Cardiovascular complications that may be caused by anti-myeloma drugs

Czech version

Authors: L. Elbl ¹; Z. Adam ²; M. Krejčí ²; L. Pour ²
Published in: Transfuze Hematol. dnes,31, 2025, No. 1, p. 13-18.
Category:
doi: https://doi.org/10.48095/cctahd2025prolekare.cz4

Overview

Most patients with multiple myeloma (MM) are over 50 years old, which is an age when cardiovascular diseases are common. Therefore, it is important to be aware of the potential adverse cardiovascular effects of anti-myeloma drugs. Among conventional cytostatics, doxorubicin is known for its cardiotoxic effects. High doses of cyclophosphamide, used for stem cell collection, can also cause cardiovascular complications. Therefore, in cases where the heart is affected by AL amyloidosis, stem cell collection after G-CSF is recommended. The doses of melphalan typically used during haematopoietic stem cell transplantation may also have a negative impact on the heart and induce arrhythmias. Among proteasome inhibitors, carfilzomib is associated with the highest number of cardiovascular side effects, while those reported with bortezomib are significantly less frequent, and ixazomib is not associated with cardiotoxicity. In the group of IMiD drugs, procoagulant effects dominate, requiring targeted prophylaxis for thrombosis and pulmonary embolism; however, rhythm disorders have also been reported. Treatment with new anti-CD38 monoclonal antibodies is not linked to evident cardiotoxicity, but adverse cardiovascular effects are associated with glucocorticoids, which are standard premedications for administering anti-CD antibodies. The aim of this text is to inform about the incidence of these complications associated with anti-myeloma treatment.

Keywords:

Cyclophosphamide – cardiovascular complications of multiple myeloma – melphalan – proteasome inhibitors – IMiD drugs – anti-CD38 monoclonal antibodies

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