Induction Chemotherapy-Related Covert Cardiac Remodeling in Pre-Autologous Hematopoietic Stem Cell Transplantation for Multiple Myeloma: A Retrospective Observational Study

IF 2.9 2区医学 Q2 ONCOLOGY

Cancer Medicine Pub Date : 2024-11-12 DOI:10.1002/cam4.70329

Chang Dai, Weidong Lin, Fangzhou Liu, Xin Chen, Yuhan Chen, Yu Jiang, Jiaojiao Bai, Yidong Lv, Jianhong Zheng, Hai Deng, Xin Du, Shulin Wu, Yumei Xue

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Abstract

Background

Autologous hematopoietic stem cell transplantation (ASCT) has emerged as a cornerstone in multiple myeloma (MM) management, offering the prospect of prolonged disease control. However, the induction chemotherapy drugs required prior to ASCT carry cardiovascular toxicity (CVT), potentially leading to a range of cardiovascular complications.

Methods and Results

This retrospective observational study, conducted at Guangdong Provincial People's Hospital from January 2020 to December 2023, analyzed 47 of the initial 173 patients who met the criteria. The cohort, comprising 22 males (46.81%) and 25 females (53.19%), had a mean age of 55.68 ± 11.38 years. They underwent various induction chemotherapy regimens, receiving a median of 5 (4–6) cycles of the course over an average duration of 7.10 ± 2.46 months. Before ASCT treatment following induction chemotherapy, echocardiographic findings indicated reductions in left ventricular end-systolic dimension, right atrial diameter, E-wave velocity, E/e' ratio, and the E/A ratio. The latter altered from a pretreatment value greater than 1 to posttreatment less than 1, marking diastolic dysfunction emergence or aggravation in 51.06% of patients. The electrocardiographic data indicate a reduced heart rate and prolonged P-wave duration and P-R duration, with an increase in arrhythmia incidence to 19.15% following induction chemotherapy.

Conclusion

Induction chemotherapy, administered prior to ASCT in patients with MM, can lead to the emergence or aggravation of cardiac diastolic dysfunction and increase the incidence of arrhythmic events. Therefore, it is crucial to emphasize the importance of balancing the benefits and risks of induction chemotherapy to maximize its efficacy while minimizing CVT.

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多发性骨髓瘤自体造血干细胞移植前诱导化疗相关的隐性心脏重塑：一项回顾性观察研究

背景：自体造血干细胞移植（ASCT）已成为多发性骨髓瘤（MM）治疗的基石，有望延长疾病控制时间。然而，自体造血干细胞移植前所需的诱导化疗药物具有心血管毒性（CVT），可能导致一系列心血管并发症：这项回顾性观察研究于 2020 年 1 月至 2023 年 12 月在广东省人民医院进行，分析了最初符合标准的 173 例患者中的 47 例。其中男性 22 人（46.81%），女性 25 人（53.19%），平均年龄（55.68±11.38）岁。他们接受了各种诱导化疗方案，中位数为5（4-6）个周期，平均疗程为（7.10±2.46）个月。诱导化疗后进行 ASCT 治疗前，超声心动图检查结果显示左心室收缩末期尺寸、右心房直径、E 波速度、E/e'比值和 E/A 比值均有所下降。后者从治疗前的大于 1 变为治疗后的小于 1，表明 51.06% 的患者出现或加重了舒张功能障碍。心电图数据显示，诱导化疗后心率降低，P波持续时间和P-R持续时间延长，心律失常发生率上升至19.15%：结论：MM 患者在接受 ASCT 之前进行诱导化疗，可导致心脏舒张功能障碍的出现或加重，并增加心律失常事件的发生率。因此，强调平衡诱导化疗的益处和风险的重要性至关重要，以便在最大限度地提高疗效的同时减少心律失常的发生。

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来源期刊

Cancer Medicine ONCOLOGY-

CiteScore

5.50

自引率

2.50%

发文量

907

审稿时长

19 weeks

期刊介绍： Cancer Medicine is a peer-reviewed, open access, interdisciplinary journal providing rapid publication of research from global biomedical researchers across the cancer sciences. The journal will consider submissions from all oncologic specialties, including, but not limited to, the following areas: Clinical Cancer Research Translational research ∙ clinical trials ∙ chemotherapy ∙ radiation therapy ∙ surgical therapy ∙ clinical observations ∙ clinical guidelines ∙ genetic consultation ∙ ethical considerations Cancer Biology: Molecular biology ∙ cellular biology ∙ molecular genetics ∙ genomics ∙ immunology ∙ epigenetics ∙ metabolic studies ∙ proteomics ∙ cytopathology ∙ carcinogenesis ∙ drug discovery and delivery. Cancer Prevention: Behavioral science ∙ psychosocial studies ∙ screening ∙ nutrition ∙ epidemiology and prevention ∙ community outreach. Bioinformatics: Gene expressions profiles ∙ gene regulation networks ∙ genome bioinformatics ∙ pathwayanalysis ∙ prognostic biomarkers. Cancer Medicine publishes original research articles, systematic reviews, meta-analyses, and research methods papers, along with invited editorials and commentaries. Original research papers must report well-conducted research with conclusions supported by the data presented in the paper.