Increased risk of new onset of arterial hypertension in patients with multiple myeloma treated with carlfizomib

Objective: Several new drugs are used nowadays to treat multiple myeloma (MM). Some drugs are loaded with an increased risk of developing cardiovascular diseases. Carfilzomib (K), a proteasome inhibitor, is well recognized to cause cardiovascular side effects. Also, arterial hypertension is a main factor leading to LV dysfunction. Purpose is to evaluate if patients who underwent the carfilzomib treatment may present an increased incidence of arterial hypertension. Design and method: We evaluated 34 patients (group K, 20M, 14F, aged 65.87±5.98) treated with carfilzomib: 25 patients were given 56 mg/m 2 (group 1, 14M, 9F, aged 67.30±5.98) while 9 27 mg/m 2 (group 2, 6M, 3F, aged 63.00±5.39). As controls, we recruited 34 patients (16M, 18F, aged 69.80±9.13) who underwent in the same period the MM treatment without carfilzomib. Hypertension was identified as new onset of disease or worsening of disease (need double the dose used, add a new drug, or no pressure control in at least 3 drugs treatments). Results: At baseline, the controls presented an increased arterial hypertension rate (76.47% vs group K 47.06%, p = 0.07). There was no difference in any other CVD risk factor. There was no difference in LV mass, volumes and ejection fraction. The group K experienced an increased incidence of arterial hypertension compared to controls (controls 0% vs group K 41.17 %, p = 0.001). This result was not related to the drug dose. Finally, there was no difference in mortality between the two groups also by analysing the CV death. Conclusions: Carfilzomib is a potent and effective drug in MM. Its cardiovascular toxicity relates to a vascular and endothelial damage leading to a new onset of arterial hypertension. This observation may be useful in preventing evolution of the CV dysfunction in survivors and long survivors MM patients. Also, it may be important for studies of vascular damage in arterial hypertension pathophysiology.