Evaluation of Cardiovascular Toxicity Associated with Treatments Containing Proteasome Inhibitors in Multiple Myeloma Therapy

被引：19

作者：

Iannaccone A. ^{[1
]}

Bruno G. ^{[1
]}

Ravera A. ^{[1
]}

Gay F. ^{[2
]}

Salvini M. ^{[2
]}

Bringhen S. ^{[2
]}

Sabia L. ^{[1
]}

Avenatti E. ^{[1
]}

Veglio F. ^{[1
]}

Milan A. ^{[1
]}

机构：

[1] Hypertension Unit, Division of Internal Medicine, Department of Medical Sciences, University Hospital “Città della Salute e della Scienza”, University of Torino, Turin

[2] Myeloma Unit, Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University Hospital ‘Città della Salute e della Scienza di Torino’, University of Torino, Turin

来源：

High Blood Pressure & Cardiovascular Prevention | 2018年 / 25卷 / 2期

关键词：

Cardiovascular toxicity; Carfilzomib; Global longitudinal strain; Multiple myeloma; Proteasome inhibitors;

D O I：

10.1007/s40292-018-0256-1

中图分类号：

学科分类号：

摘要：

Introduction: Recently new treatment options have substantially increased survival for patients with relapsed and/or refractory multiple myeloma (RRMM). Among these, proteasome inhibitors (PI), such as bortezomib and carfilzomib, offer high response rate and prolonged survival. These agents are generally well tolerated but demonstrated a significant cardiovascular toxicity, mostly for regimen containing carfilzomib. Aim: To assess the cardiovascular damage in patients treated with PI for RRMM. Methods: 28 consecutive subjects treated with PI for RRMM were evaluated and compared with a population of 22 control (Con) subjects, matched for age, sex and mean 24 h blood pressure (24hMBP). All individuals underwent trans-thoracic echocardiography, ambulatory blood pressure monitoring and pulse wave velocity (PVW) study. Results: PI patients did not have significant differences in blood pressure load and PWV compared to controls. Among echocardiographic parameters, the global longitudinal strain (GLS) was significantly decreased in PI subjects (p = 0.02). The GLS was significantly lower also considering only patients treated with carfilzomib. Moreover, among carfilzomib patients, we found increase values of left ventricle mass indexed by BSA (LVMi; p = 0.047). After correction for age, sex, BSA, 24hMBP and morphological and functional parameters of LV, treatment with PI and carfilzomib were significantly associated with GLS (p = 0.01; p = 0.036, respectively). Conclusions: PI treatment is associated with subclinical LV dysfunction in patients with RRMM compared to controls, as demonstrated by lower GLS values. These results are confirmed also considering patients treated with carfilzomib. Moreover, in this subgroup of patients, the LVMi is also increased, suggesting higher cardiotoxicity with this treatment. © 2018, Springer International Publishing AG, part of Springer Nature.

引用

页码：209 / 218

页数：9

共 39 条

[1]

Siegel R.L., Miller K.D., Jemal A., Cancer statistics, 2015, CA Cancer J Clin, 65, 1, pp. 5-29, (2015)

[2]

Mikhael J., Management of carfilzomib-associated cardiac adverse events, Clin Lymphoma Myeloma Leuk, (2016)

[3]

Mina R., Et al., New pharmacotherapy options for multiple myeloma, Expert Opin Pharmacother, 17, 2, pp. 181-192, (2016)

[4]

Stewart A.K., Et al., Carfilzomib, lenalidomide, and dexamethasone for relapsed multiple myeloma, N Engl J Med, 372, 2, pp. 142-152, (2015)

[5]

Dimopoulos M.A., Et al., Carfilzomib and dexamethasone versus bortezomib and dexamethasone for patients with relapsed or refractory multiple myeloma (ENDEAVOR): a randomised, phase 3, open-label, multicentre study, Lancet Oncol, 17, 1, pp. 27-38, (2016)

[6]

Cornell R.F., Kassim A.A., Evolving paradigms in the treatment of relapsed/refractory multiple myeloma: increased options and increased complexity, Bone Marrow Transplant, 51, 4, pp. 479-491, (2016)

[7]

Rajkumar S.V., Et al., Consensus recommendations for the uniform reporting of clinical trials: report of the International Myeloma Workshop Consensus Panel 1, Blood, 117, 18, pp. 4691-4695, (2011)

[8]

Du Bois D., Du Bois E.F., A formula to estimate the approximate surface area if height and weight be known 1916, Nutrition, 5, 5, pp. 303-311, (1989)

[9]

Nagueh S.F., Et al., Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging, J Am Soc Echocardiogr, 29, 4, pp. 277-314, (2016)

[10]

Lang R.M., Et al., Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging, Eur Heart J Cardiovasc Imaging, 16, 3, pp. 233-271, (2015)

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