Acquired von Willebrand Disease associated with Smoldering Multiple Myeloma and Hereditary Hemorrhagic Telangiectasia successfully treated with Daratumumab, Pomalidomide, and Dexamethasone: Hitting three birds with one stone?case report

Lemchukwu Amaeshi ^1* Mansour Gergi ^2* Jacqueline Poston ^2*

• ¹ Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, United States
• ² University of Vermont, Burlington, Vermont, United States

Acquired von Willebrand disease (AvWD) is a rare bleeding disorder that results from a structural or functional defect of von Willebrand factor. AvWD is often associated with a variety of underlying diseases, most frequently lymphoproliferative, myeloproliferative, and cardiovascular disorders. In this report, we present a unique case of a patient presenting with AvWD secondary to smoldering myeloma (SMM) but also found to have hereditary telangiectasias (HHT). While AvWD is not part of the defining criteria for a diagnosis of myeloma in patients with SMM, aggressive anti-myeloma treatment in this case led to a complete resolution of the bleeding disorder. Interestingly, since pomalidomide is an effective agent in HHT, a pomalidomide-based treatment was able to manage all 3 of the patient's hematologic disorders. This case adds to the body of literature supporting the efficacy of aggressive antimyeloma therapy as a definitive treatment in monoclonal gammopathyassociated AvWD and presents an alternative option to traditional supportive therapy, especially in patients with persistent bleeding.