CARDIOVASCULAR EVENTS IN MULTIPLE MYELOMA PATIENTS TREATED WITH PROTEASOME INHIBITORS (LITERATURE REVIEW)
DOI:
https://doi.org/10.32689/2663-0672-2026-1-5Keywords:
multiple myeloma, proteasome inhibitors, cardiotoxicity, carfilzomib, bortezomib, BNPAbstract
Background. This narrative review summarizes clinical experience with proteasome inhibitors in multiple myeloma, with a particular focus on the pattern of cardiovascular adverse events (CVAEs) observed during treatment. We highlight the molecular basis of proteasome inhibition in malignant plasma cells and discuss how these pathways may inadvertently damage cardiomyocytes and endothelial cells. In addition, we provide an updated overview of available strategies for the detection, prevention and management of proteasome inhibitor-related cardiotoxicity and indicate areas where current practice can be improved. Purpose. To collate and critically appraise data on CVAEs in patients with multiple myeloma treated with proteasome inhibitors and to summarize practical recommendations for surveillance and clinical management. Materials and Methods. To collate and critically appraise data on CVAEs in patients with multiple myeloma treated with proteasome inhibitors and to summarize practical recommendations for surveillance and clinical management. Results. Patients with pre-existing cardiovascular disease and those exposed to carfilzomib exhibit the highest burden of CVAEs, most commonly hypertension, heart failure and arrhythmias. The proposed mechanisms include direct inhibition of proteasomes in cardiomyocytes, endothelial dysfunction and impaired autophagy. Routine care pathways should incorporate baseline cardiovascular risk assessment, early BNP / NT-proBNP monitoring, individualized echocardiographic follow-up and timely adjustment of drug dose and infusion schedules. Conclusions. Harmonized prevention and surveillance algorithms and close collaboration within cardio-onco-hematology teams are essential to limit CVAEs while maintaining the therapeutic efficacy of proteasome inhibitor–based regimens in multiple myeloma.
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