{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T10:19:32Z","timestamp":1782555572757,"version":"3.54.5"},"reference-count":46,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2024,12,20]],"date-time":"2024-12-20T00:00:00Z","timestamp":1734652800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ministry of Innovation and Technology of Hungary from the National Research, Development and Innovation Fund","award":["TKP2021-NKTA-47"],"award-info":[{"award-number":["TKP2021-NKTA-47"]}]},{"name":"Ministry of Innovation and Technology of Hungary from the National Research, Development and Innovation Fund","award":["RRF-2.3.1-21-2022-00003"],"award-info":[{"award-number":["RRF-2.3.1-21-2022-00003"]}]},{"name":"Ministry of Innovation and Technology of Hungary from the National Research, Development and Innovation Fund","award":["EK\u00d6P-2024-9"],"award-info":[{"award-number":["EK\u00d6P-2024-9"]}]},{"name":"National Cardiovascular Laboratory Program","award":["TKP2021-NKTA-47"],"award-info":[{"award-number":["TKP2021-NKTA-47"]}]},{"name":"National Cardiovascular Laboratory Program","award":["RRF-2.3.1-21-2022-00003"],"award-info":[{"award-number":["RRF-2.3.1-21-2022-00003"]}]},{"name":"National Cardiovascular Laboratory Program","award":["EK\u00d6P-2024-9"],"award-info":[{"award-number":["EK\u00d6P-2024-9"]}]},{"name":"New National Excellence Program of the Ministry for Culture and Innovation","award":["TKP2021-NKTA-47"],"award-info":[{"award-number":["TKP2021-NKTA-47"]}]},{"name":"New National Excellence Program of the Ministry for Culture and Innovation","award":["RRF-2.3.1-21-2022-00003"],"award-info":[{"award-number":["RRF-2.3.1-21-2022-00003"]}]},{"name":"New National Excellence Program of the Ministry for Culture and Innovation","award":["EK\u00d6P-2024-9"],"award-info":[{"award-number":["EK\u00d6P-2024-9"]}]},{"name":"B + N Referencia Zrt","award":["TKP2021-NKTA-47"],"award-info":[{"award-number":["TKP2021-NKTA-47"]}]},{"name":"B + N Referencia Zrt","award":["RRF-2.3.1-21-2022-00003"],"award-info":[{"award-number":["RRF-2.3.1-21-2022-00003"]}]},{"name":"B + N Referencia Zrt","award":["EK\u00d6P-2024-9"],"award-info":[{"award-number":["EK\u00d6P-2024-9"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmaceuticals"],"abstract":"<jats:p>Background: Thrombotic microangiopathy (TMA) is a potentially life-threatening complication associated with carfilzomib, a proteasome inhibitor approved for treating multiple myeloma. TMA typically presents within the initial months of treatment; however, delayed onset is rare and poses significant diagnostic challenges. Methods: We conducted a retrospective analysis of the medical records of a 47-year-old Caucasian woman diagnosed with IgA kappa myeloma who developed signs and symptoms consistent with TMA eleven months after the initiation of carfilzomib therapy and already in ongoing very good partial remission. Results: The clinical presentation included an acute onset of weakness, dizziness, somnolence, diffuse bruising, oliguria, jaundice, severe thrombocytopenia, and acute kidney injury. An immediate workup raised a strong suspicion for TMA, confirmed by laboratory findings of schistocytosis and complement activation. Following the immediate discontinuation of carfilzomib, the patient underwent 18 plasmapheresis (PEX) sessions and received supportive fresh frozen plasma transfusions, which resulted in the complete remission of TMA symptoms without the need for complement inhibitory therapy. Conclusions: The need for ongoing monitoring for TMA throughout carfilzomib therapy, regardless of treatment duration, is emphasized. Early diagnosis and intervention, including drug discontinuation and the timely initiation of PEX, are crucial for patient recovery.<\/jats:p>","DOI":"10.3390\/ph17121722","type":"journal-article","created":{"date-parts":[[2024,12,20]],"date-time":"2024-12-20T04:07:40Z","timestamp":1734667660000},"page":"1722","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Delayed Onset of Thrombotic Microangiopathy (TMA) upon Prolonged Carfilzomib Therapy in Multiple Myeloma: A Case Report and Comprehensive Review"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4285-7518","authenticated-orcid":false,"given":"Andrea","family":"Cegl\u00e9di","sequence":"first","affiliation":[{"name":"Department of Hematology and Stem Cell Transplantation, South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, 1097 Budapest, Hungary"},{"name":"Health Sciences Program, Doctoral College, Semmelweis University, 1085 Budapest, Hungary"},{"name":"Institute of Preventive Medicine and Public Health, Semmelweis University, 1085 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00c1gnes","family":"Kir\u00e1ly","sequence":"additional","affiliation":[{"name":"Department of Hematology and Stem Cell Transplantation, South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, 1097 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"V\u00e1rkonyi","sequence":"additional","affiliation":[{"name":"Department of Hematology and Stem Cell Transplantation, South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, 1097 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6736-3493","authenticated-orcid":false,"given":"Szabolcs","family":"Tasn\u00e1dy","sequence":"additional","affiliation":[{"name":"Department of Hematology and Stem Cell Transplantation, South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, 1097 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hajnalka","family":"Andrikovics","sequence":"additional","affiliation":[{"name":"Institute of Preventive Medicine and Public Health, Semmelweis University, 1085 Budapest, Hungary"},{"name":"Laboratory of Molecular Genetics, Central Hospital of Southern Pest, National Institute of Hematology and Infectious Diseases, 1097 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8632-2120","authenticated-orcid":false,"given":"M\u00f3nika","family":"Fekete","sequence":"additional","affiliation":[{"name":"Institute of Preventive Medicine and Public Health, Semmelweis University, 1085 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B\u00e1lint G.","family":"Szab\u00f3","sequence":"additional","affiliation":[{"name":"Department of Hematology and Stem Cell Transplantation, South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, 1097 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zsuzsanna","family":"Szemlaky","sequence":"additional","affiliation":[{"name":"Department of Hematology and Stem Cell Transplantation, South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, 1097 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00c1gnes","family":"Szil\u00e1gyi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Hematology, F\u00fcst Gy\u00f6rgy Complement Diagnostic Laboratory, Semmelweis University, 1088 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5355-7318","authenticated-orcid":false,"given":"Gy\u00f6rgy","family":"Sinkovits","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Hematology, F\u00fcst Gy\u00f6rgy Complement Diagnostic Laboratory, Semmelweis University, 1088 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zolt\u00e1n","family":"Proh\u00e1szka","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Hematology, F\u00fcst Gy\u00f6rgy Complement Diagnostic Laboratory, Semmelweis University, 1088 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4682-5628","authenticated-orcid":false,"given":"Marienn","family":"R\u00e9ti","sequence":"additional","affiliation":[{"name":"Department of Hematology and Stem Cell Transplantation, South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, 1097 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2204-7398","authenticated-orcid":false,"given":"G\u00e1bor","family":"Mikala","sequence":"additional","affiliation":[{"name":"Department of Hematology and Stem Cell Transplantation, South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, 1097 Budapest, Hungary"},{"name":"Health Sciences Program, Doctoral College, Semmelweis University, 1085 Budapest, 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