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Pulmonary Vascular Disease |

Pulmonary Hypertension in Multiple Myeloma: Risk Factors and Impact on Outcomes

Rahul Sangani; Matthew Butler; Lester Kirchner; Andrea Berger; Jason Stamm
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Geisinger Medical Center, Danville, PA


Chest. 2014;146(4_MeetingAbstracts):844A. doi:10.1378/chest.1965523
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Abstract

SESSION TITLE: DVT/PE/Pulmonary Hypertension Posters IV

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Multiple myeloma (MM) patients are predisposed to develop pulmonary hypertension (PH) based on several biologically plausible mechanisms, including venous thromboembolism and effects of chemotherapy. However, there is no literature describing the prevalence or impact of PH in MM patients. We conducted a retrospective cohort study to examine PH in MM.

METHODS: A cohort of patients diagnosed with MM between 2000 and 2011 was identified using tumor registry data. Chart review was conducted on the subgroup of patients who underwent a transthoracic echocardiogram (TTE) within 2 years of diagnosis with MM.

RESULTS: Of all included patients (N=359), 123 (34.3%) had TTE performed within two years of their MM diagnosis (median 137 days). No significant demographic differences between the TTE and non-TTE subgroups were noted. In the TTE group, PH was present in 39 patients (31.7% prevalence) and was significantly associated with older age, greater left atrial diameter, and decreased renal function. No significant associations were detected between PH and gender, systolic function, relevant co-morbidities, or MM characteristics (percent marrow plasma cells, cytogenetic, or treatment). There was no significant difference in unadjusted or adjusted mortality between patients with or without PH (72% vs 62%, respectively, univariate log rank p=0.28). Those with PH were less likely to undergo autologous stem cell transplant compared to those without PH (10% vs 30%, p=0.018).

CONCLUSIONS: In our sample of MM patients, 34% underwent TTE and of those 32% had PH, implying an absolute minimum PH prevalence of 11%. The true prevalence is presumably higher but could only be determined in a prospective study. The etiology of PH in this population cannot be stated with certainly but the association with increased age, larger LA diameter, and decreased renal function suggests that underlying cardiac disease and/or volume overload may be contributing. There were no MM specific factors associated with the finding of PH in this study. Although not reaching statistical significance, there was a suggestion of increased mortality in MM patients with PH.

CLINICAL IMPLICATIONS: PH in MM is relatively common, based on the results of our study. The actual prevalence and impact on outcomes of PH in MM should be investigated in prospective studies, given the improved survival of MM patients with recent treatment breakthroughs.

DISCLOSURE: The following authors have nothing to disclose: Rahul Sangani, Matthew Butler, Lester Kirchner, Andrea Berger, Jason Stamm

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