[salma]

Beta-2 microglobulin & deep vein thrombosis (DVT)

by salma on Sun Sep 25, 2016 5:02 pm

Hello everyone,

Dad's undergone autologous stem cell transplant after achieving a complete remission (CR) from 7 cycles of Velcade, dexamethasone and cyclophosphamide (Cytoxan, Endoxan).

After dad's admission twice for fever -- non specific, responding to paracetamol (Tylenol, acetaminophen) -- and lower limb pain and edema during the first month after the transplant, the specialist recommended starting lenalidomide (Revlimid) maintenance (21 days / 1 week off).

However, the constant bone and joint aches as well as the lower limb edema made the doctor decrease the dose to 1 capsule every other day for 21 days and a week off.

Dad' s discomfort improved and after starting the 2nd cycle (coincidentally it was the end of his post-transplant 100 days period) he got a right lower limb deep vein thrombosis (DVT).

We stopped the treatment and my father is on enoxaparin (Lovenox, Clexane) 80 mg twice / day for 3 days now.

Dad is known to have renal impairment (serum creatinine level = 1.5) when we did the 100 days follow up (serum creatinine= 1.9 , urea = 46) and his beta-2 microglobulin is raised to 4.9

Still waiting for the serum protein electrophoresis and immunofixation.

But I am really scared. I don't know if the raised beta-2 microglobulin was secondary to any drugs he took? Is there a relation to the hyperviscosity state of lenalidomide and the formation of deep vein thrombosis (DVT)? Or is it coming back?

thank you in advance
salma

[NStewart]

Re: Beta-2 microglobulin & deep vein thrombosis (DVT)

by NStewart on Mon Sep 26, 2016 11:31 am

One of the known possible side effects of lenalidomide (Revlimid) is blood clots. When someone is taking this drug, it is recommended that they also take aspirin as a preventative. I took 325 mg of aspirin a day from when I started Revlimid. In spite of that, I developed multiple clots in my lungs after being on 15 mg of Revlimid and 20 mg of dexamethasone for 1 1/2 years. They still don't know where the clots originated because I had no classic signs of clots other than shortness of breath. I'm now taking 20 mg of Xarelto (rivaroxaban) daily and am still taking Revlimid 10 mg and dex 12 mg with good control. Xarelto is one of the newer blood thinners.

I can't speak to your other questions,
Nancy in Phila

[salma]

Re: Beta-2 microglobulin & deep vein thrombosis (DVT)

by salma on Mon Sep 26, 2016 12:43 pm

Thank you, Nancy, for your reply,

Dad was on daily aspirin as well, still he developed the deep vein thrombosis (DVT).

Still waiting for the rest of his lab results, and as mentioned, he's so far on Clexane (Lovenox, enoxaparin), yet the low grade fever started to rise every other day.

Thank you again,
salma

[MrPotatohead]

Re: Beta-2 microglobulin & deep vein thrombosis (DVT)

by MrPotatohead on Mon Sep 26, 2016 6:26 pm

Hello salma

I have not read anything about beta2-micro­globulin increases caused by any of the drugs you mention. However, Revlimid (as well as myeloma) can negatively affect kidney function, which in turn can cause an increase in beta2-microglobulin. Usually, the problem can be handled by adjusting the Revlimid dosage.

I am not a doctor and have no medical training; this is all based on my own reading / experience. My creatinine levels have hovered around the same values you quote for your Dad.

It does sound as if your Dad likely needs a stronger anti-coagulant than aspirin – perhaps one of the ones Nancy mentioned.

Best of luck to you and your Dad.

[salma]

Re: Beta-2 microglobulin & deep vein thrombosis (DVT)

by salma on Tue Sep 27, 2016 5:10 am

Hi MrPotatohead,

Thank you for your reply and I hope all goes well for you and Dad.

I have read the same about impaired renal function and raised values of beta-2 microglobulin.

Still waiting for the rest of lab results and the effect of Clexane (enoxaparin, Lovenox) on the developed DVT.

Thank you,
Salma