Haematology
Contributions
Type: Publication Only
Background
Thrombotic events (TEs) are a known complication of lenalidomide (LEN) therapy in patients with multiple myeloma. Venous thromboprophylaxis has been recommended to reduce this risk. There is paucity of information regarding the risk of arterial TEs in this group of patients. Furthermore the difference in the risk and pattern of TEs between the NDMM and RRMM patients exposed to LEN therapy has not been assessed in clinical trials.
Aims
- To compare the incidence and nature of arterial and venous TEs between NDMM and RRMM patients receiving LEN based therapy.
- Identification of patients at risk by correlation with thrombopropyhlactic measures, LEN dose, duration of treatment and additional anti-myeloma therapy.
Methods
We conducted a retrospective analysis of patients receiving LEN based therapy between September 2009 to January 2015 in Singleton Hospital, ABMUHB, UK. Patients were identified from our electronic prescribing system (ChemocareÓ) and correlated with clinical notes.
Results
A total of 81 patients were identified (NDMM: n=34; RRMM: n=47). The mean age at the start of treatment was 64.3 years (range 45-85 years) and 69.4 years (range 48-86 years) for NDMM and RRMM groups respectively. Thromboprophylactic measures were identified in 33 (97.1%) and 39 (83.0%) of NDMM and RRMM patients respectively.
A total of 12 TEs were noted (NDMM: n=6, 17.6%; RRMM: n=6, 12.8%). Arterial TEs were noted in 3 patients (8.8%) of the NDMM group compared to only 1 (2.1%) patient in the RRMM group. The arterial TEs in the NDMM group were 2 TIA’s and one popliteal artery thrombosis. One of the NDMM patients developed the arterial TIA whilst on LEN monotherapy in the absence of additional risk factors for arterial thrombosis. In the RRMM group, one patient who had a previous history of TIA, developed an ischaemic stroke resulting in dense hemiplegia despite dual anti-platelet therapy.
There were 3 (8.8%) venous TEs (all below knee DVTs) in the NDMM group compared to 5 (10.6%) in the RRMM group (2 PEs, 2 proximal lower limb DVT and 1 distal DVT).
The mean LEN dose of those having TEs was 22.5mg and 18.3mg in NDMM and RRMM groups respectively. The mean time to TEs was 3.0 months in NDMM patients and 5.8 months RRMM groups from the start of LEN therapy. All but one patient was on dexamethasone at the time of TE.
Summary
Our analysis confirms the thrombotic risk of LEN therapy both in NDMM and RRMM patients. There was a trend towards an increase in arterial TEs (8.8% vs 2.1%) in NDMM compared to RRMM patients. Hence LMWH in combination with anti-platelet therapy may be warranted in NDMM patients. Larger prospective studies are required to define optimal strategies of TEs prophylaxis in patients with multiple myeloma receiving LEN therapy.
Keyword(s): Immunomodulatory thalidomide analog, Myeloma, Thromboprophylaxis, Thrombosis
Session topic: Publication Only
Type: Publication Only
Background
Thrombotic events (TEs) are a known complication of lenalidomide (LEN) therapy in patients with multiple myeloma. Venous thromboprophylaxis has been recommended to reduce this risk. There is paucity of information regarding the risk of arterial TEs in this group of patients. Furthermore the difference in the risk and pattern of TEs between the NDMM and RRMM patients exposed to LEN therapy has not been assessed in clinical trials.
Aims
- To compare the incidence and nature of arterial and venous TEs between NDMM and RRMM patients receiving LEN based therapy.
- Identification of patients at risk by correlation with thrombopropyhlactic measures, LEN dose, duration of treatment and additional anti-myeloma therapy.
Methods
We conducted a retrospective analysis of patients receiving LEN based therapy between September 2009 to January 2015 in Singleton Hospital, ABMUHB, UK. Patients were identified from our electronic prescribing system (ChemocareÓ) and correlated with clinical notes.
Results
A total of 81 patients were identified (NDMM: n=34; RRMM: n=47). The mean age at the start of treatment was 64.3 years (range 45-85 years) and 69.4 years (range 48-86 years) for NDMM and RRMM groups respectively. Thromboprophylactic measures were identified in 33 (97.1%) and 39 (83.0%) of NDMM and RRMM patients respectively.
A total of 12 TEs were noted (NDMM: n=6, 17.6%; RRMM: n=6, 12.8%). Arterial TEs were noted in 3 patients (8.8%) of the NDMM group compared to only 1 (2.1%) patient in the RRMM group. The arterial TEs in the NDMM group were 2 TIA’s and one popliteal artery thrombosis. One of the NDMM patients developed the arterial TIA whilst on LEN monotherapy in the absence of additional risk factors for arterial thrombosis. In the RRMM group, one patient who had a previous history of TIA, developed an ischaemic stroke resulting in dense hemiplegia despite dual anti-platelet therapy.
There were 3 (8.8%) venous TEs (all below knee DVTs) in the NDMM group compared to 5 (10.6%) in the RRMM group (2 PEs, 2 proximal lower limb DVT and 1 distal DVT).
The mean LEN dose of those having TEs was 22.5mg and 18.3mg in NDMM and RRMM groups respectively. The mean time to TEs was 3.0 months in NDMM patients and 5.8 months RRMM groups from the start of LEN therapy. All but one patient was on dexamethasone at the time of TE.
Summary
Our analysis confirms the thrombotic risk of LEN therapy both in NDMM and RRMM patients. There was a trend towards an increase in arterial TEs (8.8% vs 2.1%) in NDMM compared to RRMM patients. Hence LMWH in combination with anti-platelet therapy may be warranted in NDMM patients. Larger prospective studies are required to define optimal strategies of TEs prophylaxis in patients with multiple myeloma receiving LEN therapy.
Keyword(s): Immunomodulatory thalidomide analog, Myeloma, Thromboprophylaxis, Thrombosis
Session topic: Publication Only