Thromboembolism Incidence and Risk Factors in Multiple Myeloma After First Exposure to Immunomodulatory Drug–Based Regimens

Patel, Jai N.; Robinson, Myra; Jagosky, Megan H.; Slaughter, Daniel; Arnall, Justin; Jandrisevits, Elizabeth; Matusz‐Fisher, Ashley; Atrash, Shebli; Paul, Barry; Bhutani, Manisha; Voorhees, Peter M.; Usmani, Saad Z.

doi:10.1016/j.clml.2020.11.015

Cited by 4 publications

(2 citation statements)

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“…Patel et al examined 485 patients treated with lenalidomide with or without dexamethasone and found a 7.3% incidence of TE. While males were more likely to develop TE in that study, the choice of thromboprophylaxis did not seem to correlate with TE risk 23 . The difference in the observed incidence between the studies could be explained by the increased thrombogenic effect of triplet versus doublet regimens and especially the addition of carfilzomib, which has been associated with increased risk in phase 3 trials 24 .…”

Section: Discussionmentioning

confidence: 67%

“…While males were more likely to develop TE in that study, the choice of thromboprophylaxis did not seem to correlate with TE risk. 23 The difference in the observed incidence between the studies could be explained by the increased thrombogenic effect of triplet versus doublet regimens and especially the addition of carfilzomib, which has been associated with increased risk in phase 3 trials. 24 In another single-institution study with 213 IMiD-treated patients, 19.3% developed a TE during the disease course.…”

Section: Discussionmentioning

confidence: 99%

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Thrombosis in multiple myeloma: Risk estimation by induction regimen and association with overall survival

et al. 2023

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Lenalidomide‐containing (R) triplet and quadruplet regimens are the standard of care for multiple myeloma (MM) and have been shown to increase the risk of thrombosis. The association between thromboembolism (TE) and survival in the novel multidrug era is not yet delineated. In this study, we evaluated the incidence of TE during the first year of MM diagnosis, its association with the type of induction regimen, and its impact on overall survival. We studied 672 newly diagnosed MM (NDMM) patients who received a triplet or quadruplet lenalidomide‐based induction at the Mayo Clinic, Rochester. TE was diagnosed in 83 patients (12.4%). Of these, 56 (8.3%) had a deep venous thrombosis (DVT), 23 (3.4%) had a pulmonary embolism (PE) with or without the DVT, and 4 (0.6%) patients had a stroke. Carfilzomib‐Rd (KRd) had the highest risk of TE (21.1%, 18/85), followed by quadruplets (11.1%, 5/45), bortezomib‐Rd (9.6%, 51/531), and 0/11 (0%), treated with other lenalidomide‐containing regimens. The difference in TE risk between KRd and the other regimens was statistically significant (OR = 2.6, p < .01). Nine patients developed a TE before being exposed to any treatment. Survival was significantly lower among patients that developed a TE (66 vs. 133 months, p < .01). The association of TE with reduced survival demonstrated in univariate analysis (HR = 2.2, 95% CI = 1.6–3.3) was maintained in the multivariable analysis adjusted for high‐risk interphase fluorescence in situ hybridization (FISH), sex, age, receipt of an upfront transplant, the response at induction, and the International Staging System (ISS) (HR = 2.61, CI = 1.74–3.9). We conclude that TE is an important aspect of MM management, and effective management is especially relevant in the novel treatment era.

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Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%