International Journal of Hematology

, Volume 87, Issue 5, pp 542–544 | Cite as

Pulmonary embolism in a patient with multiple myeloma receiving thalidomide–dexamethasone therapy

  • Wen-Juei Jeng
  • Ming-Chung Kuo
  • Lee-Yung Shih
  • Pao-Hsien Chu
Case Report


Massive pulmonary embolism is an uncommon complication of multiple myeloma treated with thalidomide–dexamethasone regimen. In 2006, multiple myeloma was diagnosed in a 72-year-old man, who received thalidomide–dexamethasone therapy. In January 2007, echocardiography and computerized tomography identified massive pulmonary embolism in the pulmonary arteries and a deep vein thrombus of the right leg. The patient also had an elevated concentration of B-type natriuretic peptide. After heparinization and warfarin therapy, the patient’s condition improved. This is the first report of a patient with a rare complication of pulmonary embolism from thalidomide-treated multiple myeloma.


Multiple myeloma Pulmonary embolism Thalidomide 



Dr Chu is supported by NHRI, Taiwan (NHRI-EX91-9108SC, NHRI-EX92-9108SC, NHRI-EX-93-9108SC, NHRI-EX94-9108SC, NHRI-EX54-9108SCl, and NHRI-EX96-9627SI), CMRPG32057 from the Chang Gung Memorial Hospital, the NSC Memorial Hospital, and the National Sciences Council (NSC 94-2314-B-182-071 and 95-2314-B-182-021).


  1. 1.
    Zangari M, Elice F, Fink L, Tricot G. Thrombosis in multiple myeloma. Expert Rev Anticancer Ther. 2007;7:307–15.PubMedCrossRefGoogle Scholar
  2. 2.
    Srkalovic G, Cameron MG, Rybicki L, Deitcher SR, Kattke-Marchant K, Hussein MA. Monoclonal gammopathy of undetermined significance and multiple myeloma are associated with an increased incidence of venothromboembolic disease. Cancer. 2004;101:558–66.PubMedCrossRefGoogle Scholar
  3. 3.
    Zangari Saghafifar F, Mehta P, Barlogie B, Fink L, Tricot G. The blood coagulation mechanism in multiple myeloma. Semin Thromb Hemost. 2003;29:275–82.CrossRefGoogle Scholar
  4. 4.
    Yagci M, Sucak GT, Haznedar R. Fibrinolytic activity in multiple myeloma. Am J Hematol. 2003;74:231–7.PubMedCrossRefGoogle Scholar
  5. 5.
    Hussein MA. Thromboembolism risk reduction in multiple myeloma patients treated with immunomodulatory drug combinations. Thromb Haemost. 2006;95:924–30.PubMedGoogle Scholar
  6. 6.
    Barlogie B, Desikan R, Eddlemon P, Spencer T, Zeldis J, Munshi N, et al. Extended survival in advanced and refractory multiple myeloma after single-agent thalidomide: identification of prognostic factors in phase 2 study of 169 patients. Blood. 2001;98:492–4.PubMedCrossRefGoogle Scholar
  7. 7.
    Weber D, Rankin K, Gavino M, Delasalle K, Alexanian R. Thalidomide alone or with dexamethasone for previously untreated multiple myeloma. J Clin Oncol. 2003;21:2732–9.CrossRefGoogle Scholar
  8. 8.
    Rajkumar SV, Gertz MA, Lacy MQ, Dispenzieri A, Fonseca R, Geyer SM, et al. Thalidomide as initial therapy for early-stage myeloma. Leukemia. 2003;17:775–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Zangari M, Siegel E, Barlogie B, Anaissie E, Saghafifar F, Fassas A, et al. Thrombogenic activity of doxorubicin in myeloma patients receiving thalidomide: implications for therapy. Blood. 2002;100:1168–71.PubMedCrossRefGoogle Scholar
  10. 10.
    Facon T, Mary JY, Pégourie B, Attal M, Renaud M, Sadoun A, et al. Dexamethasone-based regimens versus melphalan-prednisone for elderly multiple myeloma patients ineligible for high-dose therapy. Blood. 2006;107:1292–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Cavo M, Zamagni E, Cellini C, Tosi P, Cangini D, Cini M, et al. Deep-vein thrombosis in patients with multiple myeloma receiving first-line thalidomide-dexamethasone therapy. Blood. 2002;100:2272–3.PubMedCrossRefGoogle Scholar
  12. 12.
    Rajkumar SV, Hayman SR, Lacy MQ, Dispenzieri A, Geyer SM, Kabat B, et al. Combination therapy with lenalidomide plus dexamethasone (Rev/Dex) for newly diagnosed myeloma. Blood. 2005;106:4050–3.PubMedCrossRefGoogle Scholar
  13. 13.
    Rajkumar SV, Blood E, Vesole D, Fonseca R, Greipp PR, The Eastern Cooperative Oncology Group. Phase III clinical trial of thalidomide plus dexamethasone compared with dexamethasone alone in newly diagnosed multiple myeloma: a clinical trial coordinated by the Eastern Cooperative Oncology Group. J Clin Oncol. 2006;24:431–6.PubMedCrossRefGoogle Scholar
  14. 14.
    Kucher N, Printzen G, Goldhaber SZ. Prognostic role of brain natriuretic peptide in acute pulmonary embolism. Circulation. 2003;107:2545–7.PubMedCrossRefGoogle Scholar
  15. 15.
    Konstantinides S, Geibel A, Olschewski M, Kasper W, Hruska N, Jäckle S, et al. Importance of cardiac troponins I and T in risk stratification of patients with acute pulmonary embolism. Circulation. 2002;106:1263–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Pieralli F, Olivotto I, Vanni S, Conti A, Camaiti A, Targioni G, et al. Usefulness of bedside testing for brain natriuretic peptide to identify right ventricular dysfunction and outcome in normotensive patients with acute pulmonary embolism. Am J Cardiol. 2006;97:1386–90.PubMedCrossRefGoogle Scholar
  17. 17.
    Smith A, Wisloff F, Samson D, UK Myeloma Forum, Nordic Myeloma Study Group, The British Committee for Standards in Haematology. Guidelines on the diagnosis and management of multiple myeloma 2005. Br J Haematol. 2006;132:410–51.PubMedCrossRefGoogle Scholar
  18. 18.
    Gore ME, Selby PJ, Viner C, Clark PI, Meldrum M, Millar B, et al. Intensive treatment of multiple myeloma and criteria for complete remission. Lancet. 1989;2:879–82.PubMedCrossRefGoogle Scholar
  19. 19.
    Samson D, Gaminara E, Newland A, Van de Pette J, Kearney J, McCarthy D, et al. Infusion of vincristine and doxorubicin with oral dexamethasone as first-line therapy for multiple myeloma. Lancet. 1989;2:882–5.PubMedCrossRefGoogle Scholar
  20. 20.
    Alexanian R, Barlogie B, Tucker S. VAD-based regimens as primary treatment for multiple myeloma. Am J Hematol. 1990;33:86–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Abrahamson GM, Bird JM, Newland AC, Gaminara E, Giles C, Joyner M, et al. A randomized study of VAD therapy with either concurrent or maintenance interferon in patients with newly diagnosed multiple myeloma. Br J Haematol. 1996;94:659–64.PubMedCrossRefGoogle Scholar
  22. 22.
    Raje N, Powles R, Kulkarni S, Milan S, Middleton G, Singhal S, et al. A comparison of vincristine and doxorubicin infusional chemotherapy with methylprednisolone (VAMP) with the addition of weekly cyclophosphamide (C-VAMP) as induction treatment followed by autografting in previously untreated myeloma. Br J Haematol. 1997;97:153–60.PubMedCrossRefGoogle Scholar
  23. 23.
    Singhal S, Mehta J, Desikan R, Ayers D, Roberson P, Eddlemon P, et al. Anti-tumor activity of thalidomide in refractory multiple myeloma. N Engl J Med. 1999;341:1565–71.PubMedCrossRefGoogle Scholar

Copyright information

© The Japanese Society of Hematology 2008

Authors and Affiliations

  • Wen-Juei Jeng
    • 1
  • Ming-Chung Kuo
    • 2
  • Lee-Yung Shih
    • 2
  • Pao-Hsien Chu
    • 1
  1. 1.The First Cardiovascular Division, Department of Internal MedicineChang Gung Memorial Hospital, Chang Gung University College of MedicineTaipeiTaiwan
  2. 2.The Division of HematologyChang Gung Memorial Hospital, Chang Gung University College of MedicineTaipeiTaiwan

Personalised recommendations