Management of multiple myeloma in a patient with haemophilia with concurrent emicizumab – case report

Elizabeth Davies; Luke Carter-Brzezinski; Margarita Traintafillou; Rachel Brown; Charles R M Hay

doi:10.2478/jhp-2021-0016

Abstract

Abstract

With the increased life expectancies of people with severe haemophilia A, diagnoses of disorders associated with increased age are likely to become more common. Multiple myeloma is a commonly diagnosed plasma cell dyscrasia, with incidence strongly related to age. Both the disease itself and specific myeloma therapies are associated with a significant increase in rates of venous thromboembolism (VTE). Management of VTE prophylaxis can be challenging, especially in patients with a bleeding disorder. In this case report, we describe the management of a patient with concurrent diagnosis of multiple myeloma and severe haemophilia A, undergoing first line myeloma chemotherapy. The patient was successfully managed on standard of care myeloma treatment, with use of emicizumab and venous thromboprophylaxis. This case demonstrates the successful management of a haematological malignancy and a bleeding disorder using integrated and multidisciplinary patient-focused care.

Article

View Full Article

References

1. NHS England. 2013/14 NHS standard contract for haemophilia (all ages). Section B part 1 – Service specifications. B05/S/a. NHS Commissioning Service, 2013. Available from https://www.england.nhs.uk/wp-content/uploads/2013/06/b05-haemophilia.pdf (accessed 30 September 2021).
2. NICE Commissioning Support Programme for NHS England Specialised Services. Clinical Commissioning Policy: Emicizumab as prophylaxis in people with congenital haemophilia A with factor VIII inhibitors (all ages). 170067/P. NHS England, July 2018. Available from https://www.england.nhs.uk/publication/clinical-commissioning-policy-emicizumab-as-prophylaxis-in-people-with-congenital-haemophilia-a-with-factor-viii-inhibitors-all-ages/ (accessed 30 September 2021).
3. NHS England Specialised Services Clinical Reference Group for Specialised Blood Disorders. Clinical Commissioning Policy: Emicizumab prophylaxis in people with severe congenital haemophilia A without factor VIII inhibitors (all ages). 170134P. NHS England, August 2019. Available from https://www.england.nhs.uk/publication/emicizumab-as-prophylaxis-in-people-with-severe-congenital-haemophilia-a-without-factor-viii-inhibitors-all-ages/ (accessed 30 September 2021).
4. Cancer Research UK. Myeloma incidence statistics. Available from https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/myeloma/incidence (accessed 12 April 2021).
5. Moreau P, Hulin C, Macro M, et al. VTD is superior to VCD prior to intensive therapy in multiple myeloma: results of the prospective IFM2013-04 trial. Blood 2016; 127(21): 2569–2574. doi: https://doi.org/10.1182/blood-2016-01-693580.
6. NICE. Lenalidomide maintenance treatment after an autologous stem cell transplant for newly diagnosed multiple myeloma. Technology appraisal guidance [TA680] Published: 03 March 2021. Available from https://www.nice.org.uk/guidance/ta680 (accessed 30 September 2021).
7. Palumbo A, Rajkumar SV, Dimopoulos MA, et al., on behalf of the International Myeloma Working Group. Prevention of thalidomide and lenalidomide-associated thrombosis in myeloma. Leukemia 2008; 22(2): 414–23. doi: https://doi.org/10.1038/sj.leu.2405062.
8. Sonneveld P, Goldschmidt H, Rosiñol L, et al. Bortezomib-based versus non bortezomib-based induction treatment before autologous stem-cell transplantation in patients with previously untreated multiple myeloma: a meta-analysis of phase III randomized, controlled trials. J Clin Oncol 2013; 31(26): 3279–87. doi: https://doi.org/10.1200/JCO.2012.48.4626
9. Bradbury C A, Craig Z, Cook G, et al. Thrombosis in patients with myeloma treated in the Myeloma IX and Myeloma XI phase 3 randomized controlled trials. Blood 2020; 136 (9): 1091–1104. doi: https://doi.org/10.1182/blood.2020005125.
10. Martin K, Key N. How I treat patients with inherited bleeding disorders who need anticoagulant therapy. Blood 2016; 128(2): 178–184. doi: https://doi.org/10.1182/blood-2015-12-635094.
11. Roche Products Limited. Summary of product characteristics Hemlibra 150mg/ml solution for injection. Electronic Medicines Compendium. Last updated 04 March 2021. Available from https://www.medicines.org.uk/emc/product/9043/smpc (accessed 29 Oct 2021).
12. Mahlangu J, Oldenburg J, Paz-Priel I, et al. Emicizumab prophylaxis in patients who have haemophilia A without inhibitors. N Engl J Med 2018; 379: 811–822. doi: https://doi.org/10.1056/NEJMoa1803550.
13. Linari S, Castaman G. Concomitant use of rFVIIa and emicizumab in people with haemophilia A with inhibitors: current perspectives and emerging clinical evidence. Ther Clin Risk Manag 2020; 16:461–69. doi: https://doi.org/10.2147/TCRM.S205310.
14. Schmitt C, Adamkewicz JI, Xu J, et al. Pharmacokinetics and pharmacodynamics of emicizumab in persons with haemophilia A with factor VIII inhibitors: HAVEN 1 Study. Thromb Haemost 2021; 121(3): 351–360. doi: https://doi.org/10.1055/s-0040-1717114.

PDF Download

Download PDF

Open in full-page viewer

Authors

Elizabeth Davies

Elizabeth.Davies@mft.nhs.uk

Haematology and Pharmacy Department, Manchester University NHS Foundation Trust, Manchester, UK .
Luke Carter-Brzezinski

Haematology and Pharmacy Department, Manchester University NHS Foundation Trust, Manchester, UK
Margarita Traintafillou

Haematology Department, Manchester University NHS Foundation Trust, Manchester, UK
Rachel Brown

Haematology Department, Manchester University NHS Foundation Trust, Manchester, UK
Charles R M Hay

Haematology Department, Manchester University NHS Foundation Trust, Manchester, UK