Oka Satoko, Takeuchi Suguru, Shiragami Hiroshi, Hamahata Keigo, Nohgawa Masaharu
Division of Hematology, Japanese Red Cross Society Wakayama Medical Center.
Rinsho Ketsueki. 2017;58(1):37-41. doi: 10.11406/rinketsu.58.37.
A 69-year-old man was diagnosed with multiple myeloma (IgG-κ) in January 2012. He received autologous hematopoietic stem cell transplantation in August 2012 and subsequently maintained a stringent complete remission. In March 2016, he relapsed and was treated with lenalidomide and low-dose dexamethasone (Ld). On day22, he developed an asymptomatic venous thromboembolism (VTE) despite receiving prophylactic aspirin treatment. Thus, heparin and warfarin were administered. However, his prothrombin time-international normalized ratio did not remain within the target range of 2-3. Therefore, 10 mg/day of apixaban, a factor Xa inhibitor, was administered. The apixaban treatment resulted in favorable and effective control of the patient's VTE on day33. He has continued to receive Ld treatment and has suffered no further VTE or bleeding. Further large studies are needed to assess the efficacy and safety of factor Xa inhibitors for the treatment of MM-associated VTE.
一名69岁男性于2012年1月被诊断为多发性骨髓瘤（IgG-κ型）。他于2012年8月接受了自体造血干细胞移植，随后维持严格的完全缓解状态。2016年3月，疾病复发，接受来那度胺和小剂量地塞米松（Ld）治疗。在第22天，尽管接受了预防性阿司匹林治疗，他仍发生了无症状静脉血栓栓塞（VTE）。因此，给予肝素和华法林治疗。然而，他的凝血酶原时间-国际标准化比值未维持在2-3的目标范围内。因此，给予10mg/天的阿哌沙班（一种Xa因子抑制剂）治疗。阿哌沙班治疗在第33天有效控制了患者的VTE。他继续接受Ld治疗，未再发生VTE或出血。需要进一步开展大型研究以评估Xa因子抑制剂治疗MM相关VTE的疗效和安全性。
