Validation of the IMPEDE VTE Score for Prediction of Venous Thromboembolism in Multiple Myeloma: A Retrospective Cohort Study

Abstract

Venous thromboembolism (VTE) is highly prevalent in Multiple Myeloma (MM) patients, however a reliable VTE prediction tool in MM remains under study. The IMPEDE VTE score has recently emerged as a novel risk prediction tool for VTE in MM but needs external validation in different cohorts. We conducted a retrospective cohort study to validate this score. We reviewed 839 patients who were newly diagnosed with MM between 2010 and 2015 at Cleveland Clinic and included 575 patients in final analysis. The 6-month cumulative incidence of VTE among all patients was 10.7% (95% CI: 8.2 – 13.2) and the c-statistic of the IMPEDE VTE score to predict VTE within 6 months of treatment start was 0.68 (95% CI: 0.61 – 0.75). The 6-month cumulative incidence of VTE was 5.0% (95% CI: 2.1 – 7.9) in the low risk group, compared to 12.6% (95% CI: 8.9% – 16.4%) and 24.1% (95% CI: 12.2 – 36.1) in the intermediate and high risk groups (p<0.001 for both). In addition, a higher proportion of patients in the VTE cohort had ECOG performance status of ≥2 as compared to the no VTE cohort (33% vs. 16%, p=0.001). Other MM characteristics such as stage, immunoglobulin subtype, and cytogenetics were not found to be predictors of VTE. In summary, we have validated the IMPEDE VTE score in our patient cohort and our findings suggest that it can be utilized as a VTE risk stratification tool in prospective studies looking into investigating VTE prophylaxis strategies in MM patients.

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

“…Dose differences might have modulated the risk. Moreover, our incidence is lower than that observed in the Covut et al study (10.7% [95% CI: 8.2–13.2%]), but only 2.6% of their patients received heparin as prophylaxis 3 . Previous studies suggesting that bortezomib might have a protective effect are challenged by recent epidemiological literature as well as our results, 17–19 and by recent pathophysiological literature 20 .…”

“…Our analysis suggests that, despite modest IMPEDE VTE score discriminative ability (AUC was 0.67, similar to the c‐statistic in the Sanfilippo et al study [0.66] 14 ), patients with the higher incidence of VTE are well identified by this score as previously reported 3,22 . Patients in the low risk group (21% of our cohort) presented a non‐negligible VTE incidence of 2.9%.…”

“…9 However, in this study, patients received induction with RD, not but only 2.6% of their patients received heparin as prophylaxis. 3 Previous studies suggesting that bortezomib might have a protective effect are challenged by recent epidemiological literature as well as our results, [17][18][19] and by recent pathophysiological literature. 20 In the Ghansah et al study, bortezomib induced a procoagulant platelet phenotype even in an experimental setting devoid of plasma proteins.…”

“…1 In contrast with improvements in nMM treatment, there has been little progress in the prevention of venous thromboembolism (VTE), with a stable incidence around 10% during the course of the disease. 2,3 Patients with VTE experience supplementary hospitalization and have non-optimal treatment. 4,5 IMiDs in particular are associated with this risk.…”

Thrombosis in multiple myeloma: risk stratification, antithrombotic prophylaxis, and management of acute events. A consensus-based position paper from an <i>ad hoc</i> expert panel

“…Recently 575 patients with newly diagnosed MM were included in an analysis to validate the IMPEDE score. 46 The 6-month cumulative incidence of VTE was 5.0% (95% CI: 2•1-7•9) in the low-risk group, compared to 12.6% (95% CI: 8.9-16.4%) and 24.1% (95% CI:…”