Managing Cardiovascular Risk in Patients Being Treated for Myeloma

By: Joshua D. Madera, MD
Posted: Monday, August 21, 2023

Given the extent of cardiovascular toxicities associated with the therapeutic agents for multiple myeloma as well as additional risk factors such as age, patients should receive comprehensive cardiac evaluation before, during, and after treatment, according to a study by Mohamad Mohty, MD, of the Saint-Antoine Hospital and Sorbonne University, Paris, and colleagues, published in the Blood Cancer Journal. This increased surveillance strategy may improve clinical outcomes for patients by enabling earlier detection and management of these cardiovascular toxicities (eg, heart failure arrhythmia, and hypertension).

Ventricular dysfunction has been observed in patients treated with conventional multiple myeloma chemotherapy drugs, including anthracyclines and alkylating agents. In addition, patients who receive autologous stem cell transplant and melphalan for newly diagnosed and relapsed disease have been shown to develop ventricular arrhythmia. Furthermore, the use of immunomodulatory drugs has been linked to an increased risk of vascular complications and cardiotoxicity. However, the exact mechanism behind these complications remains elusive, although it is speculated that proteasome-mediated protein degradation may play a role.

Proteasome inhibitors have demonstrated varying levels of cardiotoxicity based on the specific drug administered. Bortezomib was associated with high-grade cardiotoxicity, which may be because of its role in impairing the activation of the nuclear factor kappa-beta. This subsequently negatively impacts the survival of cardiac myocytes. Carfilzomib was associated with an increased risk of cardiac failure, likely secondary to its negative impact on the mitochondria membrane potential.

Based on the associated adverse cardiovascular effects of various treatments for multiple myeloma, a detailed risk assessment should be performed on patients. Factors to assess should include age, functional status, associated medical conditions, and evaluation of polypharmacy. Patients who are considered to be at high risk for cardiovascular events should be further evaluated by a cardiologist or cardio-oncologist.

Disclosure: The study authors declared no conflicts of interest.

Blood Cancer Journal

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