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Incidence and risk of cardiac toxicities in patients with relapsed and refractory multiple myeloma treated with carfilzomib

Authors Zhao F, Yang B, Wang J, Zhang R, Liu J, Yin F, Xu W, He C

Received 14 December 2017

Accepted for publication 12 January 2018

Published 30 May 2018 Volume 2018:12 Pages 1525—1531


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Anastasios Lymperopoulos

Fang Zhao,1 Bo Yang,2 Juan Wang,1 Rui Zhang,1 Jing Liu,1 Fenglei Yin,1 Weixing Xu,1 Chunyuan He1

1Department of Hematology, Cangzhou Central Hospital, Cangzhou, People’s Republic of China; 2Department of Thoracic Surgery, Cangzhou Central Hospital, Cangzhou, People’s Republic of China

Purpose: Carfilzomib has been approved for use in relapsed and refractory multiple myeloma (RRMM). Cardiac toxicities have been reported with the use of carfilzomib. We aimed to determine the overall incidence and risk of cardiac toxicities in RRMM patients treated with carfilzomib using a meta-analysis.
Methods: We searched several databases for relevant articles. Prospective trials evaluating carfilzomib in RRMM patients with adequate data on cardiac toxicities were included for analysis. Pooled incidence, Peto ORs, and 95% CIs were calculated according to the heterogeneity of selected studies.
Results: A total of 2,607 RRMM patients from eight prospective trials were included. The pooled incidence of all-grade congestive heart failure (CHF) and ischemic heart disease (IHD) related to carfilzomib in RRMM patients was 5.5% (95% CI: 4.3%–6.9%) and 2.7% (95% CI: 1.1%–6.7%), respectively. In addition, the use of carfilzomib significantly increased all-grade (Peto OR 2.33, 95% CI: 1.56–3.48, p<0.001) and high-grade (Peto OR 3.22, 95% CI: 1.84–5.61, p<0.001) CHF when compared to controls, whereas there was no significantly increased risk of developing all-grade (Peto OR 1.31, 95% CI: 0.79–2.18, p=0.30) and high-grade (Peto OR 1.41, 95% CI: 0.73–2.72, p=0.31) IHD in RRMM patients receiving carfilzomib.
Conclusion: The use of carfilzomib in RRMM patients significantly increases the risk of developing CHF but not IHD. Clinicians should be cautious about the risk of CHF associated with carfilzomib to maximize the benefits and minimize the toxicities.

Keywords: carfilzomib, cardiac toxicities, clinical trials, meta-analysis, congestive heart failure, ischemic heart disease

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