Haematologica 2003 - Supplements

was associated with I.V. line, while 4 (30.8 %) were identified
postoperatively. We identified several univariable correlates in
MGUS patients, including family (HR-13.79, P= .014) and
personal (HR-8.95, P=. 002) history of DVT, low serum albumin
(HR-4.21, P=. 018) and increased white blood cells count (HR-
3.41, P=. 032). IgG immunoglobulin type was protective in our
analysis (HR-0.19, P=. 017). None of the patients received any
type of active treatment for their disaese. In conclusion, risk for
thromboembolic diseases in patients with MGUS is increased as
compared to general population, and is similar to incidence in
MM patients (10%). Further studies are necessary to define the
mechanisms involved.
098
Amyloidosis and Deep Venous Thrombosis (DVT)
Gordan Srkalovic, Marte A. Cameron, Lisa Rybicki and
Mohamad A. Hussein
Cleveland Clinic Foundation Multiple Myeloma Research Program
Coagulation problems in Amyloidosis are historically associated
with bleeding tendencies (mostly F X abnormalities). Increased
clotting was observed in isolated cases diagnosed with low grade
DIC. Problem of DVT in Amyloidosis was not systematically
investigated. We evaluated frequency of DVT and risk factors for
DVT in 56 consecutive Amyloidosis patients with a documented
disease evaluated and followed up at our Center from 1991-2001.
Data were collected in 5 categories: (a) demographics, (b) disease
and treatment, (c) thrombosis case information, (d) major risk
factors for thrombosis and (e) baseline laboratory data. Uni- and
multivariable correlates of DVT were assessed using Kaplan-
Meier analysis and Cox proportional hazards analysis. Mean age
of the patients was 61.8 (range 21 – 83). Male female percentage
ratio was 70/30. 30 % of the patients had high creatinine level (>
1.4 mg/dl). Personal or family history of DVT was recorded in
1.8 and 0 % of patients, respectively. Known hypercoagulable
state was present in 1 patient (1.8%). 7.6 % of patients were
smokers. Of 56 patients 6 developed DVT (10.7%). Median
time from diagnosis to DVT was 12.5 month (range 1-107).
Treatment was given within 1.4 months (range 0-4) from the
development of thrombosis. Only sites of DVT were lower
extremities. No cases were associated with I.V. line. 1 (16.7 %)
was identified postoperatively. We identified several univariable
correlates of DVT in Amyloid patients, including age at
diagnosis (HR-2.99, P=. 041), personal history of DVT (HR-47.7,
P=.006), immobility (HR-11.78, P=.006). Paradoxically, presence
of circulating serum M-protein had protective role in our analysis
(HR-.08, 95% confidence interval .01-. 80, P=. 031). There was
no correlation with the type of treatment patients was receiving.
Family and personal history of DVT were also identified as risk
factors in multivariable analysis of whole group (668) of patients
with plasma cell dyscrasias. In conclusion, risk for
thromboembolic diseases in patients with Amyloidosis is
identical to one previously described for MM patients (10%).
Further studies are necessary to define pathophysiological
processes involved.
099
Disturbances of Anticoagulation and Fibrinolytic
Systems in Monoclonal Gammapathies - Another
Mechanism of M-protein Interference with Hemostasis.
Ivan Spicka, Zuzana Rihova, Petr Cieslar, Bohumir
Prochazka *
Ist Department of Internal Medicine, Department of Hematology,
General Faculty Hospital, Charles University, Prague, Czech rep; *
National Institute of Public Health, Prague, Czech rep. Phone: +
420-2- 24962551; Fax: + 42-2-297932; e-mail: spicka@cesnet.cz
Monoclonal gammapathies (MG) may be associated with unique
M-protein induced disturbances of either primary hemostasis or
plasma coagulation. We have investigated the possible
interference of M-protein with antithrombotic systems. Decrease
of antithrombin III, protein C, protein S and plasminogen levels
or defect of APC resistance was found in 26.5% of patients.
However, higher tissue-type plasminogen activator (t-PA)
activity was the most frequent abnormality. The relationship
between M-protein type and concentration and frequency of
antithrombotic factor abnormalities was not found. The risk of
venous thrombosis was higher in patients with the defect in
comparison with the unaffected group (46% vs. 22%) but the
difference was not statistically significant. Bleeding
complications were markedly less frequent in the group of
patients with the defect of anticoagulation mechanisms (0% vs.
17%). In conclusion, we have found the defects of
anticoagulation and/or fibrinolytic system, analogous to wellknown
disturbances in hemostatic mechanisms, in more than a
quarter of patients with MG. The interference of M-protein with
coagulations inhibitors and/or fibrinolytic systems could
contribute to the development of thromboembolic events.
100
Occupation, Pesticide Exposure and Risk of Multiple
Myeloma
D. Baris1, D.T. Silverman1, L.M. Brown1, G.M. Swanson2,
R.B. Hayes1, A.G. Schwartz3, J.M. Liff4, J.B.
Schoenberg5, L. M. Pottern6, R.S. Greenberg7, P.A.
Stewart1.
1Div. of Cancer Epidemiology and Genetics, NCI, NIH, DHHS,
Bethesda, MD; 2Cancer Center, Michigan State University, E. Lansing,
MI;3Wayne State University, School of Medicine and the Karmanos
Cancer Institute, Detroit, MI; 4Rollins School of Public Health, Emory
University, Atlanta, GA; 5New Jersey State Department of Health,
Trenton, NJ; 6Women`s Health Initiative, NIHLB, NIH, DHHS,
Bethesda, MD; 7Medical University of South Carolina, Charleston, SC.
In this population-based case-control study, we examined the
relationship between occupation, farm history, pesticide exposure
and risk of multiple myeloma among blacks and whites in the
U.S. The study included 573 cases (206 blacks and 367 whites)
newly diagnosed with myeloma between 1986 and 1989 and
2,131 controls (967 blacks and 1,164 whites) from three U.S.
geographic areas. Detailed information was obtained on sociodemographic
factors, occupational and farm history, dietary
factors, smoking, and medical history. Information on usual
occupation and industry were coded according to standardized
classification systems. A job/industry exposure matrix (JEM)
was developed to estimate the level of occupational exposure to
pesticides. Odds ratios (ORs) and 95% confidence intervals (CIs)
for the analyses of occupational and farm history and pesticide
exposure were estimated by unconditional logistic regression.
Farmers and farm workers had ORs of 1.9 (95% CI=0.8-4.6) and
1.4 (95% CI=0.8-2.3), respectively. An OR of 1.7 (95% CI=1.0-
2.7) was observed among those who lived or worked on a farm
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