Cardiovascular involvement in patients affected by multiple myeloma: a comprehensive review of recent advances

ABSTRACT

Introduction

Multiple Myeloma (MM) is hematological neoplasia originating from plasma cells, which accounts for almost 1% of all oncologic malignancies. The median age of patients at diagnosis is about 65 years old and over. In this age group, cardiovascular (CV) diseases often co-exist, increasing the risk of adverse events related to MM treatment. A comprehensive search on the main educational platforms was performed and high-quality original articles and reviews were included.

Areas Covered

Patients affected by MM are at risk for heart failure, uncontrolled systemic hypertension, accelerated ischemic heart disease, arterial/venous thromboembolism, and arrhythmias. These complications may be due to the effects of chemotherapy on the CV system, which may play on preexisting risk factors, and amyloid deposition at cardiac level.

Expert Opinion

This review provides an updated overview of the spectrum of CV diseases that may affect MM patients, highlighting possible treatment strategies according to the latest recommendations. Cooperation between onco-hematologist and cardiologist is crucial in managing this population, in particular for adequate risk assessment, early diagnosis of CV complications, and proper treatment.

KEYWORDS:

• Multiple Myeloma
• cardiovascular complications
• amyloidosis
• cardiotoxicity
• cardio-oncology

Article highlights

• Multiple myeloma (MM) is the most common type of malignancy associated with cardiovascular diseases, both due to the disproportionate deposition of amyloid light-chain (AL) Ig and due to the high risk of chemotherapy-related cardiotoxicity.

• AL-Cardiac amyloidosis (CA) is responsible of a wide variety of cardiovascular clinical manifestations, including heart failure (HF), blood pressure (BP) disorders, arrhythmias and conduction disturbances, as well as arterial and venous thromboembolism. These same complications may be due to adverse effects of drugs used to treat MM.

• Non-invasive multimodality assessment is crucial in diagnosis and follow-up of CA and cardiotoxicity, with echocardiography and cardiac magnetic resonance playing key roles. Furthermore, the association of these latter imaging techniques has been proven to be effective in prognostication and risk stratification of this population.

• Several therapeutic strategies are under adequate investigation in order to prevent cardiac damage induced by drugs used for MM; early recognition of subclinical imaging signs of cardiac involvement allows proper cardioprotection.

• Collaboration between cardiologist and onco-hematologist is crucial to define patients’ follow-up, prognosis and management pathways.

Declaration of interest

The author(s) have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.