Recent developments and persisting challenges in the prevention and treatment of venous thromboembolism in patients with hematological malignancies

Sorigué, Marc; Cañamero, Eloi; Sigüenza, Patricia; Nomdedéu, Meritxell; López-Núñez, Juan J.

doi:10.1080/10428194.2020.1713321

Cited by 8 publications

(5 citation statements)

References 107 publications

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“…So far, no randomized study has specifically assessed patients with nMM receiving IMiD DOACs versus LMWH. Moreover, numerous chemotherapeutic agents such as bortezomib and dexamethasone interact with DOACs 40 . This impact on MM treatment and on hemorrhagic risk should be evaluated as much as if we use curative dose during the first months with “high gamma globulin level” or to optimize the antithrombotic management in some patients with very high risk.…”

Section: Discussionmentioning

confidence: 99%

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

Chalayer

Talbot

Frenzel

et al. 2022

Journal of Thrombosis and Haemostasis

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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.

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Section: Discussionmentioning

confidence: 99%

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

Chalayer

Talbot

Frenzel

et al. 2022

Journal of Thrombosis and Haemostasis

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“…35,36) The formal introduction of direct anticoagulants (DOACs) in the hematologic malignancy population has resulted in new developments in anticoagulation for the prevention and treatment of VTE in patients with active cancer. [37][38][39][40] In the present study, we analyzed hematologic malignancies by myeloid versus lymphoid series and found no significant differences in VTE incidence. However, Franchini, et al reviewed studies for the assessment of the risk factors for PE and the incidence of VTE in hematologic malignancy.…”

Section: Discussionmentioning

confidence: 54%

Disparities in the Outcomes of Acute Pulmonary Embolism in Hospitalized Patients with Hematologic Malignancy and Solid Tumor

Hou

Qiu

et al. 2023

Int. Heart J.

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This study aimed to compare the clinical burden and healthcare utilization outcomes of hematologic versus solid malignancies in patients hospitalized with acute pulmonary embolism (PE). This population-based, retrospective study extracted and analyzed the discharge data from the 2016-2018 US National Inpatient Sample (NIS) of hospitalized patients with a primary diagnosis of acute PE and a subsequent diagnosis of hematologic malignancies or solid tumors. Prolonged length-of-stay (LOS) was defined as ! 75th percentile LOS of the study cohort. Unfavorable discharge was defined as discharged to nursing home or long-term facility. Univariate and multivariate regression analyses were conducted to determine associations between cancer type, presence of unstable PE, and in-hospital outcomes in acute PE patients. Patients with acute PE with solid tumors had higher rates of in-hospital deaths and unfavorable discharge than those with hematologic malignancies (6.4% versus 3.2%, P < 0.001; 14.0% versus 11.2%, P = 0.01, respectively). Acute PE patients with hematologic malignancies had a lower risk of in-hospital death (aOR: 0.43, 95% CI: 0.31-0.60), unfavorable discharge (aOR: 0.76, 95% CI: 0.63-0.92), and prolonged LOS (aOR: 0.83, 95% CI: 0.71-0.98) than those with solid tumors. Stratified analysis showed that male patients aged <60 years with hematologic malignancies had a lower risk of prolonged LOS (aOR: 0.70, 95% CI: 0.52-0.94; aOR: 0.85, 95% CI: 0.68-1.05) and unfavorable discharge (aOR: 0.40, 95% CI: 0.22-0.71; aOR: 0.65, 95% CI: 0.50-0.85) than those with solid tumors. In the comparison of the outcomes of acute PE with hematologic malignancies and solid tumors, patients with hematologic malignancy had a lower risk of in-hospital deaths, prolonged LOS, and unfavorable discharge than those with solid tumors.

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“…A recent study, focused on the safety and efficacy of DOACs in patients with hematologic malignancies, report how DOACs can be an alternative approach to LMWH, although caution is needed in patients who undergo stem cell transplantation because of an increased incidence of bleedings in this subset 45 . A more novel review concluded that the lack of high‐quality evidences requires caution about the use of DOACs in particular hematological settings 46 47 ; less clear is their role and application in the setting of patients with hematologic malignancies.…”

Section: Discussionmentioning

confidence: 99%

Direct oral anticoagulants in patients with hematologic malignancies

Serrao

Fiori

Santoro

et al. 2020

Hematological Oncology

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The anticoagulant treatment for patients with hematologic malignancies is low molecular weight heparin (LMWH), which is considered the safest in this particular patients setting. Although direct oral anticoagulants (DOACs) have proven their efficacy and safety in patients with cancer, their use can be challenging in patients with hematologic malignancies due to the peculiarity of these neoplasms: high thrombotic risk, possible onset of thrombocytopenia and concomitant anticancer therapies. The aim of our study was to evaluate the efficacy and safety of DOACs for venous thromboembolism or atrial fibrillation in patients with hematologic malignancies and plasmatic DOACs level during anticancer therapy and at time of bleeding or thrombotic complications. We evaluated patients with hematologic malignancies treated with DOACs for venous thromboembolism or atrial fibrillation-therapy was maintained until the platelet count was ≥50 × 10 9 /L. In case of concomitant anticancer treatment and haemorrhagic or thrombotic events, we checked DOACs plasma levels (trough and peak). The patients evaluated were 135: 104/135 were on anticancer therapy. We did not observe either thrombotic or major haemorrhagic adverse events. Minor bleedings occurred in 10 patients and clinical relevant non-major (CRNM) in two patients. There was a statistically significant correlation between bleedings and myelodysplastic syndrome. DOACs resulted effective and safe in patients with hematologic malignancies. DOACs plasma level can be helpful in suggesting an early dose adjustment to prevent haemorrhagic adverse event in patients on concomitant anticancer therapy. Larger prospective studies including hematologic patients are warranted to confirm the safety and efficacy of DOACs.

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Recent developments and persisting challenges in the prevention and treatment of venous thromboembolism in patients with hematological malignancies

Cited by 8 publications

References 107 publications

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

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

Disparities in the Outcomes of Acute Pulmonary Embolism in Hospitalized Patients with Hematologic Malignancy and Solid Tumor

Direct oral anticoagulants in patients with hematologic malignancies

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