Elevated von Willebrand factor levels in multiple myeloma: Dysregulated mechanisms of both secretion and clearance

•Plasma VWF antigen and FVIII:C  levels are raised in patients with active  multiple myeloma (MM), irrespective of therapy•High VWF propeptide and reduced propeptide/antigen ratios suggest endothelial activation and impaired VWF clearance in MM•Increased VWF propeptide is seen in precursor MM, strengthening the hypothesis of hypercoagulability in MGUS/smouldering MM•VWF multimer distribution is not altered in MM disease and accordingly, ADAMTS13 activity is not impaired