Cardiovascular Issues in Multiple Myeloma: Clinical Implications of the Double Burden of Treatment and Immunoglobulin Light Chain Amyloidosis: A Narrative Review
Main Article Content
Abstract
Multiple myeloma (MM) represents about 0.9% of global cancer cases, with a steadily rising incidence. As the treatment landscape for MM continues to develop, with a growing range of therapeutic options. Advances in MM treatment have improved patient outcomes. However, cardiovascular (CV) complication risk has emerged as a major concern. Patients with MM are at increased risk for CV complications secondary to advanced age and disease-related symptoms such as renal impairment, anemia, and hyperviscosity syndrome. Moreover, MM patients also face a heightened risk of thrombosis. CV complications among MM patients are associated with patient-specific factors, MM-related factors, and treatment-related toxicity. Treatment-Related Factors: proteasome inhibitor, immunomodulatory drugs, chimeric antigen receptor T-cell therapy, bispecific antibodies, transplantation, etc. Understanding the specific CV complications associated with each therapeutic agent and their potential onset is also essential. Prior to initiating treatment, assessing the risk of CV complications is crucial to enhance patient safety and minimize treatment-related adverse events, which have a prognostic impact.
Another critical issue in CV complications is cardiac amyloidosis (CA) resulting from immunoglobulin light chain (AL) amyloidosis, which often coexists with MM and leads to a significant burden of disease. Early detection of CA allows targeted therapeutic strategies to be applied, ultimately improving patient outcomes. Diagnostic efforts should focus on identifying findings suggesting amyloidosis and confirming the diagnosis through comprehensive assessments. It is important to keep in mind that heart failure and arrhythmias account for a significant proportion of early deaths in MM patients with CA. Treatment for CA primarily involves two approaches: managing heart failure and reducing light chain production.
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