With the continuous improvement in survival of cancer patients, including those with multiple myeloma, related to the novel treatment agents and therapeutic approaches, the probability for patients to develop cardiovascular disease has significantly increased, especially in elderly patients and those with additional risk factors. Multiple myeloma is indeed a disease of the elderly population and so these patients are, solely by age, at an increased risk of cardiovascular disease. Risk factors for these events can be patient-, disease- and/or therapy-related, and they have been shown to adversely impact survival. Cardiovascular events affect around 7.5% of patients with multiple myeloma and the risk for different toxicities has considerably varied across trials depending on patients’ characteristics and treatment utilized. High grade cardiac toxicity has been reported with immunomodulatory drugs (odds ratio [OR] around 2), proteasome inhibitors (OR 1.67–2.68 depending on the specific agent, and generally higher with carfilzomib), as well as other agents. Cardiac arrhythmias have also been reported with various therapies and drug interaction plays a significant role in that setting. Comprehensive cardiac evaluation before, during and after various anti-myeloma therapy is recommended and the incorporation of surveillance strategies allows early detection and management resulting in improved outcomes of these patients. Multidisciplinary interaction including hematologists and cardio-oncologists is critical for optimal patient care.
随着包括多发性骨髓瘤在内的癌症患者生存率因新型治疗药物和方法的出现而持续提高，患者发生心血管疾病的概率显著增加，尤其是在老年患者及伴有其他风险因素的患者中。多发性骨髓瘤确实是一种老年人群疾病，因此这些患者仅因年龄因素，其心血管疾病风险就已增加。这些事件的风险因素可能与患者自身、疾病和/或治疗相关，并且已被证实会对生存率产生不利影响。约7.5%的多发性骨髓瘤患者受到心血管事件的影响，且在不同试验中，由于患者特征和所用治疗的差异，各类毒性的风险存在显著变化。免疫调节药物（比值比约2）、蛋白酶体抑制剂（比值比为1.67-2.68，具体因药物而异，卡非佐米通常更高）以及其他药物均报告了高级别心脏毒性。多种治疗中也报告了心律失常，且药物相互作用在此过程中起着重要作用。建议在各种抗骨髓瘤治疗前、治疗期间和治疗后进行全面的心脏评估，结合监测策略有助于早期发现和管理，从而改善患者的预后。包括血液学家和心脏肿瘤学家在内的多学科协作对于实现最佳患者管理至关重要。
肿瘤(癌症)患者之家