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Initially treated with daratumumab\u2013bortezomib\u2013lenalidomide\u2013dexamethasone (Dara-VRD) then transitioned to lenalidomide maintenance. However, he experienced a relapse and was treated with carfilzomib-based therapy (CFZ) but developed drug-induced thrombotic microangiopathy (DI-TMA). Despite receiving eculizumab and supportive care, the patient's condition worsened, leading to encephalopathy and refractory gastrointestinal bleeding in the setting of persistent thrombocytopenia. Ultimately, the decision was made to transition to comfort-focused care. DI-TMA has been documented with various proteasome inhibitors such as ixazomib and bortezomib. Additionally, other medications such as cyclosporine, tacrolimus, clopidogrel, ticlopidine, and interferon have been associated with DI-TMA as well (Pisoni et al. (Drug Saf 24:491\u2013501, 2001) [18]). Here we discuss a case of carfilzomib-induced TMA (CFZ-TMA) refractory to eculizumab as well as a review of the published literature.<\/jats:p>","DOI":"10.1007\/s00277-024-05965-9","type":"journal-article","created":{"date-parts":[[2024,8,27]],"date-time":"2024-08-27T22:02:06Z","timestamp":1724796126000},"page":"4313-4317","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Carfilzomib-induced thrombotic microangiopathy (TMA) refractory to eculizumab: A case report and literature review"],"prefix":"10.1007","volume":"103","author":[{"given":"Mina","family":"Meseha","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dan","family":"Qu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jill","family":"Lykon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Coffey","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,8,27]]},"reference":[{"key":"5965_CR1","doi-asserted-by":"crossref","unstructured":"Moscvin M, Liacos CI, Chen T, et al (2023) Mutations in the alternative complement pathway in multiple myeloma patients with carfilzomib-induced thrombotic microangiopathy. 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Thromb Res 224:73\u201379","journal-title":"Thromb Res"},{"key":"5965_CR6","doi-asserted-by":"crossref","unstructured":"Pallotti F, Queffeulou C, Bellal M, Jean-Jacques B, Gac AC, Chatelet V, Boyer A, Gueutin V (2022) Carfilzomib-Induced Thrombotic Microangiopathy Treated with Eculizumab: A Case Report and Rapid Literature Review. Kidney and Dialysis 2022, Vol 2, Pages 625\u2013637 2:625\u2013637","DOI":"10.3390\/kidneydial2040056"},{"key":"5965_CR7","doi-asserted-by":"publisher","first-page":"953","DOI":"10.1016\/S1470-2045(18)30354-1","volume":"19","author":"P Moreau","year":"2018","unstructured":"Moreau P, Mateos MV, Berenson JR, Weisel K, Lazzaro A, Song K, Dimopoulos MA, Huang M, Zahlten-Kumeli A, Stewart AK (2018) Once weekly versus twice weekly carfilzomib dosing in patients with relapsed and refractory multiple myeloma (A.R.R.O.W.): interim analysis results of a randomised, phase 3 study. 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