(A) Prevention of cardiac and vascular- related events | • Monitor cardiopulmonary symptoms |
 | • Monitor cardiopulmonary signs (vitals, weight, physical exam) |
 | • Administer carfilzomib over 30 min |
 | • Check baseline transthoracic echocardiogram, and repeat echocardiogram every two to three cyclesa Note, if baseline ejection fraction is below normal, consider utilizing prophylactically strategies listed in (B) Monitor BNPa |
 | • Close follow-up by cardiologist or cardio-oncologista |
(B) Management of treatment-emergent possibly cardiac and vascular- related complications | • Rule out alternative causes (e.g., pulmonary embolus, pneumonia, anemia)\ |
 | • Hold carfilzomib until toxicity resolves to grade <2. |
 | • If the decision is made to rechallenge: |
 |   − Implement all preventative/monitoring strategies listed in (A) |
 |   − Consider dose reduction |
 |   − Decrease or eliminate hydration, especially if the patient has completed ≥1 cycle of 27 mg/m2 carfilzomib while retaining stable renal function and without experiencing tumor lysis |
 |   − Minimize corticosteroids and concomitant fluid retention |
 |   − Cautious use of diuretics |
 |   − Use of anti-hypertensives as indicated |