Carfilzomib-Based Regimen and Cardiotoxicity in Multiple Myeloma: Incidence of Cardiovascular Events and Organ Damage in Carfilzomib-Dexamethasone versus Carfilzomib-Lenalidomide-Dexamethasone. A Real-Life Prospective Study

SIMPLE SUMMARY: Cardiotoxicity is a known adverse effect of Carfilzomib therapy; nevertheless, limited data are available on the comparison of the cardiovascular complications induced by Carfilzomib-dexamethasone versus Carfilzomib-lenalidomide-dexamethasone in patients with multiple myeloma (MM) in a real-life setting. We conducted a prospective study to determine differences in incidence and time of onset of hypertensive- and major cardiovascular-adverse events between in-patients with MM treated with the two regimens. Furthermore, we investigated differences in subclinical cardiac and vascular organ damage in these two groups, which might benefit from different monitoring strategies. ABSTRACT: Carfilzomib-mediated cardiotoxicity in multiple myeloma (MM) is a well-established adverse effect, however limited data are available on the comparison of cardiovascular complications in patients treated with Carfilzomib-dexamethasone (target dose of K 56 mg/m(2)) versus Carfilzomib-lenalidomide-dexamethasone (target dose of K 27 mg/m(2)) beyond controlled trials. A total of 109 patients were enrolled, 47 (43%) received Kd and 62 (57%) KRd. They then underwent a baseline and follow-up evaluation including trans-thoracic echocardiography and arterial stiffness estimation. All types of cardiovascular and hypertensive events occurred more frequently in the Kd group compared with the KRd (59% vs. 40% and 55% vs. 35.5% patients, respectively, p ≤ 0.05), with higher incidence of hypertensive. The time of onset of any type of CVAE, and of major and hypertensive events was shorter in the Kd regimen (p ≤ 0.05). At follow-up, Kd patients more frequently developed signs of cardiac (decline of global longitudinal strain) and vascular organ damage (rise of pulse wave velocity), as compared with KRd. Despite the older age, longer history of MM and longer period of pre-treatment of Kd patients, these factors did not increase the probability of incidence for all types of cardiovascular events at multivariate analysis (p > 0.05). In conclusion, the Kd regimen showed greater cardiovascular toxicity and earlier onset of events with respect to KRd. Thus, a closer and thorough follow-up should be considered.