Lee Dae Hyun, Fradley Michael G
Department of Internal Medicine, University of South Florida, 2 Tampa General Circle, Tampa, FL, 33606, USA.
Department of Cardiovascular Sciences, University of South Florida, 2 Tampa General Circle, Tampa, FL, 33606, USA.
Curr Treat Options Cardiovasc Med. 2018 Mar 6;20(3):19. doi: 10.1007/s11936-018-0618-y.
Multiple myeloma treatment regimens consist of proteasome inhibitors (bortezomib, carfilzomib, and ixazomib), immunomodulatory drugs (thalidomide, lenalidomide, and pomalidomide), and steroids. In this paper, we will review the pathophysiology and associated cardiotoxicities of the different multiple myeloma therapeutic modalities and present methods to mitigate the development of cardiovascular complications.
Although proteasome inhibitors and immunomodulatory drugs have led to significant improvements in oncologic outcomes, there is increasing evidence of serious cardiovascular side effects which may be exacerbated in the setting of underlying cardiovascular risk factors or disease. Cardiotoxicities include cardiomyopathy and heart failure, accelerated hypertension, arrhythmias, and both arterial and venous thromboembolism. Given the frequency of cardiovascular risk factors in multiple myeloma patients as well as the cardiotoxicities associated with the different treatment regimens, it is essential to closely monitor these patients. Collaboration between cardiologists and oncologists is necessary to ensure patients receive optimal cancer treatment while minimizing cardiovascular risk.
多发性骨髓瘤治疗方案包括蛋白酶体抑制剂（硼替佐米、卡非佐米和伊沙佐米）、免疫调节药物（沙利度胺、来那度胺和泊马度胺）以及类固醇。在本文中，我们将综述不同多发性骨髓瘤治疗方式的病理生理学及相关心脏毒性，并介绍减轻心血管并发症发生的方法。
尽管蛋白酶体抑制剂和免疫调节药物已使肿瘤学结局有显著改善，但越来越多的证据表明存在严重的心血管副作用，在存在潜在心血管危险因素或疾病的情况下，这些副作用可能会加剧。心脏毒性包括心肌病和心力衰竭、加速性高血压、心律失常以及动脉和静脉血栓栓塞。鉴于多发性骨髓瘤患者中心血管危险因素的发生率以及不同治疗方案相关的心脏毒性，密切监测这些患者至关重要。心脏病专家和肿瘤学家之间的合作对于确保患者在接受最佳癌症治疗的同时将心血管风险降至最低是必要的。
