新诊断多发性骨髓瘤患者心血管不良事件的真实世界分析OA

Objective To evaluate the characteristics,related therapeutic regimens,risk factors of cardiovascular adverse events(CVAEs)and prognosis in the current therapy of newly diagnosed multiple myeloma(NDMM)patients in China.Methods A retrospective observational study was performed on patients with NDMM treated at Zhongshan Hospital,Fudan University,from January 2013 to October 2021.The propensity score matching at a ratio of 1∶1 was employed to balance baseline confounders between the therapeutic group and the control group,and CVAEs incidences were compared between the corresponding groups.Independent risk factors for CVAEs were identified through Fine-Gray competing risk regression model.Kaplan-Meier survival curves and log-rank tests were used to assess overall survival and progression-free survival of patients.Results A total of 829 patients with NDMM were analyzed,with a median of 33.1 months of follow-up for survivors.CVAEs occurred in 65 patients(7.8%)during first-line treatment,and a total of 74 events were recorded,with 52.7%grade 3 or greater in severity.Arrhythmia(particularly atrial fibrillation),thrombotic event(TE),and heart failure were the most common types.The median time from treatment to the first occurrence of CVAEs was 26 days,while the medium occurrence time of TE was later than the other events(76 d vs 19 d,P=0.003).The exposure to immunomodulatory drugs was related to a higher incidence of TEs,whereas other therapeutic regimens,including bortezomib,didn't show the effect of cardiovascular toxicity.Results of multivariate analysis showed that Eastern Cooperative Oncology Group performance status＞2,symptomatic heart diseases within three months before treatment,and estimated glomerular filtration rate≤50 mL•min-1•(1.73 m2)-1 were independent risk factors for CVAEs.Compared with patients without CVAE,patients who experienced CVAEs had significantly inferior progression-free survival and overall survival,and higher cardiovascular mortality(P＜0.001).Conclusions The incidence of CVAE is relatively high during first-line treatment in NDMM patients,and the prognosis of CVAE patients is poor.The risk of CVAE is significantly increased in patients with underlying cardiovascular diseases.