Contribution of Rotational Thromboelastometry (ROTEM) research parameters for the evaluation of hypercoagulability in patients with Multiple Myeloma. A pilot study

Introduction: hematological malignancies are associated with an increased thrombotic risk compared to solid tumors. Multiple myeloma (MM) is a hematological neoplastic disease with strong thromboembolic repercussions. In these patients the venous thromboembolism may occur during the first months of treatment with immunomodulatory drugs (IMiDs), in combination with high-dose of dexamethasone. Although IMiDs therapy improves the clinical outcome, a concomitant increase of thromboembolic manifestations are observed. Rotational thromboelastometry, provides information on the clot formation, its stabilization and dissolution, reflecting in vivo patient's hemostasis. The aim of the study was to investigate the dynamic state of clot formation, through the evaluation of research parameters, in addition to standard ones, to best evaluate the thrombotic risk in these patients. Methods: thirty-four MM patients and thirty-five controls were unrolled from Hematology Department of the University Hospital Federico II of Naples, Italy. To evaluate the coagulation's dynamics status, we investigated EXTEM, INTEM and FIBTEM assays, through both standard (CT, CFT, MCF, α-angle) and research (MAXV, MAXVt, AUC) parameters, using Rotational Thromboelastometry. Results: among the research parameters, we observed statistical significance differences between controls and patients for EXTEM (MAXV: p=0.010; MAXVt: p=0.010), for INTEM (MAXV:10 p=0.005; MAXVt: p=0.005) and for FIBTEM (MAXV: p<0.001; AUC: p<0.001) tests. Discussion: to the best of our knowledge, this is an original study showing that research parameters can give an additional contribution to the interpretation of the hypercoagulability state in MM patients, bringing to light patients who could be at higher thrombotic risk. © 2023 Biomedia. All rights reserved.