Multiple Myeloma Patients Undergoing Carfilzomib: Development and Validation of a Risk Score for Cardiovascular Adverse Events Prediction

Abstract

Cardiovascular adverse events (CVAEs) are linked to Carfilzomib (CFZ) therapy in multiple myeloma (MM); however, no validated protocols on cardiovascular risk assessment are available. In this prospective study, the effectiveness of the European Myeloma Network protocol (EMN) in cardiovascular risk assessment was investigated, identifying major predictors of CVAEs. From January 2015 to March 2020, 116 MM patients who had indication for CFZ therapy underwent a baseline evaluation (including blood pressure measurements, echocardiography and arterial stiffness estimation) and were prospectively followed. The median age was 64.53 ± 8.42 years old, 56% male. Five baseline independent predictors of CVAEs were identified: office systolic blood pressure, 24-h blood pressure variability, left ventricular hypertrophy, pulse wave velocity value and global longitudinal strain. The resulting ‘CVAEs risk score’ distinguished a low- and a high-risk group, obtaining a negative predicting value for the high-risk group of 90%. 52 patients (44.9%) experienced one or more CVAEs: 17 (14.7%) had major and 45 (38.7%) had hypertension-related events. In conclusion, CVAEs are frequent and a specific management protocol is crucial. The EMN protocol and the risk score proved to be useful to estimate the baseline risk for CVAEs during CFZ therapy, allowing the identification of higher-risk patients.

Recent Advances on the Pathobiology and Treatment of Multiple Myeloma

“…Astarita et al focused on the cardiovascular effects of the PI carfilzomib, and carried out a prospective study to assess the effectiveness of the European Myeloma Network protocol (EMN). Importantly, this study underscored the usefulness of EMN to estimate the baseline risk of cardiovascular adverse events during carfilzomib therapy, allowing the identification of higher-risk patients [16].…”

Prediction of cardiovascular adverse events in newly diagnosed multiple myeloma: Development and validation of a risk score prognostic model

“…However, few of them could apply to MM patients. In recent years, a prospective study that investigated the relationship between Carfilzomib (CFZ) therapy in MM and CVAEs has established a risk score for CVAEs in MM patients ( 19 ). However, this risk score system is inapplicable in predicting the occurrence of CVAEs in MM, which have a range of different treatment plans.…”

Daratumumab May Attenuate Cardiac Dysfunction Related to Carfilzomib in Patients with Relapsed/Refractory Multiple Myeloma: A Prospective Study

“…For this reason, consensus recommendations have been proposed for the early recognition and management of CVAEs related to carfilzomib [4,16]. A predictive model based on baseline office systolic blood pressure, 24 h blood pressure variability, left ventricular hypertrophy, pulse wave velocity and GLS has been recently proposed to predict the risk of CVAEs and stratify the patients in low and high-risk groups [17,18]. A baseline risk assessment based on traditional risk factors for CVAEs is also essential [4,16,19].…”