Management of cardiovascular risk in patients with multiple myeloma

Abstract

Multiple myeloma (MM) is a plasma cell malignancy that accounts for 10% of hematological cancers. It predominantly affects elderly people; median age at diagnosis is 70 years. Consequently, many patients with MM have cardiovascular comorbidities or risk factors. MM can cause cardiac comorbidities such as cardiomyopathy and heart failure caused by cardiac amyloidosis and/or anemia. Some of the treatments used in MM can also affect cardiovascular health. Advances in pharmacotherapy for MM, such as the introduction of immunomodulators, proteasome inhibitors, histone deacetylase inhibitors, and monoclonal antibodies, have dramatically improved progression-free survival and life expectancy, but new agent classes are associated with adverse events that were not previously observed on a regular basis, including cardiovascular events. However, with careful risk assessment, monitoring, and prophylactic therapy, many of these cardiovascular complications can be managed or treated successfully. Most routine cardiovascular surveillance is undertaken by the treating hemato-oncologist, but a multidisciplinary approach involving cardiologists may help to optimize patient outcomes. In this review, we survey the cardiac complications commonly reported in patients with MM, discuss how they can be prevented and managed, and summarize the role cardiologists can play in delivering the best possible outcomes for patients with MM and cardiovascular comorbidities.

Fig. 1. Summary of agents approved for the treatment of patients with MM in Europe^{,–,,,,,,–,}.

MM, multiple myeloma; SCT, stem-cell transplantation

Fig. 2. Summary of cardiovascular adverse drug reactions associated with agents used to treat MM in Europe and occurring in at least 1 in 1000 patients (all AEs listed with frequency information in the relevant European SmPCs are depicted).

ADR, adverse drug reaction; ECG, electrocardiography; MM, multiple myeloma; PEG, polyethylene glycol; SmPC, summary of product characteristics