title: Spectrum of Cerebrovascular Disease in Patients with Multiple Myeloma Undergoing Chemotherapy-Results of a Case Control Study.
abstract: OBJECTIVE
  Patients with multiple myeloma (MM) are at increased risk of arterial thrombosis. Our aim was to determine the risk factors, mechanisms and outcome of strokes in these patients.
  
  
  METHODS
  We conducted a retrospective matched case-control study from our database of MM patients enrolled in Total Therapy (TT) 2, TT3a and TT3b protocols who developed a vascular event (transient ischemic attack, ischemic stroke, or intracerebral hemorrhage) from October 1998 to January 2014. Cases were matched for age-matched selected controls. Baseline demographics, risk factors, MM characteristics, laboratory values, and mortality of cases were compared to those of controls. Multivariate logistic regression analysis identified risk factors associated with stroke. Ischemic strokes (IS) were classified with modified Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria.
  
  
  RESULTS
  Of 1,148 patients, 46 developed a vascular event (ischemic stroke, 33; transient ischemic attack, 11; hypertensive intracerebral hemorrhage, 2). Multivariate logistic regression analysis determined renal insufficiency (odds Ratio, 3.528; 95% CI, 1.36-9.14; P = 0.0094) and MM Stages I and II (odds Ratio, 2.770, 95% CI, 1.31-5.81; p = 0.0073) were independent predictors of stroke. In our study, strokes attributable to hypercoagulability, atrial fibrillation and small-vessel occlusion were common mechanisms. After a stroke, 78% of patients were discharged to home or a rehabilitation facility and 4% to a long-term nursing facility; in-hospital mortality was 15%. Despite suffering a stroke no significant differences in survival were observed.
  
  
  CONCLUSIONS
  In our cohort of multiple myeloma patients, renal failure and MM Stages I and II had increased risk of stroke.
authors.affiliation: Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America.|Department of Neurology, Ohio State University Wexner Medical Center, Columbus, OH, United States of America.
authors.forename: Archana
authors.initials: A
authors.lastname: Hinduja
authors.affiliation: Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America.
authors.forename: Kaustubh
authors.initials: K
authors.lastname: Limaye
authors.affiliation: Department of Hematology and Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America.
authors.forename: Rahul
authors.initials: R
authors.lastname: Ravilla
authors.affiliation: Department of Hematology and Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America.
authors.forename: Appalnaidu
authors.initials: A
authors.lastname: Sasapu
authors.affiliation: Multiple Myeloma for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America.
authors.forename: Xenofon
authors.initials: X
authors.lastname: Papanikolaou
authors.affiliation: Department of Neurology, Ohio State University Wexner Medical Center, Columbus, OH, United States of America.
authors.forename: Lai
authors.initials: L
authors.lastname: Wei
authors.affiliation: Department of Neurology, Ohio State University Wexner Medical Center, Columbus, OH, United States of America.|Department of Neurosurgery, Ohio State University Wexner Medical Center, Columbus, OH, United States of America.
authors.forename: Michel
authors.initials: M
authors.lastname: Torbey
authors.affiliation: Multiple Myeloma for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America.
authors.forename: Sarah
authors.initials: S
authors.lastname: Waheed
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000453:epidemiology; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D016022:Case-Control Studies; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D002546:Ischemic Attack, Transient / Q000139:chemically induced* / Q000453:epidemiology / Q000401:mortality; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000401:mortality; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012189:Retrospective Studies; D020521:Stroke / Q000139:chemically induced* / Q000453:epidemiology / Q000401:mortality; D013792:Thalidomide / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D010975:Platelet Aggregation Inhibitors; D013792:Thalidomide