Samuelson Clare, O'Toole Laurence, Boland Elaine, Greenfield Diana, Ezaydi Yousef, Ahmedzai Sam H, Snowden John A
a Department of Haematology , Sheffield Teaching Hospitals NHS Foundation Trust , UK.
b Department of Cardiology , Sheffield Teaching Hospitals NHS Foundation Trust , UK.
Hematology. 2016 Jun;21(5):272-9. doi: 10.1080/10245332.2015.1122258. Epub 2016 Mar 16.
Modern management of myeloma has significantly improved survival, with increasing numbers of patients living beyond a decade. However, little is known about the long-term cardiovascular and respiratory status of intensively treated and multiply relapsed survivors.
We performed detailed cardiovascular and respiratory evaluations in patients with intensively treated, advanced but stable myeloma. All patients had received at least two lines of treatment, including at least one haematopoietic stem cell transplantation procedure, but had stable, controlled disease and were off active treatment at the time of evaluation.
Thirty-two patients with a median duration of 6 years (range 2-12) from original diagnosis of myeloma and three lines (range 2-6) of treatment were evaluated. Despite normal physical examination in the majority, there was a high prevalence of sub-clinical cardiac and respiratory dysfunction, reflected by abnormalities of electrocardiography (45%), echocardiography (50%), serum N-terminal pro-B-type natriuretic peptide level (NT-pro-BNP, 50%), and pulmonary function testing (45%). NT-pro-BNP level correlated negatively with quality of life (P = 0.012) and positively with serum ferritin (P = 0.027). Dyspnoea score correlated with BMI (P = 0.001). Risk factors for cardiovascular disease (obesity, hypertension, hyperlipidaemia, and hyperinsulinaemia) were common.
Even in the absence of overt clinical features, the majority of intensively treated long-term survivors of myeloma have established cardiovascular and/or respiratory dysfunction, above levels expected in the general population of a similar age.
This study supports routine screening and lifestyle modification combined with primary and secondary preventive strategies to reduce cardiovascular and respiratory disease and to preserve quality of life in transplanted myeloma patients.
现代骨髓瘤管理显著提高了生存率，存活超过十年的患者数量不断增加。然而，对于经过强化治疗且多次复发的幸存者的长期心血管和呼吸状况知之甚少。
我们对接受强化治疗、病情晚期但稳定的骨髓瘤患者进行了详细的心血管和呼吸评估。所有患者至少接受了两线治疗，包括至少一次造血干细胞移植手术，但疾病稳定且得到控制，在评估时已停止积极治疗。
对32例自骨髓瘤初诊起中位病程为6年（范围2 - 12年）且接受了三线（范围2 - 6线）治疗的患者进行了评估。尽管大多数患者体格检查正常，但亚临床心脏和呼吸功能障碍的患病率很高，表现为心电图异常（45%）、超声心动图异常（50%）、血清N末端脑钠肽前体水平（NT - pro - BNP，50%）以及肺功能测试异常（45%）。NT - pro - BNP水平与生活质量呈负相关（P = 0.012），与血清铁蛋白呈正相关（P = 0.027）。呼吸困难评分与体重指数相关（P = 0.001）。心血管疾病的危险因素（肥胖、高血压、高脂血症和高胰岛素血症）很常见。
即使没有明显的临床特征，大多数经过强化治疗的骨髓瘤长期幸存者也存在已确诊的心血管和/或呼吸功能障碍，高于同年龄普通人群预期的水平。
本研究支持进行常规筛查、改变生活方式，并结合一级和二级预防策略，以减少心血管和呼吸系统疾病，维护移植骨髓瘤患者的生活质量。
