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Cardiovascular Organ Damage and Blood Pressure Levels Predict Adverse Events in Multiple Myeloma Patients Undergoing Carfilzomib Therapy

1
Hypertension Unit, Department of Medical Sciences, “Città della Salute e della Scienza” Hospital, 3-10126 Turin, Italy
2
Myeloma Unit, Division of Haematology, University of Turin, “Città della Salute e della Scienza” Hospital, 3-10126 Turin, Italy
*
Author to whom correspondence should be addressed.
Cancers 2019, 11(5), 622; https://doi.org/10.3390/cancers11050622
Received: 1 March 2019 / Revised: 25 April 2019 / Accepted: 30 April 2019 / Published: 3 May 2019
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Abstract

Carfilzomib is a second-generation proteasome inhibitor approved for the treatment of multiple myeloma (MM). It seems to determine cardiovascular toxicity, primarily arterial hypertension. No predictive factors for cardiovascular adverse events (CVAEs) are known in patients affected by multiple myeloma treated with carfilzomib. We evaluated the role of cardiovascular organ damage parameters to predict CVAEs in MM patients taking carfilzomib. Seventy patients affected by MM were prospectively enrolled. A comprehensive cardiovascular evaluation was performed before carfilzomib therapy; they underwent a transthoracic echocardiogram and the assessment of carotid-femoral pulse wave velocity. All the patients were followed up (FU) to determine the incidence of CVAEs. The mean age was 60.3 ± 8.2, and 51% were male. The median FU was 9.3 (4.3; 20.4) months. A proportion of 33% experienced CVAEs, 91% of them had uncontrolled hypertension, 4.5% acute coronary syndrome, and 4.5% cardiac arrhythmias. Subjects with CVAEs after carfilzomib treatment had significantly higher blood pressure values, left ventricular mass (98 ± 23 vs. 85 ± 17 g/m2, p = 0.01), and pulse wave velocity (8.5 ± 1.7 vs. 7.5 ± 1.6 m/s, p = 0.02) at baseline evaluation compared to the others. Furthermore, baseline uncontrolled blood pressure, left ventricular hypertrophy, and pulse wave velocity ≥ 9 m/s were able to identify patients at higher risk of developing CVAEs during FU. These preliminary findings indicate that blood pressure control, left ventricular mass, and pulse wave velocity may predict CVAEs in MM patients treated with carfilzomib. View Full-Text
Keywords: cardio-toxicity; multiple myeloma; arterial hypertension; cardiovascular organ damage; cardiovascular adverse event cardio-toxicity; multiple myeloma; arterial hypertension; cardiovascular organ damage; cardiovascular adverse event
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Bruno, G.; Bringhen, S.; Maffei, I.; Iannaccone, A.; Crea, T.; Ravera, A.; Astarita, A.; Vallelonga, F.; Salvini, M.; Gay, F.; Veglio, F.; Milan, A. Cardiovascular Organ Damage and Blood Pressure Levels Predict Adverse Events in Multiple Myeloma Patients Undergoing Carfilzomib Therapy. Cancers 2019, 11, 622.

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