Objective:

To evaluate the incidence and characteristics of microangiopathic haemolytic anaemia (MAHA) associated with carfilzomib treatment in patients with multiple myeloma, specifically focusing on those who have undergone at least two cycles of treatment.

Key Findings:

• 11 out of 31 patients (35.5%) met criteria for MAHA during treatment, indicating a significant incidence of this complication.
• Two patients (6.5%) developed severe TMA, highlighting the potential severity of carfilzomib-related complications.
• Episodes of low-grade MAHA were brief and transient, with some associated acute kidney injury (AKI), suggesting a need for careful monitoring.
• Median overall survival was similar in affected and unaffected groups (21 months), indicating that MAHA may not significantly impact survival in this cohort.

Interpretation:

Carfilzomib can induce a spectrum of thrombotic microangiopathy, from low-grade MAHA to severe TMA, with significant implications for patient management and monitoring, necessitating vigilance in clinical practice.

Limitations:

• Retrospective nature of the study may introduce bias, potentially affecting the reliability of the findings.
• Small sample size limits generalizability of findings, suggesting the need for larger studies to confirm results.
• Exclusion of patients with incomplete records may affect results, as it could lead to an underestimation of the incidence of MAHA.

Conclusion:

Carfilzomib-induced TMA is an under-recognized complication that warrants careful monitoring for early detection and management.