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Multiple Myeloma Chemotherapy- Carfilzomib-Induced Heart Damage

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Carfilzomib was associated with a significant incidence of cardiovascular adverse events (in multiple myeloma), with higher rates seen with higher doses of carfilzomib.

When thinking about multiple myeloma chemotherapy and heart damage it important to understand that the key is the condition of your heart before undergoing those chemotherapy regimens known to cause heart damage. As the saying goes, an ounce of prevention is worth a pound of cure.

To say that over 18 percent of patients undergoing carfilzomib experienced heart damage overlooks what I have come to believe is the central issue. The risk of damage to the healthy heart is less than the risk of heart damage to a weak heart.

While this may sound obvious to you the next step is to figure our how to strengthen the heart of a cancer patient about to undergo, undergoing or has already undergone carfilzomib.

  • Nutrition,
  • Supplementation,
  • Lifestyle, etc.

all can contribute to the heart’s well-being before, during and after chemotherapy.

Please watch the video below to learn more about the evidence-based, integrative therapies to combat treatment side effects and enhance your chemotherapy.

I am a long-term myeloma survivor who underwent a chemotherapy regimen known for possible heart damage. I underwent adiamycin (doxorubacin) as one of my induction therapies in early 1995. I developed chronic atrial fibrillation in the fall of 2010. I now exercise moderately but regularly, supplement with heart-healthy supplements and consume a heart healthy diet.

Here is my Multiple Myeloma story. I’ve learned a lot about managing multiple myeloma since my diagnosis in 1994. Though chemotherapy may be a necessary evil for the MM patient, it is important to understand that you can take evidence-based action against the collateral damage caused by chemotherapy.

If you have any questions scroll down the page, post a question or comment and I will reply to you ASAP.

Thank you,

David Emerson

  • MM Survivor
  • MM Cancer Coach
  • Director PeopleBeatingCancer

Recommended Reading:

Carfilzomib can lead to cardiovascular toxicity in multiple myeloma patients

“The proteasome inhibitor carfilzomib has taken on an increasing role in the treatment of multiple myeloma, but new research shows the therapy comes with the risk of cardiovascular problems in a higher than expected percentage of patients…

Researchers gathered data from 24 studies reported from 2007 through 2017, which included information on 2,594 MM patients. They found 18.1 percent of patients who took carfilzomib experienced CVAE, with 8.2 percent of those cases being grade three or higher, meaning they are categorized as severe. For comparison, a similar review of bortezomib, another proteasome inhibitor, found just 3.8 percent of patients experienced CVAE and only 2.3 percent were severe…

Researchers say these findings are particularly important since there are already overlapping risk factors for both MM and cardiovascular diseases, such as older age and obesity. Previous studies have shown nearly two-thirds of MM patients had cardiovascular disease at baseline, and 70 percent experienced cardiovascular events within six years…

Carfilzomib-Associated Cardiovascular Adverse Events

A Systematic Review and Meta-analysis

Importance  Cardiovascular adverse events (CVAE) with carfilzomib in patients with multiple myeloma can be potentially life-threatening and remain incompletely characterized. We performed the first systematic review and meta-analysis of carfilzomib-associated CVAE.

Main Outcomes and Measures  Cardiovascular adverse events were defined as heart failure, hypertension, ischemia, and arrhythmia. All-grade and grades 3 or higher AEs and study characteristics were recorded.

Results  A total of 514 studies were assessed for eligibility. Of those, 24 studies were eligible, including a total of 2594 patients with multiple myeloma. All-grade and grades 3 and higher CVAE were seen in 617 (18.1%) and 274 (8.2%), respectively. Phase 2 or 3 studies and carfilzomib doses of 45 mg/m2 or higher were associated with high-grade CVAE. Median age older than 65 years, prior myeloma therapies, and concurrent myeloma therapies were not associated with CVAE. For the 3 randomized clinical trials, the summary relative risk of all-grade and grade 3 or higher CVAE for patients receiving carfilzomib compared with non-carfilzomib-receiving control patients were 1.8 and 2.2, respectively.

Conclusions and Relevance  Carfilzomib was associated with a significant incidence of CVAE, with higher rates seen with higher doses of carfilzomib. Phase 1 studies may be under-detecting CVAE. Future studies are needed to identify patients at high risk for CVAE, develop optimal monitoring strategies, and explore strategies to mitigate these risks.”


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Robert says 5 years ago

I received carfilzomib as induction therapy prior to my stem cell transplant and afterward as maintenance. I now have severe right atrial enlargement as diagnosed by an echocardiogram. I also have clinical symptoms of fatigue.

What concerns me most is that throughout this period I was being monitored by my cardiologist, who conducted regularly scheduled echocardiograms, because I have a history of heart disease. These tests showed the enlargement beginning within a few months of my starting carfilzomib. And yet I was not informed of this effect, and even now my current cardiologist denies a connection to the carfilzomib.

What is one to do if one’s doctors do not follow protocols in administering this dangerous drug? I cannot be my own doctor and doctors seem to be administering toxic multiple myeloma drugs without taking precautions to safeguard their patients’ health.

    David Emerson says 5 years ago

    Hi Robert,

    I am sorry to learn of both your MM diagnosis as well as your heart damage. The challenge that we MMers face when talking about short, long-term and late stage side effects is the very issue are trying to understand. All FDA approved MM chemotherapy regimens are toxic. The challenge we face is how we each will be effected by this toxicity.

    Your choices are several but email is limited. The two larger remedies are 1) including heart healthy nutritional supplements to your daily routine (CoQ10, mushrooms, etc.) though while these therapies may be researched to be heart healthy, they may not be FDA researched and approved.

    Re your cardiologist denying a connection between Carfilzomib and heart damage, your choices are few. Your cardiologist may justify any number of side effects from chemotherapy (induction and your ASCT) because it is possible that several of your past chemo regimens cause heart damage. I would consider changing cardiologists to someone who understand your issues more thoroughly.

    Last but not least, I experienced chemo-induced heart damage (chronic atrial fibrillation) and after much research decided to live with chronic afib without FDA approved drugs. I manage my heart through supplementation, lifestyle, nutrition etc.

    I admit that I am taking on risks I have concluded that I am also reducing many risks by not taking the many medications that come with chemo-induced heart damage.

    Good luck,

    David Emerson

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LORRAINE says 6 years ago

My husband has MM for the past 7 years as a result of the WTC. He had a lot of side effects from the Carfilzomib. they kept lowering the dose. He has been in and out of atrial fib for the past treatment of other chemos. It is always a struggle for him. I worried about his heart and kept checking his labs. I worry about no other treatment available for MM if the Carf is no longer good for his heart. He had a Stem cell transplant in 2015…only a partial remission. His numbers are ok for now but climbing.

    David Emerson says 6 years ago

    Hi Lorraine-

    I am sorry to learn of your husband’s MM as well as his side effects from his chemo. Several things.

    While there are evidence-based therapies cited to be protective for the heart damage caused by other chemotherapies, Carfilzomib is relatively new and therefore less-well researched. Therefore I cannot reference studies to support my recommendations. Further, the evidence-based therapies that I refer to such as CoQ10 and curcumin have not been researched and approved by the FDA. Therefore your husband’s oncologist will not know about them.

    Having said the above, here is what I do for my chemo-induced heart damage. I take several heart healthy supplements daily, exercise moderately but frequently, and eat a heart healthy diet. Dark chocolate is a treat once you get used to it’s bitter taste…

    As for your husband running out of therapy options I encourage you both to consider the mm cancer coaching program that I researched and created based on my own mm experiences. I realize I sound self-serving but I can’t help that.

    Watch the free MM CC webinar to learn more-

    Let me know if you have any questions. Hang in there…


    David Emerson

    PS- my guess is that your husband was a first responder to the WTC on 9/11. Thank you both very much. I hope that you and or your husband have applied for the compensation mandated for first responders who have contracted blood cancers as a result. Increased risk of blood cancers such as leukemia, NHL and MM due to 9/11 is pretty well-documented and you both deserve compensation.

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