Department of Internal Medicine, University of Connecticut Health Center, West Hartford, Conn. 06107, USA.
Acta Haematol. 2012;128(4):244-7. doi: 10.1159/000340050. Epub 2012 Sep 4.
Bortezomib is a novel, first-in-class peptide which reversibly inhibits the proteasome and is Food and Drug Administration approved for the treatment of multiple myeloma, non-Hodgkin lymphoma, Waldenström's macroglobulinemia, and systemic light chain amyloidosis, among others.
Very few cases of bortezomib-induced cardiotoxicity have been reported in the literature, and most of them have been confounded by the previous use of anthracyclins. We reviewed the case of a 56-year-old woman with a medical history of well-controlled hypertension who was newly diagnosed with International Staging System stage I multiple myeloma. She presented with new symptoms of exertional dyspnea, paroxysmal nocturnal dyspnea, and orthopnea after a 4th cycle of a bortezomib/dexamethasone-based chemotherapy. Clinical examination was consistent with heart failure. 2-D echocardiogram showed an left ventricular ejection fraction of 25%, abnormal wall motion, severe eccentric mitral regurgitation, and moderate pericardial effusion. Coronary angiogram showed normal coronaries, and cardiac magnetic resonance did not show delayed gadolinium enhancement.
We reviewed the possible mechanisms involved in cardiotoxicity caused by bortezomib, and the diagnostic methods and importance of early identification of this adverse event. Differential diagnoses such as cardiac amyloidosis and viral myocarditis are also discussed. To our knowledge, this is the first case where pericardial effusion and mitral regurgitation were described after bortezomib treatment.
硼替佐米是一种新型的、首创的肽类物，可可逆性抑制蛋白酶体，已被美国食品药品监督管理局批准用于治疗多发性骨髓瘤、非霍奇金淋巴瘤、瓦尔登斯特伦巨球蛋白血症和系统性轻链淀粉样变性等疾病。
文献中报道的硼替佐米引起的心脏毒性非常少见，而且大多数都与先前使用蒽环类药物有关。我们回顾了一例 56 岁女性的病例，该患者患有控制良好的高血压病史，新诊断为国际分期系统 I 期多发性骨髓瘤。她在接受第 4 个硼替佐米/地塞米松为基础的化疗周期后出现新的劳累性呼吸困难、阵发性夜间呼吸困难和端坐呼吸症状。临床检查符合心力衰竭的表现。二维超声心动图显示左心室射血分数为 25%，壁运动异常，严重偏心性二尖瓣反流和中度心包积液。冠状动脉造影显示冠状动脉正常，心脏磁共振未显示延迟钆增强。
我们回顾了硼替佐米引起心脏毒性的可能机制，以及早期识别这种不良事件的诊断方法和重要性。还讨论了心脏淀粉样变性和病毒性心肌炎等鉴别诊断。据我们所知，这是首例描述硼替佐米治疗后出现心包积液和二尖瓣反流的病例。
