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Background <p>Multiple myeloma (MM) is a prevalent hematological malignancy, with proteasome inhibitors (PIs) playing a crucial role in its therapeutic management. Although PIs are generally well-tolerated and associated with relatively mild side effects, recent evidence has increasingly drawn attention to proteasome inhibitor-related thrombotic microangiopathy (PI-related TMA). </p> Case presentation <p>Here, we report two cases with high clinical suspicion for PI-related TMA, highlighting the diagnostic process and subsequent management strategies. Clinical suspicion of PI-related TMA prompted the discontinuation of the offending agent and consideration of plasma exchange therapy, which proved beneficial in selected patients. These case reports further facilitate a detailed discussion regarding the underlying pathogenic mechanisms and potential therapeutic approaches for PI-related TMA in MM.</p> Conclusion <p>PI-related TMA is a rare but life-threatening complication in MM. Early recognition and prompt discontinuation of the offending drug are critical. Plasma exchange and eculizumab may be considered in selected cases.</p>

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Two cases of proteasome inhibitors related thrombotic microangiopathies and literature review

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月23日

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  • Na An,
  • Pengfei Shi,
  • Can Chen

摘要

Background

Multiple myeloma (MM) is a prevalent hematological malignancy, with proteasome inhibitors (PIs) playing a crucial role in its therapeutic management. Although PIs are generally well-tolerated and associated with relatively mild side effects, recent evidence has increasingly drawn attention to proteasome inhibitor-related thrombotic microangiopathy (PI-related TMA).

Case presentation

Here, we report two cases with high clinical suspicion for PI-related TMA, highlighting the diagnostic process and subsequent management strategies. Clinical suspicion of PI-related TMA prompted the discontinuation of the offending agent and consideration of plasma exchange therapy, which proved beneficial in selected patients. These case reports further facilitate a detailed discussion regarding the underlying pathogenic mechanisms and potential therapeutic approaches for PI-related TMA in MM.

Conclusion

PI-related TMA is a rare but life-threatening complication in MM. Early recognition and prompt discontinuation of the offending drug are critical. Plasma exchange and eculizumab may be considered in selected cases.