Assessment of rotation thromboelastometry (ROTEM) parameters in patients with multiple myeloma at diagnosis

Abstract

Patients with multiple myeloma (MM) have an increased risk of thromboembolic events (TEE). Due to the complex nature of the prothrombotic state in MM, no single laboratory test has been designed to identify patients with the highest risk of developing TEE. Hence, this study is intended to assess the feasibility of using global hemostasis test rotation thromboelastometry (ROTEM) in MM patients to identify the presence of changes indicating hypercoagulability. The study included 26 patients with MM at the time of diagnosis and 20 healthy volunteers. Clotting time (CT), clot formation time (CFT), alpha angle (α), maximum clot firmness (MCF) and maximum lysis (ML) were among the most important parameters recorded during the NATEM, INTEM, EXTEM, FIBTEM and APTEM tests. For the NATEM test, CT and CFT readings were markedly lower in MM patients than in controls (524s v. 753s; p=0.0006 and 136s v. 242s; p=0.02 respectively). However, no marked differences concerning these parameters were observed in the INTEM, EXTEM, FIBTEN or APTEM tests. α-angle values were significantly higher for MM samples according to the NATEM, EXTEM, FIBTEM and APTEM tests (64° v. 48.5°, p=0.02; 77° v. 74°, p=0.02; 80° v.69.5°, p=0.00007; 77° v. 74°, p=0.01 respectively). MCF readings were significantly higher in the FIBTEM test (22mm v. 15.5mm, p=0.0003) in MM patients. Also, the NATEM test revealed a trend toward higher MCF values in MM samples (56mm v. 49.5mm, p=0.055). No marked differences were seen in the INTEM, EXTEM and APTEM tests. ML readings were markedly lower (0 % v. 4.5 %, p=0.0008) in MM samples than in controls according to the FIBTEM test. The studied clot lysis parameters did not differ markedly between analyzed groups in other tests. Marked negative correlations were noted between IgG concentration and CT (EXTEM, FIBTEM) and CFT (INTEM), as well as a significant positive correlation between IgG concentration and MCF (INTEM, FIBTEM) and α (INTEM) in MM IgG patients. Our results suggest that patients with MM display changes in ROTEM tests at the time of diagnosis that may indicate a prothrombotic state.