• **VTE in Multiple Myeloma**

Multiple myeloma (MM) has been associated with increased risk of VTE events. Specific risk factors for VTE in MM are production of autoantibodies to haemostatic factors, high incidence of acquired protein C resistance, increased VIII:C levels and VWF and increase of production of inflammatory cytokines e.g. IL-6, TNF and C-reactive protein and paraprotein. These unique risk factors may operate along other common cancer VTE risk factors e.g. age, immobility, cancer procoagulant factors and chemotherapy.

Treatment regimens for MM include thalidomide, Lenalidomide combined with glucocorticoids and cytotoxic chemotherapy are associated with an increased risk of VTE particularly when the immunomodulatory agents are combined with anthracyclines. Combination chemotherapy including thalidomide plus dexamethasone and/or alkylating agents are associated with intermediate risk for VTE. The use of newer immunomodulator e.g. bortezomib seem to reduce the VTE risk **(200).** This topic has been well covered in chapter 5 of the book.
