Spectrum of Cerebrovascular Disease in Patients with Multiple Myeloma Undergoing Chemotherapy-Results of a Case Control Study

Archana Hinduja; Kaustubh Limaye; Rahul Ravilla; Appalnaidu Sasapu; Xenofon Papanikolaou; Lai Wei; Michel Torbey; Sarah Waheed

doi:10.1371/journal.pone.0166627

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Spectrum of Cerebrovascular Disease in Patients with Multiple Myeloma Undergoing Chemotherapy-Results of a Case Control Study

Journal article

Open access

Peer reviewed

Spectrum of Cerebrovascular Disease in Patients with Multiple Myeloma Undergoing Chemotherapy-Results of a Case Control Study

Archana Hinduja, Kaustubh Limaye, Rahul Ravilla, Appalnaidu Sasapu, Xenofon Papanikolaou, Lai Wei, Michel Torbey and Sarah Waheed

PloS one, Vol.11(11), pp.e0166627-e0166627

2016

DOI: 10.1371/journal.pone.0166627

PMCID: PMC5130211

PMID: 27902730

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Abstract

Patients with multiple myeloma (MM) are at increased risk of arterial thrombosis. Our aim was to determine the risk factors, mechanisms and outcome of strokes in these patients. We conducted a retrospective matched case-control study from our database of MM patients enrolled in Total Therapy (TT) 2, TT3a and TT3b protocols who developed a vascular event (transient ischemic attack, ischemic stroke, or intracerebral hemorrhage) from October 1998 to January 2014. Cases were matched for age-matched selected controls. Baseline demographics, risk factors, MM characteristics, laboratory values, and mortality of cases were compared to those of controls. Multivariate logistic regression analysis identified risk factors associated with stroke. Ischemic strokes (IS) were classified with modified Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria. Of 1,148 patients, 46 developed a vascular event (ischemic stroke, 33; transient ischemic attack, 11; hypertensive intracerebral hemorrhage, 2). Multivariate logistic regression analysis determined renal insufficiency (odds Ratio, 3.528; 95% CI, 1.36-9.14; P = 0.0094) and MM Stages I and II (odds Ratio, 2.770, 95% CI, 1.31-5.81; p = 0.0073) were independent predictors of stroke. In our study, strokes attributable to hypercoagulability, atrial fibrillation and small-vessel occlusion were common mechanisms. After a stroke, 78% of patients were discharged to home or a rehabilitation facility and 4% to a long-term nursing facility; in-hospital mortality was 15%. Despite suffering a stroke no significant differences in survival were observed. In our cohort of multiple myeloma patients, renal failure and MM Stages I and II had increased risk of stroke.

Cerebral Hemorrhage - chemically induced

Hospital Mortality

Multiple Myeloma - mortality

Humans

Cerebral Hemorrhage - mortality

Treatment Outcome

Antineoplastic Agents - therapeutic use

Ischemic Attack, Transient - mortality

Case-Control Studies

Ischemic Attack, Transient - chemically induced

Ischemic Attack, Transient - epidemiology

Multiple Myeloma - drug therapy

Stroke - chemically induced

Cerebral Hemorrhage - epidemiology

Antineoplastic Agents - adverse effects

Stroke - epidemiology

Acute Kidney Injury - chemically induced

Retrospective Studies

Acute Kidney Injury - epidemiology

Stroke - mortality

Thalidomide - therapeutic use

Platelet Aggregation Inhibitors - therapeutic use

Details

Title: Subtitle: Spectrum of Cerebrovascular Disease in Patients with Multiple Myeloma Undergoing Chemotherapy-Results of a Case Control Study
Creators: Archana Hinduja - Department of Neurology, Ohio State University Wexner Medical Center, Columbus, OH, United States of America
Kaustubh Limaye - Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
Rahul Ravilla - Department of Hematology and Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
Appalnaidu Sasapu - Department of Hematology and Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
Xenofon Papanikolaou - Multiple Myeloma for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
Lai Wei - Department of Neurology, Ohio State University Wexner Medical Center, Columbus, OH, United States of America
Michel Torbey - Department of Neurosurgery, Ohio State University Wexner Medical Center, Columbus, OH, United States of America
Sarah Waheed - Multiple Myeloma for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
Resource Type: Journal article
Publication Details: PloS one, Vol.11(11), pp.e0166627-e0166627
DOI: 10.1371/journal.pone.0166627
PMID: 27902730
PMCID: PMC5130211
NLM abbreviation: PLoS One
ISSN: 1932-6203
eISSN: 1932-6203
Publisher: Public Library of Science; United States
Grant note: U10 NS080368 / NINDS NIH HHS
Language: English
Date published: 2016
Academic Unit: Neurology; Radiology
Record Identifier: 9984020611502771

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