Despite having quarterly monitoring (echocardiograms every three months and a stress test every year) showing no deterioration in my heart function while on Kyprolis alone and (later) Kyprolis and Darzalex (daratumumab), I have just experienced a heart attack.
The heart attack was detected at the ER by a blood test showing an elevation of troponin I, and confirmed by an angiogram. It turned out to be a minor one, and was treated with the insertion of a stent.
We (my oncologist and cardiologist included) don't know for sure whether this was due to Kyprolis, or perhaps was caused by my recent (last April) autologous stem cell transplant, or something else. It could also be entirely unrelated to any of my treatments for multiple myeloma, and have been caused by the simple progression of my atherosclerosis. In addition, my reading on Kyprolis' cardiovascular side effects point to heart failure effects rather than infarctions (heart attacks).
And yet, despite having been diagnosed with heart disease serious enough to warrant a quadruple bypass in 2003, I had never had a heart attack before this event.
I wonder if I am far from alone in my experience.
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MrPotatohead - Name: MrPotatohead
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: March, 2015
- Age at diagnosis: 65
Re: Kyprolis (carfilzomib) and the heart
Mr PH,
I'm so sorry to hear that you experienced a heart attack. following the use of Kyprolis.
In another thread about Kyprolis, I posted this link to an article, that you may have seen:
Ritts, AJ, et al, "Cardiac Considerations for Modern Multiple Myeloma Therapies", American College of Cardiology, July 7, 2016 (link to full text of review article)
It does talk about Kyprolis potentially causing "ischemic heart disease," which I guess can result in a heart attack.
How long have you been on Kyprolis? And how effective has it been lately?
You are right that it is hard to know whether Kyprolis had anything to do with it. In our experience, my husband's cardiologist has downplayed the potential effect of Kyprolis in causing my husband's heart failure, and said it was more likely related to his heart history (heart attack and bypass surgery in 2009). This may have to do with his point of view, dealing with heart patients and heart problems all day long. He also said the myeloma burden – having more platelets or larger platelets the heart has to deal with – may also contribute to heart issues.
For what it's worth, based on patient experiences recorded in this forum, we tend to believe my husband's heart failure was caused by Kyprolis. We would try to stay away from it in the future, but we may have to go back to it at some point.
Hope you feel better soon!
I'm so sorry to hear that you experienced a heart attack. following the use of Kyprolis.
In another thread about Kyprolis, I posted this link to an article, that you may have seen:
Ritts, AJ, et al, "Cardiac Considerations for Modern Multiple Myeloma Therapies", American College of Cardiology, July 7, 2016 (link to full text of review article)
It does talk about Kyprolis potentially causing "ischemic heart disease," which I guess can result in a heart attack.
How long have you been on Kyprolis? And how effective has it been lately?
You are right that it is hard to know whether Kyprolis had anything to do with it. In our experience, my husband's cardiologist has downplayed the potential effect of Kyprolis in causing my husband's heart failure, and said it was more likely related to his heart history (heart attack and bypass surgery in 2009). This may have to do with his point of view, dealing with heart patients and heart problems all day long. He also said the myeloma burden – having more platelets or larger platelets the heart has to deal with – may also contribute to heart issues.
For what it's worth, based on patient experiences recorded in this forum, we tend to believe my husband's heart failure was caused by Kyprolis. We would try to stay away from it in the future, but we may have to go back to it at some point.
Hope you feel better soon!
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Alizabeth - Name: Alizabeth
- Who do you know with myeloma?: Husband
- When were you/they diagnosed?: March 2016
- Age at diagnosis: 61
Re: Kyprolis (carfilzomib) and the heart
Hi Alizabeth,
Thank you very much for your post, your link to the other thread (which I remember reading at the time), and your link to the article.
I was on Kyprolis for a little less than a year. Initially, I took it only with dex, and it did reduce my kappa free light chains (I have kappa light chain myeloma, and my oncologist was monitoring me with the free light chain serum assay).
After about six months, my free light chains began to climb again, and so Darzalex (daratumumab) was added, causing the free light chains to once again decline.
But, again, after several months on Kyprolis, Darzalex, and dex, the decline in free light chains stopped.
At this point, my oncologist recommended a stem cell transplant (which I had been considering for quite some time). I decided to do it (had it in April) and the results were great: Blood tests and a bone marrow biopsy done after the transplant showed no detectable myeloma. But then I had the heart attack, a little less than three months after the transplant.
I am feeling OK now, except for my ever-present companions, bone pain and fatigue, which the transplant did nothing for,
I think I am in the same boat as your husband -- my cardiologist and oncologist feel I have enough other factors going on so that they are reluctant to attribute the heart attack to Kyprolis. But I am not so sure.
Because my myeloma is aggressive and I am refractory to both bortezomib (Velcade) and Revlimid (lenalidomide) and cannot tolerate Pomalyst (pomalidomide, Imnovid), my oncologist wants me on Kyprolis as a maintenance drug.
Perhaps I will ask my oncologist if I can drop the Kyprolis and try Darzalex for maintenance, or forego maintenance entirely. I just don't trust Kyprolis now.
Note: The time frames I gave above for my experience may not be exactly right; I am currently in Europe away from my notes. But they are close.
The one thing I can be thankful for concerning the heart attack is that it was a very minor one.
Thanks again for your excellent post!
Thank you very much for your post, your link to the other thread (which I remember reading at the time), and your link to the article.
I was on Kyprolis for a little less than a year. Initially, I took it only with dex, and it did reduce my kappa free light chains (I have kappa light chain myeloma, and my oncologist was monitoring me with the free light chain serum assay).
After about six months, my free light chains began to climb again, and so Darzalex (daratumumab) was added, causing the free light chains to once again decline.
But, again, after several months on Kyprolis, Darzalex, and dex, the decline in free light chains stopped.
At this point, my oncologist recommended a stem cell transplant (which I had been considering for quite some time). I decided to do it (had it in April) and the results were great: Blood tests and a bone marrow biopsy done after the transplant showed no detectable myeloma. But then I had the heart attack, a little less than three months after the transplant.
I am feeling OK now, except for my ever-present companions, bone pain and fatigue, which the transplant did nothing for,
I think I am in the same boat as your husband -- my cardiologist and oncologist feel I have enough other factors going on so that they are reluctant to attribute the heart attack to Kyprolis. But I am not so sure.
Because my myeloma is aggressive and I am refractory to both bortezomib (Velcade) and Revlimid (lenalidomide) and cannot tolerate Pomalyst (pomalidomide, Imnovid), my oncologist wants me on Kyprolis as a maintenance drug.
Perhaps I will ask my oncologist if I can drop the Kyprolis and try Darzalex for maintenance, or forego maintenance entirely. I just don't trust Kyprolis now.
Note: The time frames I gave above for my experience may not be exactly right; I am currently in Europe away from my notes. But they are close.
The one thing I can be thankful for concerning the heart attack is that it was a very minor one.
Thanks again for your excellent post!
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MrPotatohead - Name: MrPotatohead
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: March, 2015
- Age at diagnosis: 65
Re: Kyprolis (carfilzomib) and the heart
Here is another paper that has some relevant info:
Issa, ZA, et al, "Multiple Myeloma and Diabetes," ISRN Endocrinology, 2011 (full text of article)
See section #7 ("Multiple Myeloma and Cardiovascular Diseases). Apparently the myeloma itself is a risk factor for cardiovascular disease. The paper is from 2011, so it discusses bortezomib (Velcade) but not carfilzomib (Kyprolis). Still seems relevant.
There is also the risk to the heart imposed by the transplant. See:
"Stem Cell Transplants May Increase Risk Of Heart Disease," The Myeloma Beacon, Oct 16, 2012
Issa, ZA, et al, "Multiple Myeloma and Diabetes," ISRN Endocrinology, 2011 (full text of article)
See section #7 ("Multiple Myeloma and Cardiovascular Diseases). Apparently the myeloma itself is a risk factor for cardiovascular disease. The paper is from 2011, so it discusses bortezomib (Velcade) but not carfilzomib (Kyprolis). Still seems relevant.
There is also the risk to the heart imposed by the transplant. See:
"Stem Cell Transplants May Increase Risk Of Heart Disease," The Myeloma Beacon, Oct 16, 2012
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Alizabeth - Name: Alizabeth
- Who do you know with myeloma?: Husband
- When were you/they diagnosed?: March 2016
- Age at diagnosis: 61
Re: Kyprolis (carfilzomib) and the heart
Mr PH,
I am 70 days post auto transplant. Before transplant, my treatment was almost 4 rounds of Kyprolis, Pomalyst, and dex, which really brought my numbers down. I say almost 4 rounds because I had to stop all these drugs before transplant.
Talking about the heart issue, I had to fill out a family history before transplant. On my Dad's side, almost all of the men including my Dad passed away at a young age. Mostly heart attack. Dad was 66 (my age now). Now on Mom's side, they all lived to a very old age. Mom passed at 94 and her Mom (Grandma) at 101. All her brothers passed in there mid to upper 90's.
So when I did all my pre-transplant tests, they did an ultrasound of my heart and arteries around the heart. It was about 64 images. Not really sure if all those images were standard procedure for a transplant, or if it was because of my family history and not knowing where I stand as far as what side of the family I inherited.
Of course I have had an annual test for cholesterol and the bad cholesterol is a little high, but the good cholesterol is really high. All the 64 images were without any issues.
Thanks for the article, Alizabeth. Maybe all my tests were to make sure I could handle a transplant.
Castaway
I am 70 days post auto transplant. Before transplant, my treatment was almost 4 rounds of Kyprolis, Pomalyst, and dex, which really brought my numbers down. I say almost 4 rounds because I had to stop all these drugs before transplant.
Talking about the heart issue, I had to fill out a family history before transplant. On my Dad's side, almost all of the men including my Dad passed away at a young age. Mostly heart attack. Dad was 66 (my age now). Now on Mom's side, they all lived to a very old age. Mom passed at 94 and her Mom (Grandma) at 101. All her brothers passed in there mid to upper 90's.
So when I did all my pre-transplant tests, they did an ultrasound of my heart and arteries around the heart. It was about 64 images. Not really sure if all those images were standard procedure for a transplant, or if it was because of my family history and not knowing where I stand as far as what side of the family I inherited.
Of course I have had an annual test for cholesterol and the bad cholesterol is a little high, but the good cholesterol is really high. All the 64 images were without any issues.
Thanks for the article, Alizabeth. Maybe all my tests were to make sure I could handle a transplant.
Castaway
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Castaway - Name: George
- Who do you know with myeloma?: just myself
- When were you/they diagnosed?: 1/24/14
- Age at diagnosis: 62
Re: Kyprolis (carfilzomib) and the heart
Hi all.
Thought I would chime in with regard to heart issues during treatment for multiple myeloma.
I went thru radiation and Revlimid, Velcade, and dexamethasone pretty easy. I am now on Day +7 of the first of two autologous stem cell transplants ("tandem transplants").
During the installation of the ports in preparation for the first transplant, the doctor indicated my heart "fluttered". Since the transplant, I have been placed on Coreg (carvedilol). Heart resting rate is staying in the 90s.
I have no health issues, take no prescriptions, and am not overweight.
I will be interested to seeing if this heart issue is permanent or, as I come thru the days of the transplant, the issue will resolve.
Thought I would chime in with regard to heart issues during treatment for multiple myeloma.
I went thru radiation and Revlimid, Velcade, and dexamethasone pretty easy. I am now on Day +7 of the first of two autologous stem cell transplants ("tandem transplants").
During the installation of the ports in preparation for the first transplant, the doctor indicated my heart "fluttered". Since the transplant, I have been placed on Coreg (carvedilol). Heart resting rate is staying in the 90s.
I have no health issues, take no prescriptions, and am not overweight.
I will be interested to seeing if this heart issue is permanent or, as I come thru the days of the transplant, the issue will resolve.
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Hopeful1 - Name: Hopeful1
- Who do you know with myeloma?: Self
- When were you/they diagnosed?: March 2016
- Age at diagnosis: 56
Re: Kyprolis (carfilzomib) and the heart
Thank you, Alizabeth, for the additional information. I have read that multiple myeloma itself, as well as stem cell transplants, could cause heart trouble. I'm just guessing about Kyprolis.
On the other hand, I've had multiple myeloma for years. I was diagnosed officially in March, 2015, but based on a retrospective review of my annual blood tests – done as part of a routine annual physical – I believe I've had the disease since at least 2010. But I did need my first stent in early 2015.
And the stem cell transplant happened three months ago.
So all of that is history. Nothing I can do about either. But I can stop Kyprolis, which I am still taking as a maintenance drug. So I am planning to ask my oncologist whether I can switch to another maintenance drug (or switch to some drug combo that does not include Kyprolis).
Hopeful1,
Thanks very much for sharing your experience. You are on what seems to me an aggressive treatment regimen, and I hope it obliterates your myeloma!
Coreg is a newer beta blocker. I wish you the best of luck, and hopefully the heart issue will resolve quickly.
Castaway,
Thanks so much for your post. I don't believe the kind of intensive ultrasound study they did for you is standard protocol for everyone going on Kyprolis. I could be wrong, but I definitely think your family history on your Dad's side motivated your medical team to do the testing. Great news that what sounds like a very thorough study didn't uncover any problems.
In my case, there is a strong history of early death from heart attacks on both sides of my family. Before starting Kyprolis, I had a standard electrocardiogram, an echocardiogram, and a stress test.
I would expect them to do some kind of monitoring of your heart on some regular schedule while you are on Kyprolis. Your ultrasound study will serve as a great baseline for comparison going forward. For me, I get an echocardiagram and cardiac-related blood tests once a quarter, and a stress test every year.
Good luck on your treatment. I hope the transplant did the trick for you!
On the other hand, I've had multiple myeloma for years. I was diagnosed officially in March, 2015, but based on a retrospective review of my annual blood tests – done as part of a routine annual physical – I believe I've had the disease since at least 2010. But I did need my first stent in early 2015.
And the stem cell transplant happened three months ago.
So all of that is history. Nothing I can do about either. But I can stop Kyprolis, which I am still taking as a maintenance drug. So I am planning to ask my oncologist whether I can switch to another maintenance drug (or switch to some drug combo that does not include Kyprolis).
Hopeful1,
Thanks very much for sharing your experience. You are on what seems to me an aggressive treatment regimen, and I hope it obliterates your myeloma!
Coreg is a newer beta blocker. I wish you the best of luck, and hopefully the heart issue will resolve quickly.
Castaway,
Thanks so much for your post. I don't believe the kind of intensive ultrasound study they did for you is standard protocol for everyone going on Kyprolis. I could be wrong, but I definitely think your family history on your Dad's side motivated your medical team to do the testing. Great news that what sounds like a very thorough study didn't uncover any problems.
In my case, there is a strong history of early death from heart attacks on both sides of my family. Before starting Kyprolis, I had a standard electrocardiogram, an echocardiogram, and a stress test.
I would expect them to do some kind of monitoring of your heart on some regular schedule while you are on Kyprolis. Your ultrasound study will serve as a great baseline for comparison going forward. For me, I get an echocardiagram and cardiac-related blood tests once a quarter, and a stress test every year.
Good luck on your treatment. I hope the transplant did the trick for you!
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MrPotatohead - Name: MrPotatohead
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: March, 2015
- Age at diagnosis: 65
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