Clinical Analysis of Cardiac Involvement in 53 Patients With Multiple Myeloma Coexistent With Light Chain Amyloidosis

Abstract

We analyzed 53 patients with multiple myeloma coexistent with light chain amyloidosis to evaluate the influence on survival. Of them, 22 patients were treated with a bortezomib-based regimen, and the response rate was more effective than the other. The median overall survival for the total cohort was 12 months. Cardiac involvement significantly adversely affected survival (6 vs. 40 months), as did systolic blood pressure (< 90 mmHg, 3 vs. 8.5 months). Cardiovascular dysfunction caused by light chain amyloidosis is a major determinant of shortening survival for the total cohort. Background: We identified 53 patients with multiple myeloma (MM) who had biopsy evidence of light chain amyloidosis (AL), and studied their cardiac involvement and outcomes. Patients and Methods: Our cohort consisted of 53 patients in whom MM and AL were initially diagnosed from July 1, 2006 to June 30, 2016.The diagnosis of MM required > 10% of clonal plasma cells in bone marrow and 1 of the CRAB symptoms, meanwhile, the diagnosis of AL must meet pathologic diagnostic criteria and monoclonal immunoglobulin light chain. Echocardiograms and cardiac biomarker such as N terminal pro B-type natriuretic peptide was used for evaluation of cardiac damage on the baseline and before every cycle of the regimen. Results: There were 36 men and 17 women with a median age of 59 years; their main organ involvement was kidney (72%) and heart (62%). Of these, 22 patients were treated with a bortezomibbased regimen, and the response rate was more effective than the other 21 patients who received nonbortezomib-based regimens (64% vs. 29%). The median overall survival (OS) for the total cohort was 12 months (P < .05). The median OS of the MM cohort with International Staging System stage I and II together was 34 months, which was longer than that of patients with stage III of 8 months. The median OS in Mayo stages I, II, and III was 38, 8, and 1 months, respectively (P < .05). Cardiac involvement significantly adversely affected survival (6 vs. 40 months), as did systolic blood pressure (< 90 mmHg, 3 vs. 8.5 months). Conclusions: Patients coexistent with MM and AL is rare; AL has a negative impact on survival for the total cohort. Especially, cardiovascular dysfunction caused by AL maybe a major determinant of shortening survival.

Mechanisms and Potential Treatment Options of Heart Failure in Patients With Multiple Myeloma

“…In a recent study conducted by Yu et al, it was confirmed that among multiple myeloma patients with AL amyloidosis, involvement of the heart had an adverse effect on survival (six months vs. 40 months). This study supported the idea that heart failure caused by AL amyloidosis is the main factor for decreasing survival among this group of patients [ 57 ].…”

Clinical features and prognosis of multiple myeloma and orbital extramedullary disease: Seven cases report and review of literature

“…Generally, for every 1-2 courses of induced chemotherapy, serum or urine M protein was tested to determine the efficacy of the treatment, and it usually takes 6-9 cycles to carry out induced remission. Patient response was evaluated by M protein and CT or MRI based on the sites of extramedullary invasion[ 7 ].…”

Light-Chain Cardiac Amyloidosis: A Case Report and Review of the Literature

“…Cardiovascular dysfunction caused by AL maybe a major determinant of reduced survival in patients with multiple myeloma (32). Early diagnosis of cardiac amyloidosis can lead to prolonged survival (33).…”