Cardiac involvement is one of the most important prognostic markers in multiple myeloma. However, prognostic value of novel biomarkers, such as soluble suppression of tumorigenicity 2 (sST2), P-selectin is unknown in multiple myeloma. The aim of the work was to investigate the additive predictive effects of novel biomarkers P-selectin and sST2 for cardiovascular events of multiple myeloma patients. Materials and methods. Levels of P-selectin and sST2 were after anticancer treatment in a total of 67 multiple myeloma patients. The median follow-up duration of the censored cases was 14.0 (11.4–19.1) months. A total of 4 deaths occurred during the follow-up period. ELISA method for measurements of circulating level of P-selectin and sST2 was used. Results. During follow-up, 36 cardiovascular events and 2 deaths unrelated to cardiovascular events were recorded in 18 (26.9 %) patients. During the study, patients were hospitalized 10 times due to cardiovascular disease. At baseline patients with MM and cardiovascular events which appeared during the observation period had higher levels of P-selectin (P < 0.01), sST2 (P = 0,018), compared to patients without cardiovascular events. Two novel biomarkers, P-selectin and sST2 showed satisfactory predictive performances for one-year cardiovascular events from ROC analysis. Best cut-off values for predicting one-year cardiovascular events were selected (for sST2 – 31.05 ng/ml, with a sensitivity of 71.5 % and a specificity of 89.8 %; for P-selectin – 54.21 ng/ml, with a sensitivity of 69.6 % and a specificity of 86.2 %). The combination of biomarkers had better prognostic properties compared to P-selectin. Conclusions. In patients with confirmed multiple myeloma, the biomarkers P-selectin and sST2 showed significant prognostic properties in the occurrence of cardiovascular events during 1 year of follow-up.

Heart dysfunction that occurred after using of anticancer drugs and monoclonal antibodies may be a limit factor in treatment of chronic lymphoproliferative diseases (CLPD). Cancer therapy-related cardiovascular toxicity include hypotension, hypertension, arrhythmias, conduction disturbances, pericarditis, thromboembolic events, heart failure, death. The risk of cardiotoxicity may be increased by some factors that include drug exposure, age, history of heart diseases, arterial hypertension, drug combination, previous radiotherapy or chemotherapy. The aim of the work is to assess the impact of anticancer treatment on the occurrence of cardiovascular events in patients with CLPD according to the world scientific literature data. It is important to detect the cardiovascular toxicity before the development of clinical manifestations of damage to the myocardium and blood vessels. The role of markers in identifying the risk group of adverse cardiovascular events remains unclear. Early diagnostics and determination of prognostic factors of cardiovascular toxicity, which develop after anticancer therapy of CLPD, are important and not solved problems. Conclusions. The prognosis for the development of cardiovascular events after antitumor treatment of CLPD remains unfavorable. Clinical monitoring, imaging methods, determination of the biomarker levels (natriuretic peptides, troponins) for cardiotoxicity risk stratification are recommended during antitumor treatment to identify early signs and risk of cardiotoxicity. The use of the latest biomarkers and their combinations may be a way to improve the assessment of the cardiotoxicity risk in CLPD. To date, there is no sufficient evidence on the feasibility of routine determining these biomarkers, which indicates the need to plan new studies.

Aim. We aimed to evaluate the prognostic value of circulating sST2 for cumulative cardiovascular events in patients with multiple myeloma. Materials and methods. Ninety seven patients with complete or partial remission of multiple myeloma were enrolled in the study. Observation period was up to 1 year. Blood samples for biomarkers measurements were collected. ELISA method for measurements of circulating level of sST2 was used. Results. During observation period progression of multiple myeloma was proved in 25 patients, 5 persons were excluded for poor follow-up. 67 patients were included into statistical analysis. Thirty six cumulative clinical events occurred in 18 patients (26.9 %) within the follow-up, with their distribution being as follows: 2 deaths due to cardiovascular causes, 16 heart arrhythmias, 3 cardiac ischemic events, 1 stroke, 4 episodes of chronic heart failures and 10 hospital admissions due to cardiovascular events. 2 deaths were not related to cardiovascular pathology. Medians of levels of sST2 in free-events patients and patients with cardiovascular events were 24.17 ng/ml (95 % confidence interval (CI) = 12.87–27.48 ng/ml) and 47.57 ng/ml (95 % CI = 21.36–68.79 ng/ml) (Р < 0.01) respectively. In multivariate logistic regression analysis sST2 independently predicted cardiovascular events (odds ratio (OR) = 1.112; 95 % CI = 1.081–1.154; Р = 0.010) within 1 year of observation period. Conclusions. Among patients with confirmed multiple myeloma at remission increased level of circulating sST2 associates with increased cumulative cardiovascular events during 1 year.

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Запорізький державний медичний університет, УкраїнаA -концепція та дизайн дослідження; B -збір даних; C -аналіз та інтерпретація даних; D -написання статті; E -редагування статті; F -остаточне затвердження статті Мета роботи -пошук та узагальнення доказових даних щодо прогнозу та діагностики виникнення кардіоваскулярних подій у хворих на множинну мієлому.Порушення серця при призначенні цитостатичних препаратів і моноклональних антитіл можуть бути лімітувальними факторами в лікуванні множинної мієломи. Побічні дії хіміотерапії включають гіпотензію, гіпертензію, аритмії, порушення проведення імпульсу, перикардит, тромбоемболічні ускладнення, серцеву недостатність, смерть.Ризик розвитку кардіотоксичності збільшують деякі фактори, як-от ступінь експозиції препарату, вік, захворювання серця в анамнезі, артеріальна гіпертензія, комбінована терапія, попередні променева і хіміотерапія. Принциповим є виявлення ознак кардіоваскулярної токсичності до розвитку клінічних проявів пошкодження міокарда та судин. Залишається нез'ясованою роль маркерів у виявленні групи ризику несприятливих кардіоваскулярних подій.Висновки. Рання діагностика і визначення прогностичних факторів кардіоваскулярної токсичності, які розвиваються після поліхіміотерапії онкогематологічних захворювань, є важливим і до кінця не з'ясованим завданням. Cardiovascular events after polychemotherapy of multiple myeloma: modern ways to diagnostics