Baseline cardiovascular risk assessment in patients receiving proteasome inhibitors for haematological malignancies: a tertiary referral centre experience
M Mc Kenna, A O'flynn, R DesmondAbstract
Introduction
Thanks to encouraging trial results, proteasome inhibitors have become mainstays of therapy in patients with newly diagnosed and relapsed multiple myeloma. Similar beneficial findings have been identified with their use in waldenström’s macroglobulinaemia. Patients treated with proteasome inhibitors have a high incidence of coexistent comorbidities leading to an increased baseline cardiovascular risk, and newly developed heart failure is a frequently developed adverse effect on treatment. The European Society of Cardiology have published surveillance guidance for patients receiving proteasome inhibitors, including baseline cardiovascular risk assessment and on-treatment monitoring.
Purpose
We performed a single centre study to assess the quality of pre-treatment risk assessment in patients with haematological malignancies receiving proteasome inhibitor-based treatments.
Methods
Information was collected from an academic tertiary referral hospital. Data was retrospectively extracted on patients diagnosed with multiple myeloma or waldenström’s macroglobulinaemia who were treated with proteasome inhibitors using pharmacy dispensing records. Electronic and handwritten records were reviewed for each patient to identify for the presence of comorbidities, cardiovascular biomarker levels, ECG findings, echocardiography reports, and details on referrals to the on-site cardiology service prior to commencing treatment. Baseline cardiovascular risk was calculated for each patient using the Heart Failure Association-International Cardio-Oncology Society risk score.
Results
Over the study period, 216 patients with multiple myeloma or waldenström’s macroglobulinaemia were treated with proteasome inhibitors. 50% of patients were male, 50% were female. 88.9% of patients had multiple myeloma; 11.1% had waldenström’s macroglobulinaemia. 83.3% of patients received bortezomib; 16.7% received carfilzomib. 50%, 33.3% and 16.7% of patients had high, moderate and low baseline cardiovascular risk scores respectively. 66.7% and 61.1% of patients did not have baseline troponins and BNP/NT-pro-BNPs taken respectively. 55.5% and 72.2% of patients did not undergo pre-treatment ECGs or transthoracic echocardiographs respectively.
Conclusions
Patients with multiple myeloma treated with proteasome inhibitors are frequently not receiving a full baseline cardiovascular risk assessment prior to commencing treatment. Future efforts will need to focus on improved compliance rates to ensure appropriate risk stratification, and appropriate cardiovascular monitoring, while on treatment.