Markers of endothelial and haemostatic function in the treatment of relapsed myeloma with the immunomodulatory agent Actimid (CC-4047) and their relationship with venous thrombosis.
We evaluated the serum/plasma levels of cytokines [interleukin (IL)-6, vascular endothelial growth factor (VEGF), transforming growth factor (TGF)-beta2] and markers of coagulation, fibrinolysis, endothelial and platelet activation during the first 4 wk of treatment with the thalidomide analogue Actimid (CC-4047) in 15 patients with relapsed/refractory myeloma. There was evidence of activation of endothelium (soluble vascular cell adhesion molecule, sVCAM), coagulation (prothrombin fragment 1 + 2, PF1 + 2) and fibrinolysis (D-dimers) but no evidence of platelet activation or endothelial cell damage in myeloma patients. These parameters were not affected by the use of CC-4047. Three of four patients with baseline D-dimers levels >500 microg/L subsequently developed deep vein thrombosis (DVT). The hypothesis that D-dimer level >500 microg/L may predict for those patients most at risk of thromboembolism with multiple myeloma undergoing treatment is worthy of further study.
Streetly
Matthew
M
Department of Haematology, Guys and St Thomas' NHS Foundation Trust, London, UK.
Hunt
Beverley J
BJ
Parmar
Kiran
K
Jones
Richard
R
Zeldis
Jerome
J
Schey
Steve
S
D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D006487:Hemostasis; D006801:Humans; D007155:Immunologic Factors / Q000009:adverse effects / Q000627:therapeutic use*; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000097:blood / Q000150:complications* / Q000188:drug therapy* / Q000503:physiopathology; D013792:Thalidomide / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D016212:Transforming Growth Factor beta / Q000097:blood; D053781:Transforming Growth Factor beta2; D042461:Vascular Endothelial Growth Factor A / Q000097:blood; D020246:Venous Thrombosis / Q000097:blood / Q000209:etiology* / Q000503:physiopathology
D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; D007155:Immunologic Factors; D015850:Interleukin-6; C509041:TGFB2 protein, human; D016212:Transforming Growth Factor beta; D053781:Transforming Growth Factor beta2; D042461:Vascular Endothelial Growth Factor A; C036309:fibrin fragment D; D013792:Thalidomide; C467566:pomalidomide