title: Silent venous thromboembolism in multiple myeloma patients treated with lenalidomide.
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.
authors.affiliation: Department of Hematology, National Hospital Organization Nishigunma Hospital, 2854 Kanai, Shibukawa, Gunma, 377-8511, Japan, aisoda@netnngh.hosp.go.jp.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Isoda
authors.forename: Naru
authors.initials: N
authors.lastname: Sato
authors.forename: Yuri
authors.initials: Y
authors.lastname: Miyazawa
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Matsumoto
authors.forename: Mina
authors.initials: M
authors.lastname: Koumoto
authors.forename: Masahito
authors.initials: M
authors.lastname: Ookawa
authors.forename: Morio
authors.initials: M
authors.lastname: Sawamura
authors.forename: Morio
authors.initials: M
authors.lastname: Matsumoto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D006801:Humans; D000077269:Lenalidomide; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D012189:Retrospective Studies; D013792:Thalidomide / Q000008:administration & dosage / Q000031:analogs & derivatives*; D054556:Venous Thromboembolism / Q000097:blood / Q000188:drug therapy* / Q000209:etiology
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D013792:Thalidomide; D000077269:Lenalidomide