Astarita Anna, Mingrone Giulia, Airale Lorenzo, Cesareo Marco, Colomba Anna, Catarinella Cinzia, Leone Dario, Gay Francesca, Bringhen Sara, Veglio Franco, Milan Alberto, Vallelonga Fabrizio
Hypertension Unit, Department of Medical Sciences, Division of Internal Medicine, AO "Città Della Salute e Della Scienza" University Hospital, 10126 Turin, Italy.
Myeloma Unit, Department of Medical Sciences, Division of Hematology, AO "Città Della Salute e Della Scienza" University Hospital, 10126 Turin, Italy.
Cancers (Basel). 2023 Feb 2;15(3):955. doi: 10.3390/cancers15030955.
Carfilzomib-mediated cardiotoxicity in multiple myeloma (MM) is a well-established adverse effect, however limited data are available on the comparison of cardiovascular complications in patients treated with Carfilzomib-dexamethasone (target dose of K 56 mg/m) versus Carfilzomib-lenalidomide-dexamethasone (target dose of K 27 mg/m) beyond controlled trials. A total of 109 patients were enrolled, 47 (43%) received Kd and 62 (57%) KRd. They then underwent a baseline and follow-up evaluation including trans-thoracic echocardiography and arterial stiffness estimation. All types of cardiovascular and hypertensive events occurred more frequently in the Kd group compared with the KRd (59% vs. 40% and 55% vs. 35.5% patients, respectively, ≤ 0.05), with higher incidence of hypertensive. The time of onset of any type of CVAE, and of major and hypertensive events was shorter in the Kd regimen ( ≤ 0.05). At follow-up, Kd patients more frequently developed signs of cardiac (decline of global longitudinal strain) and vascular organ damage (rise of pulse wave velocity), as compared with KRd. Despite the older age, longer history of MM and longer period of pre-treatment of Kd patients, these factors did not increase the probability of incidence for all types of cardiovascular events at multivariate analysis ( > 0.05). In conclusion, the Kd regimen showed greater cardiovascular toxicity and earlier onset of events with respect to KRd. Thus, a closer and thorough follow-up should be considered.
卡非佐米介导的多发性骨髓瘤（MM）心脏毒性是一种公认的不良反应，然而，除对照试验外，关于接受卡非佐米-地塞米松（卡非佐米目标剂量为56mg/m²）与卡非佐米-来那度胺-地塞米松（卡非佐米目标剂量为27mg/m²）治疗的患者心血管并发症比较的数据有限。共纳入109例患者，47例（43%）接受Kd方案，62例（57%）接受KRd方案。然后他们接受了包括经胸超声心动图和动脉僵硬度评估在内的基线和随访评估。与KRd组相比，Kd组各类心血管和高血压事件的发生率更高（分别为59%对40%和55%对35.5%的患者，P≤0.05），高血压发生率更高。Kd方案中任何类型的心血管不良事件、主要事件和高血压事件的发病时间更短（P≤0.05）。随访时，与KRd组相比，Kd组患者更频繁地出现心脏（整体纵向应变下降）和血管器官损伤（脉搏波速度升高）的体征。尽管Kd组患者年龄更大、MM病史更长且预处理时间更长，但在多变量分析中，这些因素并未增加各类心血管事件的发生概率（P>0.05）。总之，与KRd方案相比，Kd方案显示出更大的心血管毒性和更早的事件发生。因此，应考虑进行更密切和全面的随访。
