A review of thrombotic microangiopathies in multiple myeloma

Area of Science:

• Hematology
• Oncology
• Nephrology

Background:

• Multiple myeloma (MM) patients are prone to thrombotic microangiopathies (TMAs), including atypical hemolytic uremic syndrome (aHUS) and thrombotic thrombocytopenic purpura (TTP).
• TMAs present with thrombocytopenia and microangiopathic hemolytic anemia (MAHA), carrying high mortality and risk of irreversible organ damage if treatment is delayed.
• Triggers for TMAs in MM include chemotherapy, bone marrow transplantation, and disease progression, complicating diagnosis due to overlapping symptoms.

Purpose of the Study:

• To provide an overview of MM-related TMAs.
• To outline an approach for the workup and diagnosis of TMAs in MM patients.
• To advocate for a specific initial empiric treatment strategy for MM-related TMAs.

Main Methods:

• Review of existing literature on MM-related TMAs.
• Analysis of diagnostic challenges due to symptom overlap.
• Evaluation of current and historical treatment approaches.

Main Results:

• TMAs are a significant complication in multiple myeloma, often triggered by treatments or disease progression.
• Diagnosis requires a high index of suspicion due to overlapping clinical features with MM and its therapies.
• Evolving understanding of TMA pathophysiology necessitates updated treatment guidelines.

Conclusions:

• Initial empiric treatment with eculizumab is proposed as a superior alternative to plasma exchange for MM-related TMAs.
• This approach aims to mitigate high mortality and end-organ damage associated with delayed or suboptimal treatment.
• Further research and clinical guidelines are needed to optimize TMA management in multiple myeloma.