Abstract 18842: Left Ventricular Dysfunction Development After Bortezomib Treatment in Patients With Oncologic Diagnoses
Background: Bortezomib (VELCADE ®) has been considered a milestone in the treatment of myeloma. Within three years of its approval by the Food and Drug Administration, the first case of severe reversible cardiac failure surfaced in 2006.
Objective: Identify the incidence of left ventricular dysfunction in patients that received bortezomib.
Methods: We identified 160 patients diagnosed with multiple myeloma, mantle cell lymphoma, plasmocytoma, lymphoma, Waldenstrom’s macroglobulinemia and leukemia, retrospectively. Patients were distributed according to treatment received, in 4 cohorts. Left ventricular dysfunction (LVD) was defined as LVEF<55% by echocardiography. Descriptive analysis was used to identify the incidence of left ventricular dysfunction. CAD evaluation was done by either stress testing or coronary angiogram.
Results: One hundred and sixty patients were identified and distributed in 4 cohorts, according to the treatment received: bortezomib (n=74); bortezomib and adriamycin (n=27); adriamycin (n=25) and melphalan (n=34). The mean age was 58 ±13 years and at least 54 % (n=87) were males. Patients were followed in a 21-day to 7-year time-frame period. LVD was present in 20% (15/74); 22% (6/27), 28% (7/25) and 18% (6/34) of patients that received bortezomib, bortezomib and adriamycin, adriamycin and melphalan, respectively. Adriamycin was give prior to bortezomib in combined treatment cohort and before melphalan in the last cohort. Of those who developed LVD at least we identified 5 patients who had CAD (2, 1,1 and 1 for each cohort, accordingly).
Conclusion: Bortezomib may be associated with new onset left ventricular dysfunction when given as first line chemotherapy in the treatment of multiple myeloma, mantle cell lymphoma, plasmocytoma, lymphoma, Waldenstrom’s macroglobulinemia and leukemia. It may also potentiate the cardiotoxicity of Adriamycin when used subsequently.
Figure. Incidence of left ventricular systolic dysfunction.
- © 2013 by American Heart Association, Inc.