Summary

Lenalidomide, a derivate of thalidomide, has recently been approved in Europe for the treatment of patients with multiple myeloma. Although the substance has a better effect/side-effect profile, especially with regard to teratogenicity and neurotoxicity, the rate of therapy-induced thrombosis seems comparable to thalidomide. The observed thromboembolic events were accompanied with a high rate of deleterious pulmonary embolism. Interestingly, the substances alone are not thrombogenic but combination with anthracyclines, dexamethasone or erythropesis- stimulating factors increases the risk considerably. As up to one third of patients treated with such combinations are affected, antithrombotic co-medication is highly recommended. This review elucidates the complex interactions between an activated coagulation-system in myeloma patients and the molecular effects of these drugs. This perception is important to choose the proper prophylactic co-medication without increasing the risk of bleeding, especially in first-line treatment, patients with high paraprotein-levels, or thrombopenia, either therapyinduced or due to bone-marrow infiltration.

Erratum:

In the review article by Gieseler "Pathophysiological considerations to thrombophilia in the treatment of multiple myeloma with thalidomide and derivates" published in Thromb Haemost 2008; 99 (6): 1001-1007 on page 1005 left column, third line from the bottom and in the box "Recommendations based on pathophysiological considerations" an incorrect dosage for enoxaparin was given. It should be 40 mg/day.