Bortezomib-Induced Congestive Cardiac Failure in a Patient with Multiple Myeloma
Bortezomib-Induced Congestive Cardiac Failure in a Patient with Multiple Myeloma
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DOI：
10.1007/s12012-011-9146-7
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发表时间：
2012-06-01
影响因子：
3.2
通讯作者：
Sethi, Sumit
中科院分区：
文献类型：
--
作者：
Gupta, Ajay;Pandey, Anvita;Sethi, Sumit
众所周知，硼替佐米治疗与神经系统副作用和血小板减少有关。然而，它对心脏的副作用并不为人所知。患者为70岁女性，既往有心肌梗死史，后行冠状动脉支架植入术，确诊为多发性骨髓瘤IIIa期。她是从INJ开始的。波特佐米(1.3 mg/m(2))和Tab。地塞米松40毫克，每周一次。她对治疗表现出良好的反应。在服用第22剂Bortezomib三天后，她因充血性心力衰竭而来到医院。超声心动图显示左心室射血分数从治疗前的45-50%下降到25%。1例因疑似缺血性病因继发左心衰而接受内科治疗。冠状动脉造影术显示非危重冠状动脉疾病，右冠状动脉和左回旋支支架未通。N末端前脑利钠肽(NT-proBNP)水平最初升高4,030 pg/ml(<；125 pg/ml)，一周后降至2,280 pg/ml，随后在接下来的两周内恢复正常。患者对治疗反应良好，随后出院。在接下来的3个月中，左心室射血功能恢复正常。硼替佐米的心脏副作用没有很好的报道。老年患者和那些先前存在心脏疾病的患者可能面临更高的心血管风险。因为一旦累积剂量达到20 mg/m(2)，这种风险就会增加，一旦达到这个阈值，就需要对患者进行更密切的监测。提高对这些心脏副作用的认识对于患者的安全是必要的。
Bortezomib therapy is known to be associated with neurological side effects and thrombocytopenia. Its cardiac side effects are however not well known. The patient, a 70-year-old woman, with a previous history of myocardial infarction and subsequent coronary stenting, was detected to have multiple myeloma stage IIIa. She was started on Inj. Bortezomib (1.3 mg/m(2)) and Tab. Dexamethasone 40 mg on a weekly basis. She showed good response to therapy. Three days after administration of the 22nd dose of bortezomib, she presented to the hospital with congestive cardiac failure. Echocardiography revealed a drop in the left ventricular ejection fraction from pretreatment levels of 45-50 to 25%. Patient was treated medically for left ventricular failure secondary to a suspected ischemic etiology. Coronary angiography revealed non-critical coronary artery disease with patent right coronary artery and left circumflex stents. The N-terminal pro-brain natriuretic peptide (NT-proBNP) levels that were initially raised 4,030 pg/ml (< 125 pg/ml) declined to 2,280 pg/ml a week later and subsequently normalized over the next 2 weeks. The patient responded well to treatment and was then discharged. The left ventricular ejection normalized over the next 3 months. Cardiac side effects of bortezomib are not well reported. Elderly patients and those with preexisting cardiac conditions could be at increased cardiovascular risk. Since this risk increases once a cumulative dose of 20 mg/m(2) has been administered, patients need to be monitored more intensively once this threshold has been attained. Increased awareness of these cardiac side effects is necessary for patients' safety.