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Silent venous thromboembolism in multiple myeloma patients treated with lenalidomide

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Abstract

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.

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Acknowledgments

The authors would like to thank Drs. Momoko Mawatari, Akio Saito, Akinori Yuzuriha, Hiroko Koya, and Yohei Osaki for their contributions to patient care and data collection.

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Authors and Affiliations

  1. Department of Hematology, National Hospital Organization Nishigunma Hospital, 2854 Kanai, Shibukawa, Gunma, 377-8511, Japan

    Atsushi Isoda, Naru Sato, Yuri Miyazawa & Morio Matsumoto

  2. Department of Clinical Laboratory, National Hospital Organization Nishigunma Hospital, Shibukawa, Gunma, Japan

    Yoshinobu Matsumoto, Mina Koumoto & Masahito Ookawa

  3. Department of Clinical Research, National Hospital Organization Nishigunma Hospital, Shibukawa, Gunma, Japan

    Morio Sawamura

Authors
  1. Atsushi Isoda
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  2. Naru Sato
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  3. Yuri Miyazawa
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  4. Yoshinobu Matsumoto
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  5. Mina Koumoto
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  6. Masahito Ookawa
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  7. Morio Sawamura
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  8. Morio Matsumoto
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Correspondence to Atsushi Isoda.

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Isoda, A., Sato, N., Miyazawa, Y. et al. Silent venous thromboembolism in multiple myeloma patients treated with lenalidomide. Int J Hematol 102, 271–277 (2015). https://doi.org/10.1007/s12185-015-1838-5

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  • DOI: https://doi.org/10.1007/s12185-015-1838-5

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