title: High prevalence of cardiovascular and respiratory abnormalities in advanced, intensively treated (transplanted) myeloma: The case for 'late effects' screening and preventive strategies.
abstract: OBJECTIVE
  Modern management of myeloma has significantly improved survival, with increasing numbers of patients living beyond a decade. However, little is known about the long-term cardiovascular and respiratory status of intensively treated and multiply relapsed survivors.
  
  
  METHODS
  We performed detailed cardiovascular and respiratory evaluations in patients with intensively treated, advanced but stable myeloma. All patients had received at least two lines of treatment, including at least one haematopoietic stem cell transplantation procedure, but had stable, controlled disease and were off active treatment at the time of evaluation.
  
  
  RESULTS
  Thirty-two patients with a median duration of 6 years (range 2-12) from original diagnosis of myeloma and three lines (range 2-6) of treatment were evaluated. Despite normal physical examination in the majority, there was a high prevalence of sub-clinical cardiac and respiratory dysfunction, reflected by abnormalities of electrocardiography (45%), echocardiography (50%), serum N-terminal pro-B-type natriuretic peptide level (NT-pro-BNP, 50%), and pulmonary function testing (45%). NT-pro-BNP level correlated negatively with quality of life (P = 0.012) and positively with serum ferritin (P = 0.027). Dyspnoea score correlated with BMI (P = 0.001). Risk factors for cardiovascular disease (obesity, hypertension, hyperlipidaemia, and hyperinsulinaemia) were common.
  
  
  CONCLUSIONS
  Even in the absence of overt clinical features, the majority of intensively treated long-term survivors of myeloma have established cardiovascular and/or respiratory dysfunction, above levels expected in the general population of a similar age.
  
  
  CONCLUSIONS
  This study supports routine screening and lifestyle modification combined with primary and secondary preventive strategies to reduce cardiovascular and respiratory disease and to preserve quality of life in transplanted myeloma patients.
authors.affiliation: a Department of Haematology , Sheffield Teaching Hospitals NHS Foundation Trust , UK.
authors.forename: Clare
authors.initials: C
authors.lastname: Samuelson
authors.affiliation: b Department of Cardiology , Sheffield Teaching Hospitals NHS Foundation Trust , UK.
authors.forename: Laurence
authors.initials: L
authors.lastname: O'Toole
authors.affiliation: c Academic Unit of Supportive Care , University of Sheffield , UK.
authors.forename: Elaine
authors.initials: E
authors.lastname: Boland
authors.affiliation: d Department of Oncology , Sheffield Teaching Hospitals NHS Foundation Trust , UK.
authors.forename: Diana
authors.initials: D
authors.lastname: Greenfield
authors.affiliation: a Department of Haematology , Sheffield Teaching Hospitals NHS Foundation Trust , UK.
authors.forename: Yousef
authors.initials: Y
authors.lastname: Ezaydi
authors.affiliation: c Academic Unit of Supportive Care , University of Sheffield , UK.
authors.forename: Sam H
authors.initials: SH
authors.lastname: Ahmedzai
authors.affiliation: a Department of Haematology , Sheffield Teaching Hospitals NHS Foundation Trust , UK.
authors.forename: John A
authors.initials: JA
authors.lastname: Snowden
mesh_terms: D064591:Allografts; D002318:Cardiovascular Diseases / Q000097:blood / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D009101:Multiple Myeloma / Q000453:epidemiology / Q000628:therapy; D015995:Prevalence; D012140:Respiratory Tract Diseases / Q000097:blood / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology
keywords: Cardiovascular; Late effects; Myeloma; Respiratory; Stem cell transplantation