Prediction of venous thromboembolism in patients with multiple myeloma treated with lenalidomide, bortezomib, dexamethasone, and transplantation: Lessons from the substudy of IFM/DFCI 2009 cohort.
immunomodulatory drugs
multiple myeloma
prevention and control
risk factors
venous thromboembolism
Journal
Journal of thrombosis and haemostasis : JTH
ISSN: 1538-7836
Titre abrégé: J Thromb Haemost
Pays: England
ID NLM: 101170508
Informations de publication
Date de publication:
08 2022
08 2022
Historique:
revised:
23
03
2022
received:
10
12
2021
accepted:
08
05
2022
pubmed:
14
5
2022
medline:
23
7
2022
entrez:
13
5
2022
Statut:
ppublish
Résumé
Venous thromboembolism (VTE) is a concern for patients with newly diagnosed multiple myeloma. We aimed to evaluate VTE incidence, risk factors, and risk score. We performed a substudy of the "Intergroupe Francophone du Myelome 2009" randomized controlled trial. We assessed 700 patients receiving lenalidomide/bortezomib/dexamethasone, followed or not by autologous hematopoietic stem cell transplantation. VTE incidence at 6 months was 4.8% (95% confidence interval [CI]: 3.3-6.9%) and 1.5% (95% CI: 0.8-2.9%) from 6 to 12 months. Using multivariate analysis we confirmed history of VTE (odds ratio 5.1 [1.6-16.7], P = .007) as a strong VTE-related risk factor, invalidated erythropoietin exposure (0.6 [0.2-1.7], P = .3) as risk factor, and added two new risk factors: fracture at diagnosis (2.6 [1.3-5.5], P = .01), and serum gamma globulin level > 27 g/L (2.8 [1.2-6.8,] P = .02). Moreover, we noticed that VTE occurred earlier in patients with gamma globulin levels >27 g/L, suggesting a need to revisit the thromboprophylaxis timeframe. Heparin administration was associated with a decreased risk (0.3 [0.1-0.7], P = .005) but failed to erase the risk regardless of dose. The area under the receiver operating characteristic curve of the IMPEDE VTE score was 0.67, as previously reported, confirming our cohort was well representative. Prospective studies are warranted in light of these results to improve VTE risk stratification and to design adapted thromboprophylaxis in terms of timing and dose.
Sections du résumé
BACKGROUND
Venous thromboembolism (VTE) is a concern for patients with newly diagnosed multiple myeloma.
OBJECTIVES
We aimed to evaluate VTE incidence, risk factors, and risk score.
PATIENTS/METHODS
We performed a substudy of the "Intergroupe Francophone du Myelome 2009" randomized controlled trial.
RESULTS
We assessed 700 patients receiving lenalidomide/bortezomib/dexamethasone, followed or not by autologous hematopoietic stem cell transplantation. VTE incidence at 6 months was 4.8% (95% confidence interval [CI]: 3.3-6.9%) and 1.5% (95% CI: 0.8-2.9%) from 6 to 12 months. Using multivariate analysis we confirmed history of VTE (odds ratio 5.1 [1.6-16.7], P = .007) as a strong VTE-related risk factor, invalidated erythropoietin exposure (0.6 [0.2-1.7], P = .3) as risk factor, and added two new risk factors: fracture at diagnosis (2.6 [1.3-5.5], P = .01), and serum gamma globulin level > 27 g/L (2.8 [1.2-6.8,] P = .02). Moreover, we noticed that VTE occurred earlier in patients with gamma globulin levels >27 g/L, suggesting a need to revisit the thromboprophylaxis timeframe. Heparin administration was associated with a decreased risk (0.3 [0.1-0.7], P = .005) but failed to erase the risk regardless of dose. The area under the receiver operating characteristic curve of the IMPEDE VTE score was 0.67, as previously reported, confirming our cohort was well representative.
CONCLUSIONS
Prospective studies are warranted in light of these results to improve VTE risk stratification and to design adapted thromboprophylaxis in terms of timing and dose.
Identifiants
pubmed: 35557490
doi: 10.1111/jth.15758
pii: S1538-7836(22)02072-4
doi:
Substances chimiques
Anticoagulants
0
gamma-Globulins
0
Bortezomib
69G8BD63PP
Dexamethasone
7S5I7G3JQL
Lenalidomide
F0P408N6V4
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
1859-1867Commentaires et corrections
Type : ErratumIn
Informations de copyright
© 2022 International Society on Thrombosis and Haemostasis.
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