S Bringhen1, A Milan2, M D'Agostino1, C Ferri3, R Wäsch4, F Gay1, A Larocca1, M Offidani5, S Zweegman6, E Terpos7, H Goldschmidt8, M Cavo9, H Ludwig10, C Driessen11, H W Auner12, J Caers13, M Gramatzki14, M A Dimopoulos7, M Boccadoro1, H Einsele15, P Sonneveld16, M Engelhardt4. 1. Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy. 2. Department of Medical Sciences, Internal Medicine and Hypertension Division, AOU Città della Salute e della Scienza di Torino, Rete Oncologica Piemontese, University of Torino, Torino, Italy. 3. University of L'Aquila, MeSVA Department - San Salvatore Hospital, Division of Internal Medicine & Nephrology, Coppito, Italy. 4. Department of Medicine I, Hematology, Oncology & Stem Cell Transplantation, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany. 5. Clinica di Ematologia, AOU Ospedali Riuniti di Ancona, Ancona, Italy. 6. Amsterdam UMC, Vrije Universiteit Amsterdam, VU University Medical Center, Department of Hematology, Cancer Center Amsterdam, Amsterdam, the Netherlands. 7. Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece. 8. University Clinic Heidelberg, Internal Medicine V and National Center for Tumor Diseases (NCT), Heidelberg, Germany. 9. 'Seràgnoli' Institute of Hematology and Medical Oncology, University of Bologna, Bologna, Italy. 10. 1. Medical Department and Oncology, Wilhelminenspital Wien, Vienna, Austria. 11. Department of Oncology and Hematology, Kantonsspital St. Gallen, St. Gallen, Switzerland. 12. Faculty of Medicine, Department of Medicine, Imperial College London, London, UK. 13. Department of Hematology, Domaine University Liege, Liege, Belgium. 14. Division of Stem Cell Transplantation and Immunotherapy, University of Kiel, Kiel, Germany. 15. Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany. 16. Department of Hematology, Erasmus Medical Center, Rotterdam, the Netherlands.
Abstract
BACKGROUND: The novel proteasome inhibitor carfilzomib alone or in combination with other agents is already one of the standard therapies for relapsed and/or refractory multiple myeloma (MM) patients and produces impressive response rates in newly diagnosed MM as well. However, carfilzomib-related cardiovascular adverse events (CVAEs) - including hypertension (all grades: 12.2%; grade ≥3: 4.3%), heart failure (all grades: 4.1%; grade ≥3: 2.5%) and ischemic heart disease (all grades: 1.8%; grade ≥3: 0.8%) - may lead to treatment suspensions. At present, there are neither prospective studies nor expert consensus on the prevention, monitoring and treatment of CVAEs in myeloma patients treated with carfilzomib. METHODS: An expert panel of the European Myeloma Network in collaboration with the Italian Society of Arterial Hypertension and with the endorsement of the European Hematology Association aimed to provide recommendations to support health professionals in selecting the best management strategies for patients, considering the impact on outcome and the risk-benefit ratio of diagnostic and therapeutic tools, thereby achieving myeloma response with novel combination approaches whilst preventing CVAEs. RESULTS: Patients scheduled to receive carfilzomib need a careful cardiovascular evaluation before treatment and an accurate follow-up during treatment. CONCLUSIONS: A detailed clinical assessment before starting carfilzomib treatment is essential to identify patients at risk for CVAEs, and accurate monitoring of blood pressure and of early signs and symptoms suggestive of cardiac dysfunction remains pivotal to safely administer carfilzomib without treatment interruptions or dose reductions.
BACKGROUND: The novel proteasome inhibitor carfilzomib alone or in combination with other agents is already one of the standard therapies for relapsed and/or refractory multiple myeloma (MM) patients and produces impressive response rates in newly diagnosed MM as well. However, carfilzomib-related cardiovascular adverse events (CVAEs) - including hypertension (all grades: 12.2%; grade ≥3: 4.3%), heart failure (all grades: 4.1%; grade ≥3: 2.5%) and ischemic heart disease (all grades: 1.8%; grade ≥3: 0.8%) - may lead to treatment suspensions. At present, there are neither prospective studies nor expert consensus on the prevention, monitoring and treatment of CVAEs in myelomapatients treated with carfilzomib. METHODS: An expert panel of the European Myeloma Network in collaboration with the Italian Society of Arterial Hypertension and with the endorsement of the European Hematology Association aimed to provide recommendations to support health professionals in selecting the best management strategies for patients, considering the impact on outcome and the risk-benefit ratio of diagnostic and therapeutic tools, thereby achieving myeloma response with novel combination approaches whilst preventing CVAEs. RESULTS:Patients scheduled to receive carfilzomib need a careful cardiovascular evaluation before treatment and an accurate follow-up during treatment. CONCLUSIONS: A detailed clinical assessment before starting carfilzomib treatment is essential to identify patients at risk for CVAEs, and accurate monitoring of blood pressure and of early signs and symptoms suggestive of cardiac dysfunction remains pivotal to safely administer carfilzomib without treatment interruptions or dose reductions.
Authors: Rohit Bishnoi; Zhigang Xie; Chintan Shah; Jiang Bian; Hemant S Murthy; John R Wingard; Nosha Farhadfar Journal: Cancer Med Date: 2020-11-10 Impact factor: 4.452
Authors: Giulia Mingrone; Anna Astarita; Lorenzo Airale; Ilaria Maffei; Marco Cesareo; Teresa Crea; Giulia Bruno; Dario Leone; Eleonora Avenatti; Cinzia Catarinella; Marco Salvini; Giusy Cetani; Francesca Gay; Sara Bringhen; Franco Veglio; Fabrizio Vallelonga; Alberto Milan Journal: Front Cardiovasc Med Date: 2021-04-21