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December 9, 2021CureusOpen Access

Bortezomib-Induced Reversible Cardiomyopathy: Recovered with Guideline-Directed Medical Therapy

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Key result

Bortezomib cessation and GDMT normalize or improve cardiac function in bortezomib-induced cardiomyopathy.

  • n=3

Why the study?

Bortezomib-induced cardiotoxicity in monotherapy and combination treatments is not well described in the literature.

Does discontinuation of bortezomib and initiation of guideline-directed medical therapy improve cardiac function in patients with bortezomib-induced cardiomyopathy?

Population

3 patients with hematologic malignancies treated with bortezomib

Comparison

Discontinuation of bortezomib and initiation of guideline-directed medical therapy

Design

Case series

Follow-up

Median 5 months (range 3-13)

Authors

SSSwethika SundaravelAtrium Health Wake Forest BaptistRMRosalyn MararWinnMedMAMuhannad AbbasiWinnMed

Discussion

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Member takes

Overview

May support reversibility of bortezomib cardiomyopathy with discontinuation plus GDMT; leaves open confirmation in prospective studies.

Study Design

Type

Case Report (n=3)

Multicenter

No

Structured PICO

Does discontinuation of bortezomib and initiation of guideline-directed medical therapy improve cardiac function in patients with bortezomib-induced cardiomyopathy?

P
Population
3 patients (median age 55 years, 33% female) with multiple myeloma or mantle cell lymphoma who developed bortezomib-induced cardiomyopathy and were treated with guideline-directed medical therapy.
I
Intervention
Discontinuation of bortezomib and initiation of guideline-directed medical therapy (GDMT) for heart failure (beta-blocker and ACE inhibitor).
O
Outcome
Improvement or normalization of cardiac function (LVEF and global longitudinal strain) and duration to recovery.surrogate

Bortezomib-induced cardiomyopathy is potentially reversible with prompt discontinuation of the drug and early initiation of guideline-directed medical therapy for heart failure.

Limitations

  • Small sample size of only 3 patients.
  • Lack of routine pre-treatment echocardiograms to establish baseline global longitudinal strain.
  • Orthostatic hypotension from bortezomib-induced autonomic neuropathy limited the ability to titrate GDMT to target doses.
  • Small sample size (case series)
  • Lack of routine pre-treatment echocardiogram to use GLS trend for subclinical detection
  • Orthostatic hypotension from BTZ-induced autonomic neuropathy limited GDMT titration

Cite This Study

Sundaravel et al. (2021) conducted a case report in Bortezomib-induced cardiomyopathy (n=3). Guideline-Directed Medical Therapy (GDMT) and Bortezomib discontinuation was evaluated on Improvement or normalization of cardiac function (LVEF and GLS). Discontinuation of bortezomib and initiation of guideline-directed medical therapy resulted in improvement or normalization of cardiac function in all three patients with bortezomib-induced cardiomyopathy.

synapsesocial.com/papers/6abe518cb101bbff5e78dec8https://doi.org/10.7759/cureus.20295

Topics

Heart failureHFrEF treatment
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