely manner, but also make treatment safer and more effective.

After all, in the fight against disease, only by knowing both yourself and your enemy can you win every battle.