Abnormalities of cardiac or pulmonary function are common in myeloma survivors and can impact negatively on the quality of life.
Respiratory function can be reduced by repeated infection, thromboembolism, and chemotherapy and radiotherapy exposure. Other contributing factors include bone disease that is affecting the spine and chest wall and the use of opiate analgesia which can suppress respiratory function. Pre-existing lung disease and a history of smoking will also affect an individual’s risks and complications.
Cardiac late effects are also multifactorial. Treatment effects include the use of cardio-toxic drugs such as anthracyclines and fluid retention related to steroids, which may impact significantly daily life. Other contributing factors to cardiac complications include cardiac amyloidosis, anaemia, obesity, hypertension, and hyperlipidaemia.
Screening may pick up sub-clinical cardiac disease or be used to investigate patients with non-specific symptoms, such as breathlessness and oedema. Plasma B-type natriuretic peptide (BNP) which although not diagnostic, can have a high negative predictive value for heart failure. It has been recommended that patients with a level of more than 100 pg/ml* may require echocardiography and specialist assessment.
*Please note the units for measuring BNP vary between different hospitals
There are several strategies that can help improve symptoms for patients with cardiorespiratory late effects. These include weight management, smoking cessation, supervised exercise plans and management of anaemia.