Bortezomib-induced cardiotoxicity: Real-world data from a single-center.

Abstract

e20008 Background: Bortezomib (Velcade) has emerged as the leading component of first-line therapies in both standard and high-risk multiple myeloma since the SWOGS0777 results were published in 2016. Although the incidence of cardiac side effects is reported to be lower with bortezomib compared to carfilzomib, standardized protocols for cardiac toxicity monitoring are unavailable. Currently, reported rates of cardiomyopathy with Velcade use range between 1-5%. We aim to examine bortezomib related cardiac adverse events and their association with demographics and traditional risk factors, especially in the setting of an ethnically diverse population that our hospital serves. Methods: Our institutional retrospective study extended between 01/2015 - 12/2020 and included patients aged > 18 years who received Velcade for myeloma and excluded prisoners, pregnant women. Our primary objective was to investigate the incidence of Velcade-induced cardiomyopathy, arrythmias and coronary artery disease (CAD) as dependent variables. Independent variables included demographics, prior personal/family history of heart disease, comorbid conditions such as hypertension/diabetes/obesity/hyperlipidemia/smoking/atrial fibrillation/chronic kidney disease, myeloma subtype and RISS staging. Descriptive statistics were used to report frequencies and percentages. Fisher’s exact tests were used to report associations between dependent and independent variables. Results: This study included a total of 64 patients. Majority were males (58%), African Americans (79%), and had a mean age of 62 years. Free light chain and IgG kappa were the most common types of myeloma (73%). Mean dose of velcade and dexamethasone received was 52.4 mg/m2 and 834 mg respectively, over a mean duration of 26.14 weeks. Personal and family history of cardiovascular disease was reported in 39% and 23% patients respectively. A new diagnosis of cardiomyopathy was made in 14% of the patients. No new arrythmias or CAD were seen after Velcade use. In the unadjusted model, incidence of new cardiomyopathy was statistically significant in patients with personal (p = 0.043) and family history (p = 0.022) of cardiovascular disease. No other statistically significant associations were found with other independent variables, including dose or duration of velcade/steroid use. Multi-variate analysis is not reported due to low sample size. Conclusions: Our institution treats a diverse population with a higher multi-morbidity burden as opposed to physically and medically fit population recruited into clinical trials. This gives us an opportunity to bring forward some real world data. Given the higher incidence of cardiac toxicity in our study as opposed to current available data, we propose that high-risk patients with personal or family history of cardiovascular disease could benefit from closer monitoring during the course of their treatment with Velcade.