Contributions
Abstract: PB2230
Type: Publication Only
Background
Immunomodulatory drugs (IMiDs) bring the risk of venous thromboembolism (VTE) in patients with Multiple Myeloma (MM). Prophylactic measures such as asetylsalicylic acid (ASA), low-molecular heparins (LMWH) or warfarin usage are routine but there are no well-defined criteria in which patients which measure will be taken. Risk assessment models with disease-related, treatment-related and patient-related risk factors help in decision process. Routine D-dimer monitoring in asymptomatic patients on IMiDs may help early diagnosis of VTE.
Aims
To evaluate if routine D-dimer monitoring on IMiD usage will detect asymptomatic VTE.
Methods
Retrospective data from a total of 55 MM patients on IMiD-containing regimens diagnosed between 01.01.2001 and 01.06.2017 were analyzed. D-dimer values and radiologically or pathologically diagnosed thromboses events were recorded. Univariate analyses were done by Chi-square test for categorical and by t-test for numerical variables, respectively.
Results
Median age of diagnosis was 58 (range, 33-79 years) and median age was significantly high in thrombosis group (n=8) with respect to patients without thrombosis (n=47) (p=0.040). Thromboprophylaxis regimens were recorded in 40 patients; 19 patients with ASA and 21 patients with LMWH. Of these, 50 patients were monitored with plasma D-dimer levels during IMiD usage. 23 patients (46%) showed an elevation of D-dimer (≥1 mg/L), and there were 32 patients in whom D-dimer was <1 mg/L or was not monitored. There were 8 thromboses events (3 deep venous thromboses and 5 pulmonary venous embolisms). All thromboses events were symptomatic. Of 11 patients with asymptomatic D-dimer elevation, all were investigated radiologically for possible thrombosis and none had thromboses. There was no median D-dimer value difference between symptomatically and asymptomatically D-dimer elevated patient groups (p=0.178). There was no thromboprophylaxis regimen choice difference between thrombosis and no-thrombosis groups (p=0.664).
Conclusion
VTE events may occur despite thromboprophylaxis in IMiD using patients. In this study, symptoms suggesting thrombosis seem more important with respect to D-dimer elevation in diagnosing VTE. But there is no enough data for foregoing serial plasma D-dimer monitoring because early intervention may help to prevent symptomatic or lethal VTE events.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Keyword(s): D-dimer, Imids, Multiple Myeloma, Thrombosis
Abstract: PB2230
Type: Publication Only
Background
Immunomodulatory drugs (IMiDs) bring the risk of venous thromboembolism (VTE) in patients with Multiple Myeloma (MM). Prophylactic measures such as asetylsalicylic acid (ASA), low-molecular heparins (LMWH) or warfarin usage are routine but there are no well-defined criteria in which patients which measure will be taken. Risk assessment models with disease-related, treatment-related and patient-related risk factors help in decision process. Routine D-dimer monitoring in asymptomatic patients on IMiDs may help early diagnosis of VTE.
Aims
To evaluate if routine D-dimer monitoring on IMiD usage will detect asymptomatic VTE.
Methods
Retrospective data from a total of 55 MM patients on IMiD-containing regimens diagnosed between 01.01.2001 and 01.06.2017 were analyzed. D-dimer values and radiologically or pathologically diagnosed thromboses events were recorded. Univariate analyses were done by Chi-square test for categorical and by t-test for numerical variables, respectively.
Results
Median age of diagnosis was 58 (range, 33-79 years) and median age was significantly high in thrombosis group (n=8) with respect to patients without thrombosis (n=47) (p=0.040). Thromboprophylaxis regimens were recorded in 40 patients; 19 patients with ASA and 21 patients with LMWH. Of these, 50 patients were monitored with plasma D-dimer levels during IMiD usage. 23 patients (46%) showed an elevation of D-dimer (≥1 mg/L), and there were 32 patients in whom D-dimer was <1 mg/L or was not monitored. There were 8 thromboses events (3 deep venous thromboses and 5 pulmonary venous embolisms). All thromboses events were symptomatic. Of 11 patients with asymptomatic D-dimer elevation, all were investigated radiologically for possible thrombosis and none had thromboses. There was no median D-dimer value difference between symptomatically and asymptomatically D-dimer elevated patient groups (p=0.178). There was no thromboprophylaxis regimen choice difference between thrombosis and no-thrombosis groups (p=0.664).
Conclusion
VTE events may occur despite thromboprophylaxis in IMiD using patients. In this study, symptoms suggesting thrombosis seem more important with respect to D-dimer elevation in diagnosing VTE. But there is no enough data for foregoing serial plasma D-dimer monitoring because early intervention may help to prevent symptomatic or lethal VTE events.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Keyword(s): D-dimer, Imids, Multiple Myeloma, Thrombosis