Abstract:
:Multiple myeloma is the second most common type of hematologic malignancy. It is a B-cell malignancy that affects the bone marrow and often results in thrombocytopenia as well as renal dysfunction. Treatment options range from oral and intravenous chemotherapy to bone marrow transplantation and supportive care. Carfilzomib was approved by the U.S. Food and Drug Administration in 2012 as a treatment option for patients with refractory multiple myeloma who have received at least two previous therapies and have demonstrated recent disease progression. According to the product labeling, the frequency of tumor lysis syndrome (TLS) is less than 1% in patients treated with carfilzomib. To our knowledge, no postmarketing events of TLS have been reported or published. We describe a 55-year-old man with relapsed multiple myeloma who developed a case of TLS that occurred after he received his first two doses of carfilzomib therapy on days 1 and 2; he also had chronic kidney disease secondary to his neoplastic disease. Beginning on day 4, his uric acid levels spiked to critical levels, prompting the use of rasburicase, which returned the levels to within normal limits. His phosphorus and creatinine levels increased during days 5 and 6. On day 8, the patient died, likely due to a combination of disease progression and the adverse effects of treatment. Use of the Naranjo adverse drug reaction probability scale indicated a probable relationship (score of 6) between the patient's development of TLS and carfilzomib therapy. The Hill criteria were used as a secondary measure to ensure causality, which also suggested a link between the patient's development of TLS and the administration of carfilzomib. This case report shows that even the most unlikely of adverse events may occur with medications, especially in the case of a new or recently approved medication. Caution must be taken when deciding to treat and when choosing hydration and premedications with regard to biologic and chemotherapeutic medications. In this case, additional hydration may have been considered. Although given the extent of the adverse reaction combined with the patient's underlying renal dysfunction, extra fluid may or may not have proven beneficial. The use of prophylactic rasburicase or allopurinol could have been considered, but these measures are not typically used with multiple myeloma due to the low incidence of TLS. All things considered, this unlikely adverse reaction may occur in certain patients. If other cases such as this occur, it may be advisable to use TLS prophylaxis in the future in certain patient populations, including those with renal dysfunction or worsening disease states.
journal_name
Pharmacotherapyjournal_title
Pharmacotherapyauthors
Shely RN,Ratliff PDdoi
10.1002/phar.1397subject
Has Abstractpub_date
2014-05-01 00:00:00pages
e34-7issue
5eissn
0277-0008issn
1875-9114journal_volume
34pub_type
杂志文章相关文献
PHARMACOTHERAPY文献大全abstract::Diabetes mellitus has reached epidemic proportions worldwide, eliciting extensive research on both the disease process and its treatment. Regardless of diabetes type, the progressive nature of the disease makes insulin the long-term mainstay of diabetes management. Recently, the insulin analog glargine was reported in...
journal_title:Pharmacotherapy
pub_type: 杂志文章,实务指引
doi:10.1592/phco.30.9.955
更新日期:2010-09-01 00:00:00
abstract::Disseminated herpes simplex virus (HSV) infection in neonates represents a devastating entity that yields high mortality. Acyclovir is the primary antiviral agent used to treat life-threatening HSV infections in neonates; however, even though the agent has reduced morbidity overall from these infections, mortality wit...
journal_title:Pharmacotherapy
pub_type: 杂志文章
doi:10.1002/phar.1526
更新日期:2015-02-01 00:00:00
abstract:STUDY OBJECTIVE:To contrast the characteristics of two groups of anabolic-androgenic steroid (AAS) users-those with versus those without AAS dependence. DESIGN:Subanalysis of data from the Anabolic 500, a cross-sectional survey. PARTICIPANTS:One hundred twelve male AAS-dependent users and 367 AAS-nondependent users w...
journal_title:Pharmacotherapy
pub_type: 杂志文章
doi:10.1002/j.1875-9114.2012.01123
更新日期:2012-10-01 00:00:00
abstract:OBJECTIVE:To compare the effectiveness of an evidence-based, systematic approach to hypertension care involving comanagement of patients by primary care physicians and clinical pharmacists versus usual care in reducing blood pressure in patients with uncontrolled hypertension. METHODS:Patients in a staff model medical...
journal_title:Pharmacotherapy
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1592/phco.23.2.209.32096
更新日期:2003-02-01 00:00:00
abstract::Albuterol is a 50:50 mixture of R-albuterol, the active enantiomer, and S-albuterol, which appears to be inactive in humans. The Food and Drug Administration recently approved levalbuterol, the pure R-isomer, as a preservative-free nebulizer solution. Published studies indicate that it is neither safer nor more effect...
journal_title:Pharmacotherapy
pub_type: 杂志文章,评审
doi:10.1592/phco.20.3.123.34776
更新日期:2000-02-01 00:00:00
abstract:STUDY OBJECTIVES:To examine potential threats to internal and external study validity caused by differential patient withdrawal from a randomized controlled trial evaluating pharmacist management of hypertension, to compare the characteristics of patients who withdrew with those of patients who completed the study, and...
journal_title:Pharmacotherapy
pub_type: 杂志文章,随机对照试验
doi:10.1592/phco.26.11.1565
更新日期:2006-11-01 00:00:00
abstract::During the past decade, the incidence and severity of Clostridium difficile infection (CDI) have significantly increased, leading to a rise in CDI-associated hospitalizations, health care costs, and mortality. Although treatment options exist for CDI, recurrence is frequent following treatment. Furthermore, patients w...
journal_title:Pharmacotherapy
pub_type: 杂志文章,评审
doi:10.1002/phar.1990
更新日期:2017-10-01 00:00:00
abstract::Cefepime is a new extended-spectrum cephalosporin with gram-positive and gram-negative coverage including Staphylococcus aureus and Pseudomonas aeruginosa. We evaluated the drug's plasma, peritoneal fluid, and appendix tissue concentrations in patients with a postoperative diagnosis of perforated or gangrenous appendi...
journal_title:Pharmacotherapy
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1991-01-01 00:00:00
abstract:STUDY OBJECTIVE:A safe alternative to erythropoiesis-stimulating agents to treat anemia is warranted in patients with cancer and anemia; thus the objective of this trial was to compare the efficacy and safety of intravenous (IV) iron isomaltoside with oral iron in patients with cancer and anemia by testing the noninfer...
journal_title:Pharmacotherapy
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1002/phar.1729
更新日期:2016-04-01 00:00:00
abstract::A retrospective study evaluated the success of dosages of simvastatin lower than the 10-20 mg/day recommended by the manufacturer in patients with hypercholesterolemia. Records of 95 patients enrolled in a pharmacist-managed lipid clinic receiving stable dosages of simvastatin were reviewed. Data collected were demogr...
journal_title:Pharmacotherapy
pub_type: 临床试验,杂志文章
doi:10.1592/phco.19.6.399.31045
更新日期:1999-04-01 00:00:00
abstract::The newer quinolone antibiotics, including levofloxacin, moxifloxacin, and gatifloxacin, offer coverage of the likely pathogens in community-acquired pneumonia (CAP) and have been shown to be safe and effective treatments for CAP. Two of these agents, levofloxacin and gatifloxacin, have pharmacokinetic and antibacteri...
journal_title:Pharmacotherapy
pub_type: 杂志文章,评审
doi:10.1592/phco.21.10.100s.34534
更新日期:2001-07-01 00:00:00
abstract::The pharmacokinetic disposition of numerous antimicrobial agents is altered in critically ill patients. Pharmacokinetics of trovafloxacin, a fluoroquinolone indicated specifically for severe, life-threatening infections in the intensive care unit, have not been well studied in this population. We characterized the pha...
journal_title:Pharmacotherapy
pub_type: 临床试验,杂志文章,多中心研究
doi:10.1592/phco.20.5.400.35056
更新日期:2000-04-01 00:00:00
abstract::Cabozantinib is an oral small-molecule multitargeted tyrosine kinase inhibitor (TKI) that may confer an advantage over other TKIs that target a single receptor. It was approved by the U.S. Food and Drug Administration for the treatment of both advanced renal cell carcinoma and progressive metastatic medullary thyroid ...
journal_title:Pharmacotherapy
pub_type: 杂志文章,评审
doi:10.1002/phar.2076
更新日期:2018-03-01 00:00:00
abstract:STUDY OBJECTIVES:To determine the incidence of hepatotoxicity in critically ill patients who were treated with voriconazole and to identify potential risk factors for voriconazole-associated hepatotoxicity in these patients. DESIGN:Single-center prospective observational study. SETTING:Intensive care unit (ICU) in a ...
journal_title:Pharmacotherapy
pub_type: 杂志文章
doi:10.1002/phar.1779
更新日期:2016-07-01 00:00:00
abstract::A 58-year-old man went to his physician with complaints of midepigastric pain, flatulence, belching, and shortness of breath. During a physical examination, the patient was in no acute distress. The patient underwent an ultrasound examination, which revealed cholelithiasis, a laparoscopic cholecystectomy, which reveal...
journal_title:Pharmacotherapy
pub_type: 杂志文章
doi:10.1592/phco.27.2.299
更新日期:2007-02-01 00:00:00
abstract::Target drug programs and medication use evaluations are activities that are undertaken to improve the correct use of drugs. These programs should focus on inappropriate drug use, drug use problems, optimizing use of drugs, and improving the level of patient care. To monitor the effects of the programs, several types o...
journal_title:Pharmacotherapy
pub_type: 杂志文章
doi:10.1592/phco.20.16.322s.35014
更新日期:2000-10-01 00:00:00
abstract::Atorvastatin calcium is an HMG-coenzyme A (CoA) reductase inhibitor that was approved by the Food and Drug Administration on December 17, 1996. Like other such agents, it inhibits the action of HMG-CoA reductase and thereby decreases endogenous cholesterol synthesis, leading to a decrease in circulating low-density li...
journal_title:Pharmacotherapy
pub_type: 杂志文章,评审
doi:
更新日期:1997-11-01 00:00:00
abstract::Agitation in the elderly, manifested by verbal and physical aggression, frequently results in increased morbidity and mortality for nursing home residents and reduced morale for the family and nursing home staff. It is also responsible for increased costs associated with caring for these residents. Pharmacologic inter...
journal_title:Pharmacotherapy
pub_type: 杂志文章,评审
doi:
更新日期:1998-05-01 00:00:00
abstract::The primary objective of this study was to determine if a pharmacist-managed anticoagulation monitoring service (AMS) improved the outcomes of patients receiving warfarin in a family practice setting and was cost effective in treating and preventing thromboembolic disorders. A retrospective chart review was performed ...
journal_title:Pharmacotherapy
pub_type: 杂志文章
doi:
更新日期:1995-11-01 00:00:00
abstract::Colistin, the most widely used polymyxin antibiotic, was originally introduced in the late 1950s before the establishment of the present-day drug approval process. Originally shelved due to toxicity concerns, colistin, in the form of its inactive prodrug colistin methanesulfonate, has undergone a renaissance in the pa...
journal_title:Pharmacotherapy
pub_type: 杂志文章,评审
doi:10.1002/phar.1484
更新日期:2015-01-01 00:00:00
abstract:STUDY OBJECTIVE:To evaluate the toxicity of amphotericin B deoxycholate formulations. DESIGN:In vitro experiment. SETTING:University research center. MATERIAL:Human mononuclear THP-1 cells. INTERVENTION:The human mononuclear cells were exposed in vitro for 2 hours to the following deoxycholate formulations of ampho...
journal_title:Pharmacotherapy
pub_type: 杂志文章
doi:10.1592/phco.23.5.572.32209
更新日期:2003-05-01 00:00:00
abstract::Prostaglandins have been shown to relax the smooth muscle of the ductus arteriosus in the fetus in utero. This physiologic action has been applied to the management of newborn infants with certain types of congenital malformations. Infants with lesions producing right ventricular outflow obstruction have a compromised...
journal_title:Pharmacotherapy
pub_type: 杂志文章,评审
doi:10.1002/j.1875-9114.1982.tb04522.x
更新日期:1982-05-01 00:00:00
abstract:STUDY OBJECTIVES:To develop and validate an improved unfractionated heparin (UFH) dosage protocol, using antifactor Xa levels as the outcome variable. DESIGN:Prospective case series. SETTING:A 625-bed, adults-only private, tertiary care teaching hospital. PATIENTS:Three hundred seventy-two patients receiving UFH for...
journal_title:Pharmacotherapy
pub_type: 杂志文章
doi:10.1592/phco.24.8.713.36067
更新日期:2004-06-01 00:00:00
abstract::Peripheral blood has replaced bone marrow as a source of hematopoietic stem cells for autologous rescue after high-dose chemotherapy. Patients who receive peripheral blood stem cell (PBSC) transplants experience rapid and sustained hematopoietic reconstitution. As a result, transplant-related mortality is now less tha...
journal_title:Pharmacotherapy
pub_type: 杂志文章
doi:
更新日期:1996-05-01 00:00:00
abstract:STUDY OBJECTIVE:To assess the influence of withholding continuous enteral nutrition for 1 hour before and after warfarin administration compared with the coadministration of warfarin with continuous enteral nutrition on changes in international normalized ratios (INRs). DESIGN:Retrospective, crossover case series. SE...
journal_title:Pharmacotherapy
pub_type: 杂志文章
doi:10.1592/phco.28.3.308
更新日期:2008-03-01 00:00:00
abstract::A 76-year-old man developed akinetic mutism after 3 days of receiving low-dosage baclofen. Electroencephalography showed a diffusely slow background with intermittent generalized sharp wave discharges. The condition resolved after discontinuing baclofen. To our knowledge, this is the first reported case of baclofen-in...
journal_title:Pharmacotherapy
pub_type: 杂志文章
doi:10.1592/phco.19.6.468.31053
更新日期:1999-04-01 00:00:00
abstract::Patients undergoing cardiopulmonary bypass may develop clinically significant physiologic alterations in the perioperative period, including alteration of thyroid hormone concentrations. Alterations in the concentration of thyroid hormones are of concern due to the effects of these hormones on cardiac function. Hypoth...
journal_title:Pharmacotherapy
pub_type: 杂志文章,评审
doi:10.1592/phco.21.17.1368.34425
更新日期:2001-11-01 00:00:00
abstract::Data obtained from 23 critically ill patients treated with intravenous ciprofloxacin in two clinical trials were used to validate prospectively a previously developed maximum a posteriori (MAP)-Bayesian estimator and optimal plasma-sampling strategy (OSS). Dosages ranged from 200 mg every 12 hours to 400 mg every 8 ho...
journal_title:Pharmacotherapy
pub_type: 临床试验,杂志文章
doi:
更新日期:1996-09-01 00:00:00
abstract::Recent evidence suggests that periodontal disease may predispose to atherosclerotic cardiovascular disease. Data support mechanisms of host-derived local and systemic proinflammatory responses similar to atherosclerosis, consisting of monocytic-derived cytokines and other inflammatory mediators, which are induced by p...
journal_title:Pharmacotherapy
pub_type: 杂志文章,评审
doi:10.1592/phco.20.9.805.35189
更新日期:2000-07-01 00:00:00
abstract::We reviewed the spectrum of activity, pharmacokinetics, clinical efficacy, adverse effects, and relative advantages of piperacillin-tazobactam, a new beta-lactam-beta-lactamase inhibitor. Piperacillin-tazobactam has a wide spectrum of activity that includes gram-positive organisms such as staphylococci and streptococc...
journal_title:Pharmacotherapy
pub_type: 杂志文章
doi:
更新日期:1996-03-01 00:00:00