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Optimising cardiovascular care of patients with multiple myeloma
  1. Marta Fontes Oliveira1,2,
  2. Willeke R Naaktgeboren3,4,
  3. Alina Hua5,
  4. Arjun K Ghosh1,6,
  5. Heather Oakervee7,
  6. Simon Hallam7,8,
  7. Charlotte Manisty1,9
  1. 1Department of Cardio-Oncology, St Bartholomew's Hospital, London, UK
  2. 2Department of Cardiology, Centro Hospitalar Universitário do Porto, Porto, Portugal
  3. 3Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
  4. 4Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
  5. 5Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
  6. 6Hatter Institute, London, UK
  7. 7Department of Haemato-Oncology, St Bartholomew's Hospital, London, UK
  8. 8Queen Mary University of London, London, UK
  9. 9University College London, London, UK
  1. Correspondence to Dr Charlotte Manisty, Department of Cardio-Oncology, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, United Kingdom; charlotte.manisty{at}nhs.net

Abstract

Multiple myeloma (MM) is the third most common haematological malignancy, with increasing prevalence over recent years. Advances in therapy have improved survival, changing the clinical course of MM into a chronic condition and meaning that management of comorbidities is fundamental to improve clinical outcomes. Cardiovascular (CV) events affect up to 7.5% of individuals with MM, due to a combination of patient, disease and treatment-related factors and adversely impact survival. MM typically affects older people, many with pre-existing CV risk factors or established CV disease, and the disease itself can cause renal impairment, anaemia and hyperviscosity, which exacerabate these further. Up to 15% of patients with MM develop systemic amyloidosis, with prognosis determined by the extent of cardiac involvement. Management of MM generally involves administration of multiple treatment lines over several years as disease progresses, with many drug classes associated with adverse CV effects including high rates of venous and arterial thrombosis alongside heart failure. Recommendations for holistic management of patients with MM now include routine baseline risk stratification including ECG and echocardiography and administration of thromboprophylaxis drugs for patients treated with immunomodulatory drugs. Close surveillance of high-risk patients with collaboration between haematology and cardiology is required, with prompt investigation in the event of CV symptoms, in order to identify and treat complications early. Decisions regarding discontinuation of cardiotoxic therapies should be made in a multidisciplinary setting, taking into account the severity of the complication, prognosis, expected benefits and the availability of effective alternatives.

  • education
  • medical
  • heart failure
  • risk factors

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Footnotes

  • Twitter @martafontesoli1, @alinahua, @arjunkg, @dr_manisty

  • Contributors All authors have made significant contributions to the manuscript. All authors have reviewed and agreed with the final version of the manuscript.

  • Funding MFO was awarded a EACVI training grant 2020. AH is supported by Clinical Research Training Fellowship, British Heart Foundation FS/20/13/34857. CM is supported directly and indirectly by University College London Hospitals National Institute of Health Research Biomedical Research Centre.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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