Supportive Care
imf hotLine coorDinators answer your Questions
The IMF Hotline 800-452-CURE (2873) is staffed by Debbie Birns, Paul Hewitt, and Nancy Baxter.
The phone lines are open Monday through Friday, 8am to 4pm (Pacific Time).
To submit your question online, please email TheIMF@myeloma.org.
My doctor has just prescribed
individual risk factors are: increased
Revlimid® (lenalidomide) and
age, obesity, history of blood clots, hav-
dexamethasone and I've read that
ing a central-venous catheter, prolonged
blood clots can be caused by this
inactivity (such as during a long airplane
regimen. What can I do to guard
flight), varicose veins, other diseases
against this?
(diabetes, infections, sickle cell disease,
As always, it is best to discuss this ques-
cardiac diseases), surgical procedures
tion with your own doctor. For exam-
(including vertebroplasy and kypho-
ple, prior blood clot issues or heart/
plasty) and inheritied thrombophilia
lung/vascular problems may mean that
(genetic mutations that can increase the
Revlimid/dexamethasone is not a good
likelihood of forming a blood clot). In
choice for you. If you go ahead with
addition, myeloma itself is a risk factor,
Revlimid/dexamethasone, your doctor
as is hyperviscosity (thickening of the
is in the best position to decide what
blood).
Hotline staff: Debbie Birns, Paul Hewitt, and Nancy Baxter
medications you might need to help
Aspirin alone is recommended for
prevent blood clots based upon the drugs and dosages you are receiv-
patients who have either no risk factor or only one individual/myeloma-
ing and whether or not you are at a higher risk than average for blood
related risk factor. Thus, for a majority of patients receiving Revlimid com-
clots. We can provide some general background that you can use as a
bined with low-dose dexamethasone (i.e. dexamethasone taken only one
basis for a discussion with your doctor. The IMF's International Myeloma
day each week), aspirin alone is sufficient prophylaxis.Patients who have at
Working Group has just had an article published in Leukemia (2008, vol.
least two individual/myeloma-related or therapy-related risk factors (high-
22, pp. 414-423) on the prevention of blood clots in thalidomide- and
dose dexamethasone, doxorubicin, or multi-agent chemotherapy) should
Revlimid- based therapies. You can access the full article on our website
receive LMWH or full-dose warfarin. The International Myeloma Working
www.myeloma.org. The IMF's Nurse Leadership Board has also created
Group has stated that ongoing randomized trials comparing aspirin, war-
the Consensus Statement for the Prevention of Thromboembolic Events
farin, and LMWH will soon determine the optimal prophylaxis strategy.
Associated with Novel Therapies in Patients with Multiple Myeloma, which
will shortly be published in the Clinical Journal of Oncology Nursing, and
The patient (and his or her doctor) must also keep in mind that there are
will appear on our website at that time.
side effects and risks associated with prophylaxis. Thus the doctor must
weigh your entire situation when making a decision about what type of
While the addition of both thalidomide and Revlimid to the arsenal of
prophylaxis is best for you.
anti-myeloma treatments has extended survival for patients, there are
some potential serious side effects of these treatments. Myeloma patients
Again, we caution that this is a complicated issue and that the above
treated with thalidomide or Revlimid in combination with steroids or
information is designed to provide a basis for discussing this issue with
chemotherapy have an increased risk of blood clots: venous thromboem-
your doctor. We encourage you to share the Leukemia article from the
bolisms (VTEs) or deep vein thrombosis (DVTs). Blood clots or DVTs are
International Myeloma Working Group with your doctor, as well as the
a serious condition and are potentially life threatening. DVT is a blood
IMF Nurse Leadership Board consensus statement on this issue. mt
clot in a deep vein of the lower extremities (usually occurring in the leg
or thigh, and very occasionally in the neck or upper arm). A blood clot
What do you get at an
from a DVT can break loose (embolize) and travel to the lung, causing a
IMF Patient & Family Seminar?
pulmonary embolism (PE), which is very dangerous. The symptoms of
DVT are warmth, swelling, redness and/or pain in an extremity, or dif-
·Education
·Access to Experts
ficulty breathing. Any of these symptoms should be reported immediately
Get vital, up-to-date information,
Get one-on-one access to the
including:
experts with time to ask questions
to your doctor.
· Options for front-line therapy
about your treatment options.
All patients on a regimen of thalidomide or Revlimid in combination with a
· What to do at relapse
·Camaraderie
steroid or chemotherapy should receive routine prophylaxis (medications
· What is the current role
Share your experiences and gain
strength from hearing other
taken to prevent something) in the form of a blood thinner to prevent
of transplantation
people's stories, as you become
blood clots. The choices of prophylaxis are several: aspirin (81325 mg
· Which emerging therapies
look promising
part of the IMF family.
once daily), LMWH (low molecular-weight heparin) or full-dose warfarin.
See the calendar on the back page for dates and locations of upcoming
Which drug is best for you depends upon both the regimen you are on and
seminars. To register for a seminar, please call (800) 452-CURE (2873)
whether you have any additional risk factors for blood clots. The primary
or email TheIMF@myeloma.org.
800-452-CURE (2873)
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