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. 2023 Feb 2;15(3):955.
doi: 10.3390/cancers15030955.

Carfilzomib-Based Regimen and Cardiotoxicity in Multiple Myeloma: Incidence of Cardiovascular Events and Organ Damage in Carfilzomib-Dexamethasone versus Carfilzomib-Lenalidomide-Dexamethasone. A Real-Life Prospective Study

Anna Astarita  1 , Giulia Mingrone  1 , Lorenzo Airale  1 , Marco Cesareo  1 , Anna Colomba  1 , Cinzia Catarinella  1 , Dario Leone  1 , Francesca Gay  2 , Sara Bringhen  2 , Franco Veglio  1 , Alberto Milan  1 , Fabrizio Vallelonga  1
Affiliations

Carfilzomib-Based Regimen and Cardiotoxicity in Multiple Myeloma: Incidence of Cardiovascular Events and Organ Damage in Carfilzomib-Dexamethasone versus Carfilzomib-Lenalidomide-Dexamethasone. A Real-Life Prospective Study

Anna Astarita et al. Cancers (Basel). .

Abstract

Carfilzomib-mediated cardiotoxicity in multiple myeloma (MM) is a well-established adverse effect, however limited data are available on the comparison of cardiovascular complications in patients treated with Carfilzomib-dexamethasone (target dose of K 56 mg/m2) versus Carfilzomib-lenalidomide-dexamethasone (target dose of K 27 mg/m2) beyond controlled trials. A total of 109 patients were enrolled, 47 (43%) received Kd and 62 (57%) KRd. They then underwent a baseline and follow-up evaluation including trans-thoracic echocardiography and arterial stiffness estimation. All types of cardiovascular and hypertensive events occurred more frequently in the Kd group compared with the KRd (59% vs. 40% and 55% vs. 35.5% patients, respectively, p ≤ 0.05), with higher incidence of hypertensive. The time of onset of any type of CVAE, and of major and hypertensive events was shorter in the Kd regimen (p ≤ 0.05). At follow-up, Kd patients more frequently developed signs of cardiac (decline of global longitudinal strain) and vascular organ damage (rise of pulse wave velocity), as compared with KRd. Despite the older age, longer history of MM and longer period of pre-treatment of Kd patients, these factors did not increase the probability of incidence for all types of cardiovascular events at multivariate analysis (p > 0.05). In conclusion, the Kd regimen showed greater cardiovascular toxicity and earlier onset of events with respect to KRd. Thus, a closer and thorough follow-up should be considered.

Keywords: KRd; Kd; cardiotoxicity; cardiovascular adverse events; carfilzomib; dexamethasone; echocardiography; hypertensive events; lenalidomide; multiple myeloma; pulse wave velocity; real-life.

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Conflict of interest statement

Alberto Milan received honoraria for advisory board from Amgen and Janssen. Sara Bringhen received honoraria from Bristol-Myers Squibb, Celgene, Amgen and Janssen; advisory boards for Amgen, Karyopharm, Janssen and Celgene; consultancy fees from Takeda and Janssen. Francesca Gay received honoraria from Amgen, Janseen, Celgene, BMS, Takeda, Abbvie; advisory boards for Amgen, Janseen, Celgene, BMS, Takeda, Abbvie; advisory adaptive for Roche Oncopeptides. The other authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Study protocol.
Figure 2
Figure 2
Kaplan–Meier curves for adverse events in Kd (blue) and KRd (red) groups: (a) Cumulative survival without Cardiovascular event; (b) Cumulative survival without Major CV event; (c) Cumulative survival without Hypertensive event.
Figure 3
Figure 3
Box plots of main parameters of organ damage at second visit between Kd and KRd: (a) left ventricle global longitudinal strain; (b) left ventricle ejection fraction; (c) left ventricle indexed mass; (d) pulse wave velocity.
See this image and copyright information in PMC

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