ABSTRACT
BACKGROUND:
Although most studies on the cardiovascular
toxicity of
proteasome inhibitors have focused on carfilzomib, the
risk of
cardiotoxicity associated with
bortezomib remains controversial. This study aimed to evaluate the
incidence and
risk factors of cardiovascular adverse events (CVAEs) associated with
bortezomib in
patients with
multiple myeloma in a real-world setting.
METHODS:
This
cross-sectional study included
patients who were treated with
bortezomib at a
tertiary hospital in
South Korea. CVAEs, defined as
hypertension,
arrhythmia,
heart failure,
myocardial infarction,
pulmonary arterial hypertension, angina, and
venous thromboembolism, were detected using cardiac markers,
ECG,
echocardiography, medications, or
documentation by clinicians. The
patients were observed for at least 6 months and up to 2 years after starting
bortezomib administration.
RESULTS:
Among the 395
patients, 20.8% experienced CVAEs of any grade, and 14.7% experienced severe adverse events. The median onset
time for any CVAE was 101.5 days (IQR, 42-182 days), and new-onset/worsened
hypertension was the most prevalent CVAE. The
risk of CVAEs increased in
patients with a
body mass index lower than 18.5 (adjusted HR (aHR) 3.50, 95%
confidence interval (CI) 1.05-11.72),
light chain (1.80, 1.04-3.13), and
IgD (4.63, 1.06-20.20) as the
multiple myeloma subtype, baseline
stroke (4.52, 1.59-12.80), and
hypertension (1.99, 1.23-3.23). However, CVAEs did not significantly
affect the 2-year overall
survival and
progression-free survival.
CONCLUSION:
Approximately 15% of the Korean
patients treated with
bortezomib experienced severe CVAEs. Thus,
patients, especially those with identified
risk factors, should be closely monitored for CVAE symptoms during
bortezomib treatment.
