ABSTRACT
Venous thromboembolism (VTE) is a disease with a high prevalence in elderly people,
affecting > 5% of the population > 65 years of age. Cancer patients have a 4.3-fold
higher incidence of thrombotic complications, due to multiple risk factors that are
not always related to the disease. Among hematologic malignancies, multiple myeloma
(MM) confers a high risk of developing such complications, with a VTE rate of nearly
10%. Multiple factors are involved in MM-related VTE, such as increased blood viscosity,
high levels of immunoglobulin, procoagulant activity of monoclonal protein, and inflammatory
cytokines. Since the introduction of the immunomodulatory derivatives (IMiDs) thalidomide
and lenalidomide in the therapeutic armamentarium of MM, VTE has emerged as one of
the leading complications, in particular in patients with newly diagnosed MM. In this
setting, IMiDs-based treatments are associated with rates of VTE reaching values up
to 14 to 26%, particularly when dexamethasone or chemotherapy are added. The optimal
prophylaxis for patients receiving these antiangiogenetic agents is still a matter
of debate. Due to the lack of prospective randomized clinical trials, different studies
have used various anticoagulant prophylaxes, including fixed low-dose warfarin (1
mg or 1.25 mg), therapeutic doses of warfarin (international normalized ratio between
2.0 and 3.0), low molecular weight heparin, or low-dose aspirin. As yet, no study
has clearly demonstrated a significant superiority of one prophylactic regimen in
comparison with the others. Further investigation and more randomized clinical trials
are needed to define the best thromboprophylaxis.
KEYWORDS
Multiple myeloma (MM) - deep vein thrombosis (DVT) - thalidomide - lenalidomide -
venous thromboembolism (VTE)
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Elena Zamagni
Istituto di Ematologia “Seràgnoli,” Università degli Studi di Bologna - Policlinico
S. Orsola-Malpighi, Via Massarenti
9 – 40138 Bologna, Italy
eMail: e.zamagni@unibo.it
