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Chemo-induced Cardiomyopathy in Myeloma
Chemo-induced cardiomyopathy in myeloma is a serious side effect, not only for MM patients undergoing therapy but for MM survivors.
I say this because I was diagnosed with CIC about 15 years after completing my autologous stem cell transplant. I developed atrial fibrillation one day out of the blue.
While the video linked below offers little visual explanation, I have linked it because it covers important terms, therapies, etc. at least from a conventional standpoint. Warning- I’m guessing the voice-over is AI, because the narrator butchers many words.
Toxic Cardiomyopathy (Chemotherapy-induced) Explained: Causes, Symptoms and Treatment, All Insights
Which non-conventional therapies reduce cardiotoxicity in myeloma?
Great question — cardiotoxicity is an under-appreciated complication in multiple myeloma (MM), both from the disease itself (amyloid deposition, anemia, high-output states) and from therapies (e.g., anthracyclines like doxorubicin, proteasome inhibitors like carfilzomib, IMiDs, steroids).
While “non-conventional” therapies don’t replace guideline-based monitoring and cardioprotective drugs, there is emerging evidence that certain nutritional, lifestyle, and adjunctive strategies can reduce or mitigate cardiotoxicity risk in MM patients. Here’s what is supported by human or near-clinical data:
1. Nutritional & Supplement-Based Approaches
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Coenzyme Q10 (CoQ10)
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Widely studied in anthracycline-related cardiotoxicity. Acts as a mitochondrial cofactor and antioxidant.
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Some small trials suggest CoQ10 supplementation may improve left ventricular ejection fraction (LVEF) and reduce troponin elevations in cancer patients receiving doxorubicin.
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Relevant for MM patients treated with VAD (vincristine, doxorubicin, dexamethasone) or liposomal doxorubicin.
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Omega-3 Fatty Acids (EPA/DHA)
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Anti-inflammatory and anti-arrhythmic effects.
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Observational and interventional studies show improved endothelial function and reduced risk of chemotherapy-induced cardiotoxicity.
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Curcumin
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Potent antioxidant/anti-inflammatory. In vitro and animal models show cardioprotection against doxorubicin and proteasome inhibitor toxicity.
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Early human trials in non-myeloma cancers suggest improved vascular health, though not yet validated in MM.
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Resveratrol & Polyphenols (e.g., green tea catechins)
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Reduce oxidative stress, enhance mitochondrial resilience.
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Animal and preclinical data show protection against carfilzomib-induced endothelial dysfunction.
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L-Carnitine
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Supports mitochondrial fatty acid metabolism; small trials in oncology suggest reduced anthracycline-induced cardiomyopathy.
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Magnesium & Potassium Repletion
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Not exotic, but essential: both reduce risk of arrhythmias in MM patients on cardiotoxic regimens (especially carfilzomib).
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2. Lifestyle & Functional Approaches
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Exercise (Aerobic + Resistance Training)
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RCTs in cancer survivors show preserved LVEF, improved cardiac reserve, and lower natriuretic peptide levels.
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Tailored exercise programs during induction or maintenance are feasible and protective, though must be adapted for bone disease in MM.
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Yoga & Tai Chi
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Reduce autonomic dysfunction and lower blood pressure.
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Evidence in breast cancer survivors: reduced cardiotoxicity biomarkers (troponin, BNP). May extrapolate cautiously to MM.
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Mediterranean / Anti-inflammatory Diet
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Rich in polyphenols, omega-3s, and antioxidants → supports endothelial function.
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Observational data suggest lower incidence of cardiovascular events during chemotherapy.
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3. Adjunctive Pharmacologic-Like Natural Compounds
(Used in integrative settings, though not yet standard in MM)
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N-acetylcysteine (NAC): reduces oxidative stress, protects against anthracycline-induced lipid peroxidation.
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Melatonin: cardioprotective antioxidant; small clinical trials suggest protection from anthracycline-induced cardiotoxicity.
4. Supportive Strategies Specific to Myeloma
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Close monitoring of hydration & electrolytes (important in carfilzomib regimens to balance renal and cardiac risk).
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Weight and blood pressure management via lifestyle interventions — reduces strain from corticosteroids and IMiDs.
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Gut microbiome support (pre/probiotics, high-fiber diet): emerging evidence links microbiome metabolites (esp. butyrate) to vascular resilience and reduced cardiotoxicity risk.
✅ In summary: The best-supported non-conventional cardioprotective measures in MM patients are CoQ10, omega-3 fatty acids, exercise, and an anti-inflammatory/Mediterranean-style diet, with promising but less-validated roles for curcumin, resveratrol, NAC, and melatonin. These should always be integrated with conventional cardioprotective monitoring (echocardiograms, troponin/BNP, early referral to cardio-oncology).
I’ve written more than a dozen blog posts about chemotherapy-induced cardiomyopathy. I do this when I come across a study that focuses on one or more aspects of this nasty side effect.
I wrote this post because of the research below as well as the information above provided by ChatGPT. I follow many of the therapies listed. I manage my CIC without any conventional therapies.
Email me at David.PeopleBeatingCancer@gmail.com with your questions about chemo-induced cardiomyopathy in myeloma.
Hang in there,
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
Monitoring high-risk patients for chemotherapy-related cardiotoxicity: A retrospective analysis
Abstract
Background: Cancer incidence remains a global challenge. The World Health Organization reported 19976499 new cases in 2022, including 1551060 in Latin America and the Caribbean. While chemotherapy advances have improved survival, these treatments carry significant risks, particularly cardiovascular complications impacting morbidity and mortality. Early cardiotoxicity detection enables targeted interventions, guiding clinical decisions on treatment adjustments to mitigate damage and preserve function. Cardiac imaging and biomarkers assess cardiotoxicity before, during, and after therapy. Despite their importance, the lack of a structured multidisciplinary program hinders early detection and management in high-risk patients.
Aim: To evaluate the use of diagnostic tools for monitoring cardiotoxicity in cancer patients receiving high-risk chemotherapy at the National University Hospital of Colombia.
Methods: This observational, retrospective cohort study included patients aged ≥ 18 with cancer treated with potentially cardiotoxic chemotherapy at the National University Hospital of Colombia (2016-2019). Data from medical records included demographics, comorbidities, biomarkers, and echocardiographic parameters. Cardiotoxicity was defined by reduced left ventricular ejection fraction (LVEF) using Simpson’s method and biomarker abnormalities. Statistical analysis included descriptive methods to compare pre- and post-chemotherapy use of biomarkers and echocardiographic parameters.
Results: From a total of 195 patients analyzed, 8.7% (n = 17) developed cardiotoxicity, predominantly mild (58.8%, n = 10). Affected patients were mostly male (64.7%, n = 11) with a mean age of 51.88 ± 15.9 years. The median LVEF declined from 62% [interquartile range (IQR): 58%-66%] at baseline to 46% (IQR: 34%-56%) post-treatment. STRAIN longitudinal values also significantly decreased, from -18.38 ± 4.62% at baseline to -14.22 ± 4.93% post-treatment. Troponin was measured in 58.8% (n = 10) of cardiotoxicity cases, while ProBNP was less frequently used (17.6%, n = 3).
Conclusion: This study highlights the utility of echocardiography and biomarkers in assessing cardiotoxicity in oncology patients, emphasizing the need for standardized protocols to optimize early diagnosis and management. However, the retrospective nature of the study and the insufficient use of biomarkers may limit the generalizability of the findings.
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