Department of Cardio-Oncology, St Bartholomew's Hospital, London, UK.
Department of Cardiology, Centro Hospitalar Universitário do Porto, Porto, Portugal.
Heart. 2021 Nov;107(22):1774-1782. doi: 10.1136/heartjnl-2020-318748. Epub 2021 Apr 5.
Multiple myeloma (MM) is the third most common haematological malignancy, with increasing prevalence over recent years. Advances in therapy have improved survival, changing the clinical course of MM into a chronic condition and meaning that management of comorbidities is fundamental to improve clinical outcomes. Cardiovascular (CV) events affect up to 7.5% of individuals with MM, due to a combination of patient, disease and treatment-related factors and adversely impact survival. MM typically affects older people, many with pre-existing CV risk factors or established CV disease, and the disease itself can cause renal impairment, anaemia and hyperviscosity, which exacerabate these further. Up to 15% of patients with MM develop systemic amyloidosis, with prognosis determined by the extent of cardiac involvement. Management of MM generally involves administration of multiple treatment lines over several years as disease progresses, with many drug classes associated with adverse CV effects including high rates of venous and arterial thrombosis alongside heart failure. Recommendations for holistic management of patients with MM now include routine baseline risk stratification including ECG and echocardiography and administration of thromboprophylaxis drugs for patients treated with immunomodulatory drugs. Close surveillance of high-risk patients with collaboration between haematology and cardiology is required, with prompt investigation in the event of CV symptoms, in order to identify and treat complications early. Decisions regarding discontinuation of cardiotoxic therapies should be made in a multidisciplinary setting, taking into account the severity of the complication, prognosis, expected benefits and the availability of effective alternatives.
多发性骨髓瘤（MM）是第三大常见血液系统恶性肿瘤，近年来其发病率呈上升趋势。治疗的进步提高了生存率，使 MM 的临床过程转变为慢性疾病，这意味着合并症的管理对于改善临床结果至关重要。心血管（CV）事件影响多达 7.5%的 MM 患者，这是由于患者、疾病和治疗相关因素的综合作用，并且对生存产生不利影响。MM 通常影响老年人，许多人存在预先存在的 CV 危险因素或已确诊的 CV 疾病，并且该疾病本身可导致肾功能损害、贫血和高粘滞血症，进一步加重这些疾病。多达 15%的 MM 患者会发展为系统性淀粉样变性，其预后取决于心脏受累的程度。MM 的管理通常涉及在疾病进展过程中多年内多次使用多种治疗方案，许多药物类别与 CV 不良影响相关，包括静脉和动脉血栓形成以及心力衰竭的高发生率。现在，建议对 MM 患者进行全面管理，包括常规基线风险分层，包括心电图和超声心动图，并对接受免疫调节药物治疗的患者使用血栓预防药物。需要血液学和心脏病学之间的密切协作，对高危患者进行密切监测，一旦出现 CV 症状，立即进行调查，以便早期发现和治疗并发症。应在多学科环境中做出关于停止使用心脏毒性疗法的决定，需要考虑并发症的严重程度、预后、预期获益和有效替代疗法的可用性。
