Long-Term Remission of Acquired von-Willebrand's Disease and Platelet Dysfunction after High-Dose Melphalan in a Patient with Multiple Myeloma

  • Jan Alexander Stratmann Department of Hemostaseology, Johann Wolfgang Goethe University of Frankfurt, Frankfurt am Main, Germany http://orcid.org/0000-0001-7726-6622
  • Stefan Gundermann 1Department of Hemostaseology, Johann Wolfgang Goethe University of Frankfurt, Frankfurt am Main, Germany
  • Christof Geisen German Red Cross Blood Donor Department, Frankfurt am Main, Germany
  • Alexandra Dukat Department of Hematology and Oncology, Johann Wolfgang Goethe University of Frankfurt, Frankfurt am Main, Germany
  • Wolfgang Miesbach Department of Hemostaseology, Johann Wolfgang Goethe University of Frankfurt, Frankfurt am Main, Germany
Keywords: Acquired von-Willebrand's disease; Multiple myeloma; Autologous stem cell transplantation; Platelet dysfunction; Immunoglobulin

Abstract

Background: Autologous stem cell transplantation is considered a standard of care treatment in eligible patients with multiple myeloma, but puts the patient at high risk for infections and bleeding complications. Acquired von-Willebrand's disease (AVWD) and acquired platelet dysfunction are rare bleeding disorders that are associated with lymphoproliferative disorders such as multiple myeloma. Patients with acquired bleeding disorders who are planned for ASCT to treat the underlying condition are considered at highest risk for bleeding complications, and optimal treatment strategies are not known.

Materials and Methods: We summarized the diagnostic and therapeutic approach to a patient affected by AVWD and acquired platelet disorder related to multiple myeloma. The patient who was planned for ASCT presented with moderate to severe bleeding symptoms.

Results: Acute bleeding episodes were successfully controlled and prevented during induction and consolidation therapy with immunoglobulins, whereas replacement of plasma-derived VW factor showed no clinical improvement. High-dose melphalan-based consolidation therapy supported with autologous stem-cell transplantation led to an immediate and sustainable rise of von-Willebrand antigen and activity and a subsequent normalization of platelet aggregation activity. After a follow-up of 40 weeks, the patient maintained normalized VW levels and platelet aggregation capacity. There were no further signs or symptoms of bleeding.

Conclusion: This case report highlights the necessity for combined supportive and causal treatment in patients with AVWD and paraproteinemic PD. High-dose melphalan with autologous stem cell support may function as a treatment option in patients with myeloma-related AVWD.

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Published
2019-01-02
How to Cite
1.
Stratmann J, Gundermann S, Geisen C, Dukat A, Miesbach W. Long-Term Remission of Acquired von-Willebrand’s Disease and Platelet Dysfunction after High-Dose Melphalan in a Patient with Multiple Myeloma. Int J Hematol Oncol Stem Cell Res. 13(1):7-11.
Section
Case Report(s)