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Fibrinolytic activity in multiple myeloma
Author(s) -
Yağcı Münci,
Sucak Gülsan Türköz,
Haznedar Rauf
Publication year - 2003
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/ajh.10433
Subject(s) - medicine , gastroenterology , multiple myeloma , fibrinolysis , plasminogen activator , incidence (geometry) , tissue plasminogen activator , optics , physics
Abstract 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‐1β, 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 IL‐6 (8.27 ± 0.74 [9.65, 0.90–13.32] 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, 1.34–330.00] 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‐1β ( r = 0.29, P < 0.05), and PAI‐1 ( r = 0.35, P < 0.01) and negatively correlated with GFC ( r = −0.37, 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 = −0.44, P < 0.001). A significant negative correlation between PAI‐1 level and GFC ( r = −0.75, P < 0.001) was also detected. IL‐1β levels were negatively correlated with tPA level ( r = −0.26, 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. J. Hematol. 74:231–237, 2003. © 2003 Wiley‐Liss, Inc.