Relapsed/Refactory Patients

DVT is a blood clot that forms in a deep vein in an extremity, usually the calf. The clot can block blood flow and if the clot breaks off the vein, it can travel through the bloodstream to the lungs, where it can cause severe shortness of breath and/or chest pain. Thus, it is important to identify DVT as early as possible. You should tell your doctor immediately if you have any of the following symptoms with your legs (or arms):

• Swelling of calf or ankle in one leg
  
• Warm, painful, or tender area
  
• Reddened or discolored area
  
• Hardened area

You should also contact your doctor if you have difficulty breathing or chest pain. These symptoms may indicate that a clot has traveled to the lung (known as a pulmonary embolism).

The risk of DVT has been reported to be higher for individuals with myeloma treated with Thalomid than for individuals treated with other drugs. In addition, the risk is even greater when Thalomid is used in combination with dexamethasone or certain chemotherapy drugs (such as doxorubicin). DVT most often occurs within the first 6 months after the start of treatment.

The use of an anticoagulant agent (a drug that thins the blood to prevent the formation of blood clots) has substantially reduced the occurrence of DVT among individuals treated with Thalomid for myeloma, and it is recommended that an anticoagulant agent be used preventively for these individuals.

Anticoagulant agents include warfarin (Coumadin; Bristol-Myers Squibb), low-molecular-weight heparin, and aspirin. Immobility, either through prolonged bedrest or sitting for a long period of time (such as on a long plane or car trip), also increases the risk of DVT. Individuals who take Thalomid should avoid long periods of immobility.

Some individuals may be at greater risk for DVT (aside from the risk associated with Thalomid). Risk factors include

• Prior DVT or family history of DVT
  
• Recent surgery (particularly hip, knee, pelvic, and some gynecologic procedures)
  
• Fractures
  
• Pacemakers or a catheter in a major vein (used to give some types of anticancer
  drugs)
  
• Pregnancy or childbirth within the past 6 months
  
• Horomone-replacement therapy or birth control pills
  Older age
  
• Overweight
  
• History of smoking