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Semin Thromb Hemost 2011; 37(8): 929-945
DOI: 10.1055/s-0031-1297372
© Thieme Medical Publishers

Bleeding and Thrombosis in Multiple Myeloma and Related Plasma Cell Disorders

Antonio Coppola1 , Antonella Tufano1 , Mirko Di Capua1 , Massimo Franchini2
  • 1Regional Reference Center for Coagulation Disorders, Federico II University Hospital, Naples, Italy
  • 2Immunohematology and Transfusion Center, Department of Pathology and Laboratory Medicine, University Hospital, Parma, Italy
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Publication History

Publication Date:
23 December 2011 (online)

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ABSTRACT

A variety of disease- and treatment-related factors affect the coagulation system and the risk of bleeding and thrombotic complications in patients with multiple myeloma (MM) and related plasma cell disorders (PCD). As commonly observed in other cancer settings, the malignant clone induces a cytokine environment responsible for a hypercoagulable state. The increase of blood viscosity and impairment of platelet and coagulation function due to circulating monoclonal proteins are considered key mechanisms in the hemostatic abnormalities frequently detected in patients with PCD. However, clinically significant bleeding is relatively rare and poorly correlated with these abnormalities. Management is often challenging because of the multifactorial pathogenesis and underestimation or misdiagnosis of acquired bleeding disorders, particularly acquired von Willebrand syndrome. In recent years, growing interest in thromboembolic risk has emerged after the introduction of novel and more effective antimyeloma agents (thalidomide and lenalidomide), which was associated with increased risk of venous thromboembolism, particularly when associated with dexamethasone and multiagent chemotherapy in newly diagnosed patients. The clinical impact of bleeding and thrombotic complications in patients with PCD, with emphasis on MM, will be discussed in this review, reporting the current knowledge about pathophysiologic mechanisms and implications for management.

KEYWORDS

Bleeding - hypercoagulability - M protein - multiple myeloma - plasma cell disorders - prophylaxis - thrombosis

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Antonio CoppolaM.D. 

Regional Reference Center for Coagulation Disorders

Federico II University Hospital, Via S. Pansini, 5 - Naples, Italy

Email: antocopp@unina.it