melphalan and Venous-Thrombosis

Fifty patients with multiple myeloma >or=75 years of age received primary treatment with melphalan (M) 8 mg/m(2) on days 1-4, dexamethasone (D) 12 mg/m2 on days 1-4 and 17-20 and thalidomide (T) 300 mg at bedtime on days 1-4 and 17-20. This regimen was repeated every 5 weeks for three courses. Patients without evidence of disease progression received nine additional courses of MDT, but without DT on days 17-20, every 5 weeks. Sixty-two percent of patients achieved a partial response and 10% a complete response. The median time to response was 2 months. The median time to progression for all patients was 21.2 months. Deep venous thrombosis and peripheral neuropathy each occurred in 9% of patients.

Topics: Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Dexamethasone; Disease-Free Survival; Female; Humans; Male; Melphalan; Multiple Myeloma; Peripheral Nervous System Diseases; Remission Induction; Thalidomide; Venous Thrombosis

Thalidomide has demonstrated a remarkable efficacy in the treatment of multiple myeloma but its use may cause several toxicities. We have investigated the common and rare side-effects, especially analysing peripheral neuropathy, in order to optimise the thalidomide dose for minimizing this harmful side-effect.. Fifty-nine patients were treated with thalidomide alone or combined with oral melphalan. The median age was 69 yr. The initial dose of thalidomide was 100 mg/day increasing weekly by 100 mg increments until a maximum dose of 400 mg was attained. Melphalan was administered at a dose of 0.20 mg/kg/d for 4 d every 28 d.. Nearly one-fourth of patients discontinued thalidomide because of toxicity. Constipation (71%), somnolence (36%) and fatigue (20%) were the most common side-effects and they were not dose dependent. Peripheral neuropathy occurred in 39% of patients and a thalidomide median daily dose of more than 150 mg was significantly associated with higher frequency and actuarial risk of peripheral neuropathy without improving the response rate. Deep venous thrombosis was observed in 7% of patients and other side-effects were rare. In patients with advanced multiple myeloma we found that a thalidomide daily dose of 150 mg minimizes peripheral neuropathy without jeopardizing response and survival.

Topics: Aged; Aged, 80 and over; Constipation; Disorders of Excessive Somnolence; Dose-Response Relationship, Drug; Fatigue; Female; Humans; Male; Melphalan; Middle Aged; Multiple Myeloma; Peripheral Nervous System Diseases; Probability; Thalidomide; Venous Thrombosis

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Disease-Free Survival; Female; Humans; Male; Melphalan; Middle Aged; Multiple Myeloma; Salvage Therapy; Survival Analysis; Thalidomide; Treatment Outcome; Venous Thrombosis

Topics: Aged; Clonal Hematopoiesis; Female; Hematopoietic Stem Cell Transplantation; Humans; Immunologic Factors; Lenalidomide; Maintenance Chemotherapy; Male; Melphalan; Middle Aged; Multiple Myeloma; Prognosis; Retrospective Studies; Salvage Therapy; Transplantation Conditioning; Transplantation, Autologous; Venous Thrombosis

Amyloidosis is a rare systemic disorder of protein metabolism with progressive extra-cellular deposition of insoluble fibrillary protein, disorganization of tissue architecture, and subsequent organ dysfunction. Primary amyloidosis is the most common form of this disorder, however, it can develop secondary to plasma cell dyscrasias such as multiple myeloma (MM); 10-15% of MM patients may develop amyloidosis of vital organs. Amyloidosis is usually associated with bleeding, but less commonly with thrombosis. We present a 52-year-old Saudi female with amyloidosis secondary to multiple myeloma. She presented with both venous and extensive arterial thrombosis. Although relatively rare, plasma cell dyscrasias such as amyloidosis and multiple myeloma could present with thrombotic rather than hemorrhagic complications.

Topics: Amyloidosis; Antineoplastic Agents, Alkylating; Aortography; Arterial Occlusive Diseases; Biopsy; Female; Humans; Kidney; Melphalan; Middle Aged; Multiple Myeloma; Prednisolone; Treatment Outcome; Venous Thrombosis

The purpose was to evaluate the incidence and risk factors of thromboembolism associated with lenalidomide therapy in newly diagnosed myeloma.. A pooled analysis was performed of patients with previously untreated multiple myeloma enrolled in clinical trials of lenalidomide-based therapy at the Mayo Clinic, Rochester, Minnesota, and the Italian Myeloma Network, Italy. The incidence of thrombosis, the effect of risk factors such as steroid dose and erythropoietin supplementation, and the effect of prophylaxis were examined.. In all, 125 patients enrolled in 3 clinical trials were identified. Patients were stratified based on the concomitant corticosteroid dose. Fifty-two patients were in the high-dose group (dexamethasone 40 mg, 12 days a month); 73 patients were in the low-dose group (prednisone at any dose; or dexamethasone 40 mg, 4 days a month). A total of 110 patients were initiated on thromboprophylaxis; of these, 104 patients (95%) received aspirin. Ten patients (8%) developed deep vein thrombosis, including 4 who were not receiving any thromboprophylaxis at the time of the event. The rate of thromboembolic events was not different between patients who received concomitant erythropoietin therapy and those who did not, 4.8% and 8.6%, respectively (P= .54). A higher number of venous thrombotic episodes occurred in the high-dose corticosteroid group compared with the low-dose corticosteroid therapy group (12% vs 6%), but the difference was not statistically significant (P= .3).. The incidence of deep vein thrombosis is lower than previously reported in the literature. There was a trend to a higher incidence of thrombosis in patients receiving high-dose corticosteroid therapy.

Topics: Adult; Aged; Anti-Inflammatory Agents; Antineoplastic Agents; Dexamethasone; Drug Therapy, Combination; Female; Fibrinolytic Agents; Humans; Incidence; Lenalidomide; Male; Melphalan; Middle Aged; Multiple Myeloma; Myeloablative Agonists; Prednisone; Risk Factors; Survival Rate; Thalidomide; Venous Thrombosis

Patients with a central venous catheter (CVC) undergoing high-dose chemotherapy (HDC) followed by peripheral-blood stem-cell transplantation (PBSCT) for malignancies are at high risk of thrombosis, but the use of anti-coagulant prophylaxis remains debatable in this setting of patients. We analyzed the efficacy and the safety of minidose warfarin in 228 patients in whom CVCs had been placed and who had received 292 HDC courses of therapy. The catheters remained in place for a mean of 173 (range 40-298) days. All patients received prophylactic oral warfarin in the fixed dose of 1 mg/day starting on the day of CVC insertion. Prophylaxis was interrupted during aplasia when platelet counts fell below 50,000/dL. There were no toxic deaths related to the prophylaxis. Overall there were 4 thrombotic events. Three occurrences were directly related to the catheter, while the remaining event was a deep saphenous-vein thrombosis. A number of potential predictive factors were analyzed for their impact on thrombotic events without finding any significant correlation. Four episodes of bleeding occurred, with each of these individuals having a normal INR but a platelet count below 50,000/dL. Minidose warfarin is effective and safe to use for preventing thrombotic events in this setting of patients.

Topics: Administration, Oral; Anticoagulants; Antineoplastic Combined Chemotherapy Protocols; Carmustine; Catheterization, Central Venous; Cytarabine; Female; Hemorrhage; Humans; Male; Melphalan; Neoplasms; Peripheral Blood Stem Cell Transplantation; Platelet Count; Podophyllotoxin; Retrospective Studies; Risk Factors; Transplantation, Homologous; Venous Thrombosis; Warfarin

Topics: Adult; Age Factors; Aged; Angiogenesis Inhibitors; Antineoplastic Combined Chemotherapy Protocols; Humans; Melphalan; Middle Aged; Multiple Myeloma; Prednisone; Prognosis; Risk Factors; Survival Analysis; Thalidomide; Venous Thrombosis

Topics: Adult; Androstenes; Angiography; Antineoplastic Combined Chemotherapy Protocols; Carmustine; Contraceptives, Oral, Synthetic; Cytarabine; Etoposide; Female; Hodgkin Disease; Humans; Immunotherapy; International Normalized Ratio; Lynestrenol; Melphalan; Mineralocorticoid Receptor Antagonists; Risk; Risk Factors; Time Factors; Venous Thrombosis; Warfarin

Bone marrow transplant (BMT) recipients have risk factors for deep vein thrombosis (DVT) including venous stasis caused by immobilization in the sterile unit, vessel wall damage caused by preparative regimen or indwelling catheters, and hypercoagulability caused by decreased natural anticoagulants. We successfully treated a patient who developed massive DVT in the superior vena cava after BMT with anticoagulation and the use of temporary vena caval filters. Considering the delayed complications, permanent filter is not appropriate for BMT recipients, because the risk factors for DVT associated with BMT are transient. We considered that temporary vena caval filter is a safe and useful device to prevent pulmonary embolism after DVT in BMT recipients.

Topics: Anticoagulants; Antineoplastic Combined Chemotherapy Protocols; Bone Marrow Transplantation; Catheterization, Central Venous; Coagulation Protein Disorders; Combined Modality Therapy; Cyclophosphamide; Dexamethasone; Doxorubicin; Endothelium, Vascular; Heparin; Humans; Immobilization; Male; Melphalan; Middle Aged; Multiple Myeloma; Radiography; Salvage Therapy; Thrombophilia; Transplantation, Homologous; Vena Cava Filters; Vena Cava, Superior; Venous Thrombosis; Vincristine; Warfarin