The evolving hemostatic profile of patients with myeloma receiving treatment

Thrombosis is a well-described complication of myeloma and the drugs used to treat it. The causes are multifactorial. Traditional screening tests of coagulation, such as the prothrombin time and the activated partial thromboplastin time, are known to be poor at assessment of thrombosis risk. It has been suggested that global measures of haemostasis, such as thromboelastography, may have a role to play in the assessment of this risk. The aim of this study was to look at traditional measures of haemostasis, that measure certain parts of the coagulation cascade, as well as thromboelastography, to see if a coagulation profile of patients with myeloma could be established. Sixteen consecutive patients with symptomatic myeloma were recruited and had their coagulation parameters measured at baseline and following four consecutive cycles of treatment. IgG was the most common subtype of myeloma. Almost two thirds received an immunomodulatory agent and the majority of patients (13/16) received some form of thromboprophylaxis. The median FVIII:C level was elevated at baseline. It significantly increased after one cycle of chemotherapy (p = 0.02). This pattern was replicated with VWF:Ag (p = 0.039). Thromboelastography demonstrated a significant shortening of the mean k time (p = 0.015) and a mean increase in the alpha angle (p = 0.032) between baseline and after two cycles of treatment consistent with increasing hypercoagulability. Markers of hypercoagulability are increased in patients with myeloma and further increase when they commence treatment. There is a suggestion that after this initial increase, as the burden of myeloma decreases, so do these markers of hypercoagulability.