Assessment and Management of Cardiotoxicity in Hematologic Malignancies

Dis Markers. 2021 Feb 3:2021:6616265. doi: 10.1155/2021/6616265. eCollection 2021.


With the increasing overall survival of cancer patients due to recent discoveries in oncology, the incidence of side effects is also rising, and along with secondary malignancies, cardiotoxicity is one of the most concerning side effects, affecting the quality of life of cancer survivors. There are two types of cardiotoxicity associated with chemotherapy; the first one is acute, life-threatening but, fortunately, in most of the cases, reversible; and the second one is with late onset and mostly irreversible. The most studied drugs associated with cardiotoxicity are anthracyclines, but many new agents have demonstrated unexpected cardiotoxic effect, including those currently used in multiple myeloma treatment (proteasome inhibitors and immunomodulatory agents), tyrosine kinase inhibitors used in the treatment of chronic myeloid leukemia and some forms of acute leukemia, and immune checkpoint inhibitors recently introduced in treatment of refractory lymphoma patients. To prevent irreversible myocardial damage, early recognition of cardiac toxicity is mandatory. Traditional methods like echocardiography and magnetic resonance imaging are capable of detecting structural and functional changings, but unable to detect early myocardial damage; therefore, more sensible biomarkers like troponins and natriuretic peptides have to be introduced into the current practice. Baseline assessment of patients allows the identification of those with high risk for cardiotoxicity, while monitoring during and after treatment is important for early detection of cardiotoxicity and prompt intervention.

Publication types

  • Review

MeSH terms

  • Anthracyclines / administration & dosage
  • Anthracyclines / adverse effects*
  • Antineoplastic Agents / administration & dosage
  • Antineoplastic Agents / adverse effects*
  • Biomarkers / blood
  • Cancer Survivors
  • Cardiotoxicity / diagnostic imaging
  • Cardiotoxicity / etiology
  • Cardiotoxicity / prevention & control*
  • Echocardiography
  • Hematologic Neoplasms / diagnostic imaging
  • Hematologic Neoplasms / drug therapy*
  • Hematologic Neoplasms / genetics
  • Hematologic Neoplasms / immunology
  • Humans
  • Immune Checkpoint Inhibitors / administration & dosage
  • Immune Checkpoint Inhibitors / adverse effects
  • Immunologic Factors / administration & dosage
  • Immunologic Factors / adverse effects*
  • Magnetic Resonance Imaging
  • Natriuretic Peptides / blood
  • Natriuretic Peptides / genetics
  • Proteasome Inhibitors / administration & dosage
  • Proteasome Inhibitors / adverse effects
  • Protein Kinase Inhibitors / administration & dosage
  • Protein Kinase Inhibitors / adverse effects
  • Quality of Life / psychology
  • Troponin / blood
  • Troponin / genetics


  • Anthracyclines
  • Antineoplastic Agents
  • Biomarkers
  • Immune Checkpoint Inhibitors
  • Immunologic Factors
  • Natriuretic Peptides
  • Proteasome Inhibitors
  • Protein Kinase Inhibitors
  • Troponin