Silent venous thromboembolism in multiple myeloma patients treated with lenalidomide

Lenalidomide treatment in combination with dexamethasone and/or chemotherapy is associated with a significant risk of venous thromboembolism (VTE) in patients with multiple myeloma (MM). However, the incidence of asymptomatic VTE in lenalidomide-treated MM patients remains unclear. A total of 80 rel...

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Bibliographic Details
Published in:International journal of hematology 2015-09, Vol.102 (3), p.271-277
Main Authors: Isoda, Atsushi, Sato, Naru, Miyazawa, Yuri, Matsumoto, Yoshinobu, Koumoto, Mina, Ookawa, Masahito, Sawamura, Morio, Matsumoto, Morio
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Female
Fibrin Fibrinogen Degradation Products - metabolism
Hematology
Humans
Male
Medicine
Medicine & Public Health
Middle Aged
Multiple Myeloma - blood
Multiple Myeloma - complications
Multiple Myeloma - drug therapy
Oncology
Original Article
Retrospective Studies
Thalidomide - administration & dosage
Thalidomide - analogs & derivatives
Venous Thromboembolism - blood
Venous Thromboembolism - drug therapy
Venous Thromboembolism - etiology
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Summary:Lenalidomide treatment in combination with dexamethasone and/or chemotherapy is associated with a significant risk of venous thromboembolism (VTE) in patients with multiple myeloma (MM). However, the incidence of asymptomatic VTE in lenalidomide-treated MM patients remains unclear. A total of 80 relapsed and refractory MM patients treated with lenalidomide-containing regimens in a single institution between July 2010 and July 2014 were retrospectively analyzed. Of these, eight patients had asymptomatic VTE before starting lenalidomide. The remaining 72 patients received thromboprophylaxis with low-dose aspirin (100 mg daily) and monitoring of plasma D-dimer levels on each visit. During the median follow-up time of 7.3 months (range 1.0–43.5 months), 29 patients (40.3 %) showed an elevation of D-dimer (≥2.5 μg/mL), and 13 (18.1 %) showed asymptomatic VTE in a lower extremity. Median time to asymptomatic VTE events from initiation of lenalidomide treatment was 3.0 months (range 1.0–13.1 months). All patients having an asymptomatic VTE continued lenalidomide treatment on warfarinization (target international normalized ratio 1.5–2.5), and none of them developed symptomatic VTE. In conclusion, an asymptomatic VTE event occurred in 18 % of Japanese MM patients receiving lenalidomide-containing therapy despite aspirin prophylaxis. Serial monitoring of plasma D-dimer levels and early intervention may help to prevent symptomatic or lethal VTE events.
ISSN:0925-5710
1865-3774
DOI:10.1007/s12185-015-1838-5