Bortezomib therapy-related lung disease in a patient with light chain amyloidosis: A case report

Abstract

Bortezomib was the first antineoplastic proteasome inhibitor and is currently indicated for the treatment of hematologic malignancies including multiple myeloma and mantle cell lymphoma. This report describes a 57-year-old patient with light chain (primary) amyloidosis receiving weekly subcutaneous bortezomib injections who presented with recurrent hypoxemia and interstitial pneumonitis. Following the failure of conventional therapy, the patient responded rapidly to high-dose intravenous methylprednisolone. Oxygen therapy was able to be weaned off within three days and he was able to be discharged to home in stable condition, with follow-up computed tomography showing improving lung lesions. Bortezomib is known to rarely cause acute lung injury, but this complication has not been previously described in the setting of amyloidosis. Clinicians should be aware of potentially severe pulmonary adverse effects in all patients treated with bortezomib.

Keywords

Bortezomib pulmonary amyloidosis corticosteroids

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References

Dahlman

. Role of proteosomes in disease. BMC Biochem 2007; 8: S1–S3.

Roccaro

Vacca

Ribatti

. Bortezomib in the treatment of cancer. Recent Patent Antican Drug Discov 2006; 1: 397–403.

Utecht

Kolesar

. Bortezomib: A novel chemotherapeutic agent for hematologic malignancies. Am J Health Syst Pharm 2008; 65: 1221–1231.

Jagannath

Barlogie

Berenson

et al.

A phase 2 study of two doses of bortezomib in relapsed or refractory myeloma. Br J Haematol 2004; 127: 165–172.

Richardson

Sonneveld

Schuster

et al.

Bortezomib or high-dose dexamethasone for relapsed multiple myeloma. N Engl J Med 2005; 352: 2487–2498.

Fisher

Bernstein

Kahl

et al.

Multicenter phase II study of bortezomib in patients with relapsed or refractory mantle cell lymphoma. J Clin Oncol 2006; 24: 4867–4874.

Gotoh

Ohyashiki

Oshimi

et al.

Lung injury associated with bortezomib therapy in relapsed/refractory multiple myeloma in Japan: a questionnaire-based report from the “lung injury by bortezomib” joint committee of the Japanese society of hematology and the Japanese society of clinical hematology. Int J Hematol 2006; 84: 406–412.

Yoshizawa

Mukai

Miyazawa

et al.

Bortezomib therapy-related lung disease in Japanese patients with multiple myeloma: incidence, mortality and clinical characterization. Cancer Sci 2014; 105: 195–201.

Min

Lee

Kim

et al.

Cutaneous leucoclastic vasculitis (LV) following bortezomib treatment for multiple myeloma: association with pro-inflammatory cytokines. Eur J Haematol 2006; 76: 265–268.

10.

Weiss

Budinger

Mutlu

et al.

Proteasomal regulation of pulmonary fibrosis. Proc Am Thorac Soc 2010; 7: 77–83.

11.

Chacey

Exline

. Pulmonary toxicity from bortezomib successfully treated with steroids in a patient with acute myelogenous leukemia. Am J Respir Crit Care Med 2012; 185: A5422–A5422.

12.

Zappasodi

Dore

Castagnola

et al.

Rapid response to high-dose steroids of severe bortezomib-related pulmonary complication in multiple myeloma. J Clin Oncol 2007; 25: 3380–3386.

13.

Miyakoshi

Kami

Yuji

et al.

Severe pulmonary complications in Japanese patients after bortezomib treatment for refractory multiple myeloma. Blood 2006; 107: 3492–3494.

14.

Wirk

. Bortezomib-related diffuse alveolar hemorrhage. J Clin Oncol 2012; 30: 379–381.

15.

Vandeix

Favard

Pichon

et al.

Bortezomib-induced bronchiolitis obliterans organizing pneumonia. Case Rep Pulmonol 2012; 2012: 430141–430141.

16.

Yamaguchi

Sasaki

Itoh

. Bortezomib-induced pneumonitis during bortezomib retreatment in multiple myeloma. Jpn J Clin Oncol 2012; 42: 637–639.

17.

Duek

Feldberg

Haran

et al.

Pulmonary fibrosis in a myeloma patient on bortezomib treatment. A new severe adverse effect of a new drug. Am J Hematol 2007; 82: 502–503.

18.

Pitini

Arrigo

Altavilla

et al.

Severe pulmonary complications after bortezomib treatment for multiple myeloma: an unrecognized pulmonary vasculitis?

Leuk Res 2007; 31: 1027–1028.

19.

Mukai

Ohyashiki

Katoh

et al.

Lung injury associated with bortezomib therapy in Japan. Rinsho Ketsueki 2011; 52: 1859–1869.

20.

Zhou

Sun

Wang

et al.

Rapid fatal pulmonary complications in a Chinese patient after bortezomib treatment for ALK-negative anaplastic large-cell lymphoma. Clin Lymphoma Myeloma Leuk 2010; 10: 152–154.

21.

Dun

Yuan

et al.

Severe pulmonary complications after bortezomib treatment in multiple myeloma. Hematol Oncol 2010; 28: 49–52.

22.

Chew

Filshie

Wei

. Development of fatal bortezomib induced acute lung injury despite concurrent therapy with high-dose dexamethasone. Leuk Lymphoma 2007; 48: 212–213.

23.

Ohri

Arena

. Severe pulmonary complications in African-American patient after bortezomib therapy. Am J Ther 2006; 13: 553–555.

24.

Naranjo

Busto

Sellers

et al.

A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 1981; 30: 239–245.