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Journal = Reports
Section = Haematology

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6 pages, 1055 KiB  
Case Report
Tumor Lysis Syndrome with Venetoclax/Carfilzomib/Dexamethasone for Relapsed/Refractory Multiple Myeloma: A Case Report
by Reilly Fankhauser, Alan Lu, Adetola Kassim and Eden Biltibo
Reports 2024, 7(4), 108; https://doi.org/10.3390/reports7040108 - 29 Nov 2024
Viewed by 471
Abstract
Background and Clinical Significance: Tumor lysis syndrome (TLS) is a rare occurrence in patients treated with venetoclax mono- or combination therapy, and clear protocols guiding TLS prophylaxis are lacking. Case Presentation: We present a 53-year-old male with a history of relapsed refractory multiple [...] Read more.
Background and Clinical Significance: Tumor lysis syndrome (TLS) is a rare occurrence in patients treated with venetoclax mono- or combination therapy, and clear protocols guiding TLS prophylaxis are lacking. Case Presentation: We present a 53-year-old male with a history of relapsed refractory multiple myeloma (RRMM) with t(11;14) treated with venetoclax, carfilzomib and dexamethasone (VenKd), resulting in TLS with subsequent renal failure. Repeat marrow biopsy showed no monoclonal plasma cells but extensive fibrosis. Venetoclax was reintroduced after two months with marrow recovery. Venetoclax was titrated from 200 to 400 mg daily alongside IV fluids and allopurinol without TLS recurrence. Conclusions: Here, we highlight the importance of risk stratification, dose titration, and TLS prophylaxis with venetoclax use in RRMM. Full article
(This article belongs to the Section Haematology)
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Figure 1
<p>Bone Marrow Biopsy 2 weeks after VenKd therapy: (<b>A</b>) Fibrotic, hypocellular marrow with scant islands of hematopoietic elements, predominantly erythroid precursors, and scalloping of bony trabeculae (H&amp;E, 100× magnification). (<b>B</b>) Rare residual plasma cells comprising &lt;1% of marrow cellularity, that mark as polytypic by kappa and lambda IHC (CD138 IHC, 100× magnification). (<b>C</b>) Diffuse reticulin fibrosis (Reticulin special stain, 100× magnification). (<b>D</b>) Focal coarse bundles of collagen fibers consistent with focal WHO grade MF-3 fibrosis in a background of grade MF-2 fibrosis (trichrome stain, 100× magnification).</p>
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