Coagulation disorders in cancerII. multiple myeloma

Sánchez-Ávalos, Julio César; Soong, Bernadette C. F.; Miller, Sherwood P.

doi:10.1002/1097-0142(196906)23:6<1388::aid-cncr2820230621>3.0.co;2-g

Cited by 31 publications

(9 citation statements)

References 21 publications

(3 reference statements)

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“…The prevalence of venous thromboembolism is 4.5%, with a median follow-up of 7 months in our myeloma group. In previous studies, a high incidence of thromboembolic events in MM has been reported [6][7][8]12], and our data are consistent with these reports.…”

Section: Discussionsupporting

confidence: 93%

“…Studies of fibrinolytic function in MM are frequently designed to assess the relationship between the hemorrhagic features and increased activity of the fibrinolytic system. In MM, both decreased and increased fibrinolytic activity have been reported [12,[20][21][22][23]. The evaluation of these results is hampered by the relatively low patient number; the lack of knowledge about stage and disease activity; and the variability of the methods used to measure fibrinolytic activity.…”

Section: Discussionmentioning

confidence: 99%

“…Although several clinical characteristics of patients with myeloma are factors predisposing to thrombosis, including immobilization [10], hyperviscosity and hypercalcemia [11], amyloidosis [6], increased levels of plasma fibrinogen [12], activated protein C resistance in the absence of factor V Leiden mutation [13], hypercoagulability underlying MM has not been precisely defined. Thromboembolic events associated with lupus anticoagulants, protein C, and free protein S deficiency are rarely reported in MM [14][15][16].…”

Section: Introductionmentioning

confidence: 99%

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Fibrinolytic activity in multiple myeloma

Yağcı¹,

Sucak

Haznedar

2003

American J Hematol

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The incidence of thromboembolic events is high as a result of disease, disease-related complications, and therapy in multiple myeloma (MM). In patients with hematologic tumors, impaired fibrinolysis may be present and may contribute to the development of thrombotic complications. Therefore, we designed a study to investigate fibrinolytic activity in MM. We compared plasma levels of interleukin (IL)-6, C-reactive protein (CRP), IL-1b, IL-11, tissue plasminogen activator (tPA) activity, plasminogen activator inhibitor-1 (PAI-1) activity, and global fibrinolytic capacity (GFC) in patients with MM (n = 66) and in control subjects (n = 18). The prevalence of venous thromboembolism was 4.5%, with a median follow-up period of 7 months in our myeloma group. Results are given as mean (median, range). Plasma levels of .32] pg/mL versus 2.64 ± 0.66 [1.80, 0.10-11.86] pg/mL, P < 0.001), CRP (45.57 ± 9.92 [21.00,.00] mg/L versus 1.96 ± 0.50 [1.05, 0.19-8.03] mg/L, P < 0.001), PAI-1 (7.40 ± 0.67 [5.57, 2.40-31.80] IU/mL versus 4.73 ± 0.65 [3.60, 2.32-11.00] IU/mL, P < 0.01), GFC score (1.90 ± 0.02 [2, 1-3] versus 2.50 ± 0.14 [3, 1-3], P < 0.001) were increased compared with controls. In patients with MM, the level of IL-6 was positively correlated with CRP (r = 0.66, P < 0.001), IL-1b (r = 0.29, P < 0.05), and PAI-1 (r = 0.35, P < 0.01) and negatively correlated with GFC (r = À0.37, P < 0.01). CRP level was positively correlated with plasma PAI-1 level (r = 0.40, P < 0.01) and negatively correlated with GFC (r = À0.44, P < 0.001). A significant negative correlation between PAI-1 level and GFC (r = À0.75, P < 0.001) was also detected. IL-1b levels were negatively correlated with tPA level (r = À0.26, P < 0.05). These results suggest that patients with myeloma have a decreased fibrinolytic activity mainly because of increased PAI-1 activity. In MM, increased PAI-1 activity seems to be related with elevated IL-6 level. MM should be considered as a hypercoagulable state as a result of both increased procoagulant activity and decreased fibrinolytic activity. Achieving a plateau by means of conventional chemotherapies does not improve the decreased fibrinolytic activity. Am.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Fibrinolytic activity in multiple myeloma

Yağcı¹,

Sucak

Haznedar

2003

American J Hematol

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“…The most common coagulation test abnormality in human myeloma patients is a prolongation of the thrombin time [62]. This finding is associated with paraprotein-fibrin binding that impairs fibrin monomer polymerization.…”

Section: Lymphoproliferative Disordersmentioning

confidence: 99%

Hematopoietic Neoplasias in Horses: Myeloproliferative and Lymphoproliferative Disorders

Muñoz

Riber

Trigo

et al. 2009

JES

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Leukemia, i.e., the neoplasia of one or more cell lines of the bone marrow, although less common than in other species, it is also reported in horses. Leukemia can be classified according to the affected cells (myeloproliferative or lymphoproliferative disorders), evolution of clinical signs (acute or chronic) and the presence or lack of abnormal cells in peripheral blood (leukemic, subleukemic and aleukemic leukemia). The main myeloproliferative disorders in horses are malignant histiocytosis and myeloid leukemia, the latter being classified as monocytic and myelomonocytic, granulocytic, primary erythrocytosis or polycythemia vera and megakaryocytic leukemia. The most common lymphoproliferative disorders in horses are lymphoid leukemia, plasma cell or multiple myeloma and lymphoma. Lymphoma is the most common hematopoietic neoplasia in horses and usually involves lymphoid organs, without leukemia, although bone marrow may be affected after metastasis. Lymphoma could be classified according to the organs involved and four main clinical categories have been established: generalized-multicentric, alimentary-gastrointestinal, mediastinal-thymic-thoracic and cutaneous. The clinical signs, hematological and clinical pathological findings, results of bone marrow aspirates, involvement of other organs, prognosis and treatment, if applicable, are presented for each type of neoplasia. This paper aims to provide a guide for equine practitioners when approaching to clinical cases with suspicion of hematopoietic neoplasia.

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“…163 Other platelet function defects have also been consistently noted in cancer patients and include defective platelet aggregation to ADP and other presumptive evidence of platelet dysfunction as manifested by a prolonged thromboplastin generation test, prolonged template bleeding times, positive tourniquet test, and poor clot retraction. 7,[163][164][165] It is unclear whether these defects develop secondary to the malignancy itself, whether they happen from partial release of platelet contents after contact with malignant tissue, or whether they develop in response to circulating activated clotting factors. The malignant paraprotein disorders are frequently associated with platelet function abnormalities, which develop from coating of platelet surfaces by circulating immunoglobulins; 5,166,167 consistent platelet aggregation abnormalities are found in the myeloproliferative and myelodysplastic syndromes.…”

Section: Platelet Function Defectsmentioning

confidence: 99%

Coagulation Abnormalities in Malignancy: A Review

Bick¹

1992

Semin Thromb Hemost

215

150

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As outlined in this review, patients with cancer may harbor many alterations of hemostasis. These are multifaceted and must be taken into account when trying to control hemorrhage or thrombosis in cancer patients. Often, hemorrhage or thrombosis is the final fatal event in many patients with metastatic solid tumor or hematologic malignancies. Patients with malignancy present a major clinical challenge in this new era of oncologic awareness and more aggressive care, which has led to prolonged survival for patients and a longer time frame during which these complications may develop. Therefore, these complications are occurring more commonly. It is important to realize that these alterations of hemostasis exist and must be approached in a sequential and logical manner with respect to diagnosis; only in this way can responsible, efficacious, and rational therapy be delivered to patients. By far the most common alteration of hemostasis in malignancy is that of hemorrhage associated with thrombocytopenia, either drug-induced, radiation-induced, or from bone marrow invasion. However, hemorrhage resulting from DIC is also quite common and may present as hemorrhage, thrombosis, thromboembolus, or any combination thereof. Many antineoplastic drugs and radiation therapy may lead to or significantly enhance hemorrhage in patients with malignancy. Thrombosis, also commonly seen in patients with malignancy, is often a manifestation of low-grade DIC, conspicuous as an intravascular thrombotic or thromboembolic event instead of an intravascular proteolytic (hemorrhagic) event. When suspecting this, confirmatory laboratory evidence must be sought and the patient treated appropriately. When approaching the patient with malignancy and either hemorrhage or thrombosis, all the potential defects in hemostasis must be taken into account, defined from the laboratory standpoint, and treated in as precise and logical manner as possible.

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Coagulation disorders in cancerII. multiple myeloma

Cited by 31 publications

References 21 publications

Fibrinolytic activity in multiple myeloma

Fibrinolytic activity in multiple myeloma

Hematopoietic Neoplasias in Horses: Myeloproliferative and Lymphoproliferative Disorders

Coagulation Abnormalities in Malignancy: A Review

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