Summary
Deep vein thrombosis and its lethal complication pulmonary embolism are manifestations
of venous thromboembolism (VTE), which is typically associated with cancer and recent
major surgery. Certain solid tumors and hematologic malignancies impose an inherently
elevated risk of VTE that is compounded by chemotherapy and other risk factors. Multiple
myeloma (MM) and other plasma cell dyscrasias are thrombogenic as a consequence of
their multiple hemostatic effects, including elevated interleukin-6 levels, pro-coagulant
antibody formation, paraprotein interference with fibrin structure, activated protein
C re sistance, and endothelial damage. The oral immunomodulatory drugs thalidomide
and lenalidomide have produced major therapeutic responses in patients with MM when
used in combination with oral steroids and chemotherapy, but a high incidence of VTE
has been reported. Various VTE prophylaxis strategies with thalidomide- and lenalidomide-containing
combinations have been investigated in clinical studies. This review discusses emerging
results on the use of VTE prophylaxis to minimize VTE risks associated with MM treatment
regimens containing thalidomide and lenalidomide.
Key words
Multiple myeloma - thrombosis - anticoagulants - thalidomide - lenalidomide