Pathophysiological considerations to thrombophilia in the treatment of multiple myeloma with thalidomide and derivates

Frank Gieseler

doi:10.1160/TH08-01-0009

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2008; 99(06): 1001-1007
DOI: 10.1160/TH08-01-0009

Review Article

Schattauer GmbH

Pathophysiological considerations to thrombophilia in the treatment of multiple myeloma with thalidomide and derivates

Frank Gieseler

¹Department of Internal Medicine, University Hospital of Kiel, Kiel, Germany

› Author Affiliations

Abstract

Summary

Lenalidomide, a derivate of thalidomide, has recently been approved in Europe for the treatment of patients with multiple myeloma. Although the substance has a better effect/side-effect profile, especially with regard to teratogenicity and neurotoxicity, the rate of therapy-induced thrombosis seems comparable to thalidomide. The observed thromboembolic events were accompanied with a high rate of deleterious pulmonary embolism. Interestingly, the substances alone are not thrombogenic but combination with anthracyclines, dexamethasone or erythropesis-stimulating factors increases the risk considerably. As up to one third of patients treated with such combinations are affected, antithrombotic co-medication is highly recommended. This review elucidates the complex interactions between an activated coagulation-system in myeloma patients and the molecular effects of these drugs. This perception is important to choose the proper prophylactic co-medication without increasing the risk of bleeding, especially in first-line treatment, patients with high paraprotein-levels, or thrombopenia, either therapy-induced or due to bone-marrow infiltration.

Keywords

Thalidomide - lenalidomide - thrombosis - prophylaxis - multiple myeloma

Full Text

References

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