RISK FACTORS FOR VENOUS THROMBOEMBOLISM IN 401 MULTIPLE MYELOMA PATIENTS: OBSERVATION OVER A 25-YEARS PERIOD IN A SINGLE INSTITUTION.
(Abstract release date: 05/18/17)
EHA Library. Fernandez Caballero M. 05/18/17; 182670; PB1956
Mariana Fernandez Caballero
Contributions
Contributions
Abstract
Abstract: PB1956
Type: Publication Only
Background
Patients with multiple myeloma (MM) have shown an incidence of 3-10% of venous thromboembolic events (VTE). The introduction of immunomodulatory drugs (IMIDs) in the treatment regimen has further increased the risk of VTE, especially when combined with steroids or chemotherapy (20-30%). Actual guidelines recommend thromboprophylaxis measures, but the proposed strategies are the results of expertise consensus or derived from the extrapolation of data from many studies.
Aims
The aim of this study is to analyze the development of VTE in a large cohort of MM patients, treated for 25 years in a single institution, to assess risk factors suggested in general population, also to confirm the VTE risk of IMIDs based-regimens and the relevance of anticoagulant thromboprophylaxis.
Methods
Four hundred and one consecutive patients diagnosed with MM in a tertiary University Hospital between 1991 to 2015 were included. Data about VTE development, patient characteristics, myeloma-related factors, treatment and thromboprophylatic measures were retrospectively recorded. Multivariable correlates of VTE were assessed using Cox proportional hazards analysis.
Results
The median age at diagnosis was 66 years (range 24-90 years), and 47% were males. The results concerning treatment are extracted from 374 patients who were symptomatic and received myeloma treatment. Among the 164 patients that received IMIDs-based regimen, 27% did not receive any antithrombotic treatment, due to the lack of strong recommendations at the beginning of the use of IMIDs-based regimens. On the other hand, the most common thromboprophylaxis was set with LMWH (54%), followed by low doses of aspirin (13%) and anti-vitamin K (VKA) (6%).
Median follow was 40 months (range, 1-293) and VTE occurred in 11% of patients, with a median time from diagnosis of 10 months. IMIDs based-regimen demonstrated to be a risk factor associated on multivariate analysis, and the relevance of thromboprophylaxis has been proved, as the absence of this measure increased significantly the risk. Other factors that have also demonstrated to be independently associated with a higher risk for VTE were: BMI > 30 kg/m2, prior Stroke or TIA, prior malignant neoplasm, and the use of high dose of dexamethasone.
Conclusion
Our data support the actual recommendation of antithrombotic prophylaxis in IMIDs-based regimens, especially in association with high dose of dexamethasone. We recommend the use of a risk factor model including obesity and previous history of thromboembolic disease or cancer, in order to guide the appropriate thromboprophylaxis measures.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Keyword(s): Thromboembolic events, Risk factor, Multiple Myeloma, Immunomodulatory thalidomide analog
Abstract: PB1956
Type: Publication Only
Background
Patients with multiple myeloma (MM) have shown an incidence of 3-10% of venous thromboembolic events (VTE). The introduction of immunomodulatory drugs (IMIDs) in the treatment regimen has further increased the risk of VTE, especially when combined with steroids or chemotherapy (20-30%). Actual guidelines recommend thromboprophylaxis measures, but the proposed strategies are the results of expertise consensus or derived from the extrapolation of data from many studies.
Aims
The aim of this study is to analyze the development of VTE in a large cohort of MM patients, treated for 25 years in a single institution, to assess risk factors suggested in general population, also to confirm the VTE risk of IMIDs based-regimens and the relevance of anticoagulant thromboprophylaxis.
Methods
Four hundred and one consecutive patients diagnosed with MM in a tertiary University Hospital between 1991 to 2015 were included. Data about VTE development, patient characteristics, myeloma-related factors, treatment and thromboprophylatic measures were retrospectively recorded. Multivariable correlates of VTE were assessed using Cox proportional hazards analysis.
Results
The median age at diagnosis was 66 years (range 24-90 years), and 47% were males. The results concerning treatment are extracted from 374 patients who were symptomatic and received myeloma treatment. Among the 164 patients that received IMIDs-based regimen, 27% did not receive any antithrombotic treatment, due to the lack of strong recommendations at the beginning of the use of IMIDs-based regimens. On the other hand, the most common thromboprophylaxis was set with LMWH (54%), followed by low doses of aspirin (13%) and anti-vitamin K (VKA) (6%).
Median follow was 40 months (range, 1-293) and VTE occurred in 11% of patients, with a median time from diagnosis of 10 months. IMIDs based-regimen demonstrated to be a risk factor associated on multivariate analysis, and the relevance of thromboprophylaxis has been proved, as the absence of this measure increased significantly the risk. Other factors that have also demonstrated to be independently associated with a higher risk for VTE were: BMI > 30 kg/m2, prior Stroke or TIA, prior malignant neoplasm, and the use of high dose of dexamethasone.
Conclusion
Our data support the actual recommendation of antithrombotic prophylaxis in IMIDs-based regimens, especially in association with high dose of dexamethasone. We recommend the use of a risk factor model including obesity and previous history of thromboembolic disease or cancer, in order to guide the appropriate thromboprophylaxis measures.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Keyword(s): Thromboembolic events, Risk factor, Multiple Myeloma, Immunomodulatory thalidomide analog
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