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Published on: May 15, 2019
Non-thromboembolic pulmonary hypertension in multiple myeloma, after thalidomide treatment: a pilot study
Background:
Multiple myeloma (MM) is thrombogenic as a consequence of multiple hemostatic effects and endothelial damage. Thalidomide has been associated with an increased risk of thromboembolic pulmonary hypertension (PH). PH in the absence of venous thromboembolism has also been described in MM patients during thalidomide treatment.
Aim:
Detection of clinical and subclinical nonthromboembolic PH in MM patients after thalidomide treatment.
Patients And Methods:
Eighty-two patients, 46-82 years (median age 61 years), 42 males, were studied. They underwent echocardiographic study at baseline, 1 month thereafter, 6 months later and whenever symptoms indicating deterioration of cardiac function appeared. Echocardiographic signs of PH were especially identified.
Results:
Clinical and echocardiographic evaluation revealed four patients (out of 82 patients, 4.87%) with PH. Nonimaging and imaging diagnostic methods excluded thromboembolic PH. Statistical analysis demonstrated significant correlation between structural heart disease and PH (r = 14.078; P = 0.008). No significant correlation between age (r = 0.770; P = 0.724), gender (r = 1.157; P = 0.285), International Staging System (ISS) (r = 0.316; P = 0.716) and PH was found.
Conclusions:
Preexisted endothelial dysfunction due to structural cardiac disease enhances the vasoactive substances release causing increased pulmonary vascular resistance. Thalidomide possibly causes a vasodilator and vasoconstriction imbalance, which may cause abnormal pulmonary vascular response interfering to a vicious circle perpetuating PH.
Insights
Pulmonary hypertension (PH) was detected in 4.87% of multiple myeloma patients treated with thalidomide. Pre-existing heart conditions, not age or gender, correlated with PH development, suggesting thalidomide may exacerbate existing cardiac issues.
Area of Science:
- Cardiology
- Hematology
- Pulmonology
Background:
- Multiple myeloma (MM) is associated with thrombotic events and endothelial damage.
- Thalidomide treatment in MM patients carries a risk of thromboembolic pulmonary hypertension (PH).
- Non-thromboembolic PH has also been observed in MM patients during thalidomide therapy.
Purpose of the Study:
- To detect clinical and subclinical nonthromboembolic pulmonary hypertension (PH) in multiple myeloma (MM) patients undergoing thalidomide treatment.
- Investigate the incidence and potential contributing factors of PH in this patient cohort.
Main Methods:
- Eighty-two MM patients were evaluated using echocardiography at baseline, 1 month, and 6 months post-treatment.
- Echocardiographic signs indicative of PH were specifically identified.
- Diagnostic methods were employed to exclude thromboembolic causes of PH.
Main Results:
- Four out of 82 patients (4.87%) were diagnosed with PH.
- Thromboembolic PH was ruled out through comprehensive diagnostic evaluations.
- A significant correlation was found between structural heart disease and the development of PH (r = 14.078; P = 0.008).
- No significant correlation was observed between PH and patient age, gender, or International Staging System (ISS) score.
Conclusions:
- Pre-existing endothelial dysfunction, often linked to structural cardiac disease, may predispose MM patients to PH.
- Thalidomide might induce an imbalance between vasodilation and vasoconstriction, contributing to abnormal pulmonary vascular responses and perpetuating PH.
- Structural cardiac disease is a key factor in the development of non-thromboembolic PH in MM patients treated with thalidomide.
