Multiple myeloma is the
second most common type of hematologic malignancy.
Carfilzomib is a
second-generation epoxyketone proteasome inhibitor that is approved for
treatment of relapsed and refractory multiple myeloma. Phase 2 trials have
reported that 25% of treated patients have renal adverse effects. Pre-renal/vasoconstriction-related
insult from this chemotherapy agent has been documented.
Recently, even a case of tumor lysis syndrome has
been reported with this agent. According to the product labeling, the frequency
of tumor lysis syndrome (TLS) is less than 1% in patients treated with
carfilzomib. Is it possible then to prevent AKI via pre treatment with
allopurinol and or rasburicase?
Also being presented at NKF
2014 e poster and a recent
publication is the use of N-acetyl-l-cysteine to partially mitigated the
renal injury upon re-challenge in case of carfilzomib related AKI. This case
report hypothesizes that acute renal injury from carfilzomib is caused by
vasoconstriction of the renal vessels, which may be prevented by
N-acetyl-l-cysteine.
More can be learned about
the mechanism of renal injury if biopsy proven cases are published. Thus far no
biopsy proven AKI cases have been reported in the literature.
image source: www.cancer.gov
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