Pulmonary Arterial Hypertension: An Adverse Effect of Carfilzomib Therapy for Myeloma?
Posted: Tuesday, December 21, 2021
The description in Pulmonary Circulation of carfilzomib-associated pulmonary arterial hypertension in two patients with multiple myeloma should enhance awareness of this potential adverse effect. Jenny Z. Yang, MD, of the University of California, San Diego, and colleagues noted that although a link between the proteasome inhibitor carfilzomib and such cardiovascular adverse events as ischemic heart disease and heart failure has been well noted, its potential connection to pulmonary arterial hypertension has not.
The two patients, both women in their late 50s, developed pulmonary arterial hypertension soon after carfilzomib initiation. Both had previously undergone autologous stem cell transplantation and then relapsed, the first after about 10 months and the second after about 2 years. Both also initially presented with severe dyspnea, described the team, and had elevated right ventricular systolic pressure seen on transthoracic echocardiography. They both ultimately underwent right heart catheterization.
The hemodynamics of both patients improved when carfilzomib was discontinued, but the second patient nonetheless required further treatment to reverse the pulmonary arterial hypertension—which has not been fully effective, as her right ventricular function has continued to worsen.
Echocardiography can be an important initial screening tool, stressed Dr. Yang and co-investigators. If pulmonary arterial hypertension develops in conjunction with carfilzomib therapy, it may be reversible, especially with early diagnosis. In any case in which this adverse effect develops, however, extended follow-up is essential.
What’s more, they added, “drug-induced pulmonary arterial hypertension is constantly evolving as new drugs are developed.” Both patients had taken bortezomib, too, which has also been linked to pulmonary arterial hypertension as an adverse effect, but the temporal correlation with the hypertension in these cases appeared to be with carfilzomib.
Disclosure: The study authors reported no conflicts of interest.