From the Guidelines
Multiple myeloma is not directly associated with decreased von Willebrand Factor (VWF) levels, but rather, the treatment of multiple myeloma, particularly with thalidomide and lenalidomide, can increase the risk of thromboembolism, which may be related to changes in VWF and other coagulation factors. The relationship between multiple myeloma and VWF is complex, and the available evidence does not support a direct link between the two. However, the treatment of multiple myeloma, especially with immunomodulatory drugs like lenalidomide and thalidomide, can increase the risk of thromboembolism, as noted in a study published in the Journal of the American College of Cardiology 1.
The exact mechanism of this increased risk is not fully understood, but it may be related to changes in VWF and other coagulation factors, such as factor VIII and soluble thrombomodulin. A study published in Blood Advances 1 discusses the management of venous thromboembolism in patients with cancer, including those with multiple myeloma, and highlights the importance of balancing the risk of thromboembolism with the risk of bleeding when using anticoagulant prophylaxis.
Key points to consider in the management of multiple myeloma and its associated thrombotic risks include:
- The use of anticoagulant prophylaxis, such as low-dose aspirin or low molecular weight heparin, to reduce the risk of venous thromboembolism in patients receiving lenalidomide- or thalidomide-based regimens 1
- The importance of monitoring VWF levels and other coagulation factors in patients with multiple myeloma, particularly those receiving immunomodulatory drugs 1
- The need for further research to understand the relationship between multiple myeloma, its treatment, and the risk of thromboembolism, as well as the development of effective strategies for preventing and managing this risk 1
From the Research
Relationship between Multiple Myeloma and von Willebrand Factor (VWF)
- Multiple myeloma has been associated with acquired von Willebrand disease (aVWD), a rare bleeding disorder characterized by a decrease in von Willebrand factor (VWF) activity 2.
- Studies have shown that patients with multiple myeloma often have decreased VWF levels, which can lead to bleeding complications 3, 4.
- The decrease in VWF levels in multiple myeloma patients is thought to be due to the production of monoclonal immunoglobulins that inhibit VWF activity 4.
- Disease progression and defects in primary hemostasis, including decreased VWF levels, are major causes of bleeding in multiple myeloma patients 3.
- Treatment of the underlying disease can lead to an improvement in VWF levels and a reduction in bleeding complications 2, 4.
Coagulation Abnormalities in Multiple Myeloma
- Multiple myeloma patients often have coagulation abnormalities, including elevated factor VIII and VWF levels, which can increase the risk of thrombosis 5, 6.
- However, some studies have found that VWF levels can be decreased in multiple myeloma patients, particularly those with advanced disease 3, 4.
- The relationship between multiple myeloma and VWF levels is complex and may be influenced by various factors, including disease activity and treatment 5, 6.
Clinical Implications
- The decrease in VWF levels in multiple myeloma patients can have significant clinical implications, including an increased risk of bleeding complications 3, 4.
- Assessment of VWF levels and other coagulation parameters is important in the management of multiple myeloma patients, particularly those with a history of bleeding or thrombosis 3, 5.
- Further studies are needed to fully understand the relationship between multiple myeloma and VWF levels and to develop effective strategies for managing coagulation abnormalities in these patients 3, 5, 6.