Left Ventricular Diastolic Function and Carfilzomib-Induced Cardiovascular Events
Posted: Monday, August 19, 2019
For older East Asian patients who have relapsed or refractory multiple myeloma, treatment with carfilzomib may be a double-edged sword. Although the proteasome inhibitor may impart a survival benefit, Yoshiaki Abe, MD, of the Kameda Medical Center, Japan, and colleagues reported a correlation between patients with reduced baseline left ventricular diastolic function and severe cardiovascular adverse events, shortly after starting treatment with carfilzomib. Their findings were published in a commentary to the editor of the journal Blood Advances.
In this retrospective study, the adverse-event profiles of 72 patients with relapsed or refractory myeloma, who were treated with carfilzomib and dexamethasone alone or with lenalidomide, were analyzed over a 2-year period. Prior to initiation of carfilzomib, all patients received baseline echocardiography to evaluate left ventricular diastolic function. Events that occurred within 3 months of carfilzomib initiation were of interest.
Severe cardiovascular adverse events attributable to carfilzomib occurred in 16.7% of patients and were significantly more common in those with baseline left ventricular diastolic dysfunction. Nearly half of the 20 patients with definite left ventricular diastolic dysfunction experienced severe carfilzomib-induced cardiovascular adverse events, compared with 3 patients with negative or intermediate left ventricular diastolic dysfunction. The most common events were acute heart failure, hypertension, left ventricular ejection fraction decrease, acute coronary syndrome, and QT prolongation. Three patients died, due to heart failure or acute myocardial infarction.
“Assessment of [left ventricular] diastolic function before treatment may…have the potential to establish risk-adapted modifications of [carfilzomib]-based chemotherapy, monitoring, and prophylaxis strategies,” the authors concluded.
Disclosure: The study authors’ disclosure information may be found at bloodadvances.org.
