Aspirin or enoxaparin thromboprophylaxis for patients with newly diagnosed multiple myeloma treated with lenalidomide

Larocca, Alessandra; Cavallo, Federica; Bringhen, Sara; Raimondo, Francesco Di; Falanga, Anna; Evangelista, Andrea; Cavalli, Maide; Stanevsky, Anfisa; Corradini, Paolo; Pezzatti, Sara; Patriarca, Francesca; Cavo, Michèle; Peccatori, Jacopo; Catalano, Lucio; Carella, Angelo Michele; Cafro, Anna Maria; Siniscalchi, Agostina; Crippa, Claudia; Petrucci, Maria Teresa; Yehuda, Dina Ben; Beggiato, Eloise; Toritto, Tommaso Caravita di; Boccadoro, Mario; Nagler, Arnon; Palumbo, Antônio

doi:10.1182/blood-2011-03-344333

Cited by 257 publications

(179 citation statements)

References 28 publications

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“…Nadroparin (3800 anti-Xa IU once a day) reduced VTE risk by 68·0% in patients receiving gemcitabine alone and by 78·0% when combined with a platinum-based agent. 115 Two randomised studies (with 342 patients 118 and 991 patients 119 ) and one meta-analysis (6632 patients 120 ) that were not identifi ed in the 2013 CPGs compared LMWH thromboprophylaxis with aspirin or warfarin in patients treated with thalidomide or lenalidomide with multiple myeloma. Overall, these studies indicated that prophylactic doses of LMWH, aspirin (100 mg per day), or warfarin reduced the risk of VTE in patients with myeloma treated with lenalidomide or thalidomide without increasing bleeding complications.…”

Section: Khorana Predictive Model For Chemotherapy-associated Vte 10mentioning

confidence: 99%

International clinical practice guidelines including guidance for direct oral anticoagulants in the treatment and prophylaxis of venous thromboembolism in patients with cancer

Farge

Bounameaux

Brenner

et al. 2016

The Lancet Oncology

363

422

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Venous thromboembolism (VTE) is the second leading cause of death in patients with cancer. These patients are at an increased risk of developing VTE and are more likely to have a recurrence of VTE and bleeding while taking anticoagulants. Management of VTE in patients with cancer is a major therapeutic challenge and remains suboptimal worldwide. In 2013, the International Initiative on Thrombosis and Cancer (ITAC-CME), established to reduce the global burden of VTE in patients with cancer, published international guidelines for the treatment and prophylaxis of VTE and central venous catheter-associated thrombosis. The rapid global adoption of direct oral anticoagulants for management of VTE in patients with cancer is an emerging treatment trend that needs to be addressed based on the current level of evidence. In this Review, we provide an update of the ITAC-CME consensus recommendations based on a systematic review of the literature ranked according to the Grading of Recommendations Assessment, Development, and Evaluation scale. These guidelines aim to address in-hospital and outpatient cancer-associated VTE in specifi c subgroups of patients with cancer.

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Section: Khorana Predictive Model For Chemotherapy-associated Vte 10mentioning

confidence: 99%

International clinical practice guidelines including guidance for direct oral anticoagulants in the treatment and prophylaxis of venous thromboembolism in patients with cancer

Farge

Bounameaux

Brenner

et al. 2016

The Lancet Oncology

363

422

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“…[56][57][58] Thromboprophylaxis strategies have not been specifically evaluated in patients on maintenance therapy with novel immune-modulatory agents after transplant, however, studies in patients with newly diagnosed MM receiving lenalidomide or thalidomide-based treatments show a significant benefit of thromboprophylaxis. 59,60 Palumbo et al 59 randomly assigned 659 patients receiving thalidomide-based regimens to low-dose aspirin, warfarin or enoxaparin. The rate of VTE, serious cardiovascular events or sudden cardiac death in the first 6 months was 6.4% in the aspirin group, 8.2% in the warfarin group and 5% in the enoxaparin group, whereas there were three major bleeding episodes, all in the aspirin group.…”

Section: Multiple Myelomamentioning

confidence: 99%

“…Compared with LMWH, the absolute difference in the proportion of VTE was 1.07% (95% CI, − 1.69 to 3.83; P = 0.452) in the ASA group. 60 Therefore, ASA may be an effective and less-expensive alternative to LMWH thromboprophylaxis in low-risk patients. The International Myeloma Working group and ASCO recommend prophylaxis with either aspirin or LMWH for lower risk patients, and LMWH for higher risk patients receiving thalidomide or lenalidomide.…”

Section: Multiple Myelomamentioning

confidence: 99%

Venous thromboembolism in hematopoietic stem cell transplant recipients

Chaturvedi

Neff

Nagler

et al. 2015

Bone Marrow Transplant

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Venous thromboembolism (VTE) is an increasingly recognized problem in the post-hematopoietic stem cell transplantation (HSCT) setting, with a lack of high-quality evidence-based data to recommend best practices. Few patients with hematologic malignancies and even fewer post-HSCT patients were included in randomized trials of VTE prophylaxis and treatment. Prior VTE, GVHD, infections and indwelling venous catheters are risk factors for thrombosis. The increasing use of post-transplant maintenance therapy with lenalidomide in patients with multiple myeloma adds to this risk after autologous HSCT. These patients are also at high risk of bleeding complications because of prolonged thrombocytopenia and managing the competing risks of bleeding and thrombosis can be challenging. This review aims to provide a practical, clinician-focused approach to the prevention and treatment of VTE in the post-HSCT setting.

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“…All patients treated with Rd require antithrombosis prophylaxis. Aspirin is adequate for most patients, but in patients who are at higher risk of thrombosis, either low-molecular weight heparin or coumadin is needed [53][54][55].…”

Section: Risk-adapted Therapymentioning

confidence: 99%

Multiple myeloma: 2013 update on diagnosis, risk‐stratification, and management

2013

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Disease overviewMultiple myeloma accounts for approximately 10% of hematologic malignancies.DiagnosisThe diagnosis requires 10% or more clonal plasma cells on bone marrow examination or a biopsy proven plasmacytoma plus evidence of associated end‐organ damage. In addition, the presence of 60% or more clonal plasma cells in the marrow is also considered as myeloma regardless of the presence or absence of end‐organ damage.Risk stratificationIn the absence of concurrent trisomies, patients with 17p deletion, t(14;16), and t(14;20) are considered to have high‐risk myeloma. Patients with t(4;14) translocation are considered intermediate‐risk. All others are considered as standard‐risk.Risk‐adapted initial therapyStandard‐risk patients can be treated with lenalidomide plus low‐dose dexamethasone (Rd), or a bortezomib‐containing triplet such as bortezomib, cyclophosphamide, dexamethasone (VCD). Intermediate‐risk and high‐risk patients require a bortezomib‐based triplet regimen. In eligible patients, initial therapy is given for approximately 4 months followed by autologous stem cell transplantation (ASCT). Standard‐risk patients can opt for delayed ASCT if stem cells can be cryopreserved. In patients are not candidates for transplant, initial therapy is given for approximately 12–18 months.Maintenance therapyAfter initial therapy, lenalidomide maintenance is considered for standard‐risk patients who are not in very good partial response or better, while maintenance with a bortezomib‐based regimen should be considered in pateints with intermediate or high‐risk myeloma.Management of refractory diseasePatients with indolent relapse can be treated first with two‐drug or three‐drug combinations. Patients with more aggressive relapse often require therapy with a combination of multiple active agents. Am. J. Hematol. 88:225–235, 2013. © 2013 Wiley Periodicals, Inc.

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Aspirin or enoxaparin thromboprophylaxis for patients with newly diagnosed multiple myeloma treated with lenalidomide

Abstract: Lenalidomide plus dexamethasone is effective in the treatment of multiple myeloma (MM) but is associated with an increased risk of venous thromboembolism (VTE

Cited by 257 publications

References 28 publications

International clinical practice guidelines including guidance for direct oral anticoagulants in the treatment and prophylaxis of venous thromboembolism in patients with cancer

International clinical practice guidelines including guidance for direct oral anticoagulants in the treatment and prophylaxis of venous thromboembolism in patients with cancer

Venous thromboembolism in hematopoietic stem cell transplant recipients

Multiple myeloma: 2013 update on diagnosis, risk‐stratification, and management

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