Complicanze trombotiche nel mieloma multiplo
Mauro BerrettiniS.C. Medicina Generale-DH Oncologico
Ospedale di Orvieto
Mediterranean School of Oncology
Orvieto 22 Novembre 2009
Hemostasis-related complications in plasma cell dyscrasias
thrombocytopenia endothelial damageacquired von Willebrand disease acquired APC resistanceheparin-like anticoagulants hypofibrinolisisclotting factor deficiencies increased F.VIII/vWFamyloidosis lupus anticoagualant
Bleeding Thrombosis
Incidence of deep vein thrombosis (DVT) in monoclonal gammopathy (MGUS) and multiple myeloma(MM)
• US VA hospital records (1980-1996)
Incidence R.R
1000 pt/years
• General (4.196.197) 0.9
• MGUS (2374) 3.1 3.3
• MM( 6192) 8.7 9.2
Kristinsson S.Y.et al, Blood 2008;112:3582-86
High variability due:• Age• History venous thromboembolism(VTE)• Stage of the disease• Hypercoagulability• Immobilization• CVC• Comorbidities• Therapy: chemotherapies, immunomodulatory
drugs (thalidomide,lenalidomide)
Incidence of deep vein thrombosis (DVT) in monoclonal gammopathy (MGUS) and multiple myeloma(MM)
Meta-analysis of the incidence of venous thromboembolic events with induction thalidomide
Hicks L.K. et al., , Cancer Treatment Rewies,2008; 34:442-452
Meta-analysis of the incidence of venous thromboembolic events with maintenance thalidomide
Hicks L.K. et al., , Cancer Treatment Rewies,2008; 34:442-452
Clinical studies of thromboprophylaxis in MM patients receiving thalidomide or lenalidomide
Falanga A, Marchetti M., J.Clin.Onc.2009;27:4848-57
Meta-analysis of the incidence of venous thromboembolic events with induction thalidomide
Hicks L.K. et al., , Cancer Treatment Rewies,2008; 34:442-452
Prevention of venous thromboembolism (VTE) in MM
“In the absence of clear data from randomized studies,…..
…..proposed strategies are the result of common sense……
……further investigation is needed to define the best VTE prophylaxis…..”
The International Myeloma Working GroupPalumboA. et al., Leukemia 2008;22:414-423
Prevention of VTE in MMWhich drug?
efficacy safety
• ASA yes/? yes/?
• Warfarin
Low fixed dose no yes
Therapeutic dose yes no/?
• Low m.w.heparin yes yes
Prevention of VTE in MM patientsreceiving thalidomide or lenalidomide?
When? Which Patient? At higher risk:• Induction therapy• High dose dexametasone, doxorubicine• Multiagent chemotherapy• + other risk factors: age, history of VTE, CVC, comorbidities, immobilization
The International Myeloma Working GroupPalumbo A. et al., Leukemia 2008;22:414-423
Top Related