According to a study published in the European Journal of Haematology, bleeding complications in multiple myeloma (MM) may be caused by defects in primary hemostasis, particularly prolonged closure times and qualitative defects of von Willebrand factor (VWF). Furthermore, these complications may be associated with disease progression.
The single center observational study assessed blood samples from 164 patients with MM who were categorized as bleeding (86 patients; mean age, 65.3 years; men, 60.5%) or nonbleeding (78 patients; mean age, 67.8 years; men, 55.1%) and were seen at the University Hospital Tuebingen in Germany for coagulation disorders and bleeding complications.
According to the PFA-100 platelet function analyser, the most common defect was prolonged closure time, which was seen in 66% of bleeding patients and 5% of nonbleeding patients (P <.001). The second most common defect was in VWF, which was measured using the ratio of collagen binding activity to VWF antigen quantity (VWF:CB/VWF:Ag; 34% vs 1% in bleeding vs nonbleeding patients, respectively; P =.02).
In terms of disease progression, patients with bleeding complications had a higher serum free light chain ratio (kappa/lambda, 171.9 vs 22.3; P <.001), increased serum creatinine level (1.3 mg/dL vs 1.1 mg/dL; P =.013), increased beta-2 microglobulin (7.2 mg/dL vs 5.8 mg/dl; P =.03), elevated lactate dehydrogenase (240 U/L vs 196 U/L; P =.016), and more bone marrow infiltration (46.4% vs 25.8%; P <.001) compared with nonbleeding patients.
In addition, the coagulation experiments were repeated in 46.5% (40/86) of bleeding patients, and in 43.9% (18/40) of those patients, the coagulation parameters normalized. Of this subset of patients, 88.9% (16/18) experienced at least a partial remission.
The authors concluded that “this study underlines the importance of extensive coagulation diagnostics in patients with MM” and suggested that in instances of “considerably increased bleeding risk” for MM patients (such as major surgery), “a preoperative trial to correct the hemostatic disorder using an algorithm describing the sequential use of therapeutic approaches might be considered.”
1. Hinterleitner C, Pecher A, Kreißelmeier K, et al. Disease progression and defects in primary hemostasis as major cause of bleeding in multiple myeloma [published online September 21, 2019]. Eur J Haematol. doi:10.1111/ejh.13331