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Low incidence of clinically apparent thromboembolism in Korean patients with multiple myeloma treated with thalidomide

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Abstract

The frequency of thromboembolic events (TE) in Caucasian patients with multiple myeloma (MM) receiving thalidomide as the initial treatment has been reported to be 10~58% without prophylactic anticoagulation. Korean MM patients treated with thalidomide were studied to determine the frequency of TE and associated risk factors. A retrospective medical record review of the Korean MM registry from 25 centers in Korea between 2003 and 2007 was performed. We assessed the incidence of arterial and venous TE and the associated clinical parameters. Three hundred and sixty MM patients (median age 61 years, range 32–88 years) received thalidomide treatment. Fourteen patients (3.9%) developed TE: 12 had venous and two had arterial locations. The sites for the venous TE included lungs (seven), lower extremities (four), upper extremities (one), and neck (one). Arterial TE developed in cerebral and peripheral arteries each. No single clinical parameter such as prerequisite for the metabolic syndrome, disease status, and treatment regimen were predictive for the development of TE. The frequency of TE in patients who received thalidomide as initial therapy (7/155) was not different from those who received thalidomide for progressive or relapsed disease (7/205, p = 0.592). The frequency of TE during thalidomide treatment in Korean patients with MM was low. No significant clinical factor was found to be a risk factor. The subgroup requiring thromboprophylaxis among the Korean patients with MM, receiving thalidomide, needs to be clarified.

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References

  1. Lyman GH, Khorana AA, Falanga A et al (2007) American Society of Clinical Oncology guideline: recommendations for venous thromboembolism prophylaxis and treatment in patients with cancer. J Clin Oncol 25:5490–5505

    Article  CAS  PubMed  Google Scholar 

  2. Khorana AA, Francis CW, Culakova E et al (2006) Thromboembolism in hospitalized neutropenic cancer patients. J Clin Oncol 24:484–490

    Article  PubMed  Google Scholar 

  3. Blom JW, Doggen CJ, Osanto S, Rosendaal FR (2005) Malignancies, prothrombotic mutations, and the risk of venous thrombosis. JAMA 293:715–722

    Article  CAS  PubMed  Google Scholar 

  4. Heit JA, Silverstein MD, Mohr DN et al (2000) Risk factors for deep vein thrombosis and pulmonary embolism: a population-based case-control study. Arch Intern Med 160:809–815

    Article  CAS  PubMed  Google Scholar 

  5. Zangari M, Anaissie E, Barlogie B et al (2001) Increased risk of deep-vein thrombosis in patients with multiple myeloma receiving thalidomide and chemotherapy. Blood 98:1614–1615

    Article  CAS  PubMed  Google Scholar 

  6. Shah MA, Ilson D, Kelsen DP (2005) Thromboembolic events in gastric cancer: high incidence in patients receiving irinotecan- and bevacizumab-based therapy. J Clin Oncol 23:2574–2576

    Article  PubMed  Google Scholar 

  7. Palumbo A, Facon T, Sonneveld P et al (2008) Thalidomide for treatment of multiple myeloma: 10 years later. Blood 111:3968–3977

    Article  CAS  PubMed  Google Scholar 

  8. Singhal S, Mehta J, Desikan R et al (1999) Antitumor activity of thalidomide in refractory multiple myeloma. N Engl J Med 341:1565–1571

    Article  CAS  PubMed  Google Scholar 

  9. Palumbo A, Giaccone L, Bertola A et al (2001) Low-dose thalidomide plus dexamethasone is an effective salvage therapy for advanced myeloma. Haematologica 86:399–403

    CAS  PubMed  Google Scholar 

  10. Palumbo A, Avonto I, Bruno B et al (2006) Intravenous melphalan, thalidomide and prednisone in refractory and relapsed multiple myeloma. Eur J Haematol 76:273–277

    Article  CAS  PubMed  Google Scholar 

  11. Offidani M, Corvatta L, Marconi M et al (2006) Low-dose thalidomide with pegylated liposomal doxorubicin and high-dose dexamethasone for relapsed/refractory multiple myeloma: a prospective, multicenter, phase II study. Haematologica 91:133–136

    CAS  PubMed  Google Scholar 

  12. Palumbo A, Rajkumar SV, Dimopoulos MA et al (2008) Prevention of thalidomide- and lenalidomide-associated thrombosis in myeloma. Leukemia 22:414–423

    Article  CAS  PubMed  Google Scholar 

  13. Scarpace SL, Hahn T, Roy H et al (2005) Arterial thrombosis in four patients treated with thalidomide. Leuk Lymphoma 46:239–242

    Article  PubMed  Google Scholar 

  14. Weber D, Rankin K, Gavino M et al (2003) Thalidomide alone or with dexamethasone for previously untreated multiple myeloma. J Clin Oncol 21:16–19

    Article  CAS  PubMed  Google Scholar 

  15. Zangari M, Barlogie B, Anaissie E et al (2004) Deep vein thrombosis in patients with multiple myeloma treated with thalidomide and chemotherapy: effects of prophylactic and therapeutic anticoagulation. Br J Haematol 126:715–721

    Article  CAS  PubMed  Google Scholar 

  16. Minnema MC, Breitkreutz I, Auwerda JJ et al (2004) Prevention of venous thromboembolism with low molecular-weight heparin in patients with multiple myeloma treated with thalidomide and chemotherapy. Leukemia 18:2044–2046

    Article  CAS  PubMed  Google Scholar 

  17. Baz R, Li L, Kottke-Marchant K et al (2005) The role of aspirin in the prevention of thrombotic complications of thalidomide and anthracycline-based chemotherapy for multiple myeloma. Mayo Clin Proc 80:1568–1574

    Article  CAS  PubMed  Google Scholar 

  18. Dispenzieri A, Rajkumar SV, Gertz MA et al (2007) Treatment of newly diagnosed multiple myeloma based on Mayo Stratification of Myeloma and Risk-adapted Therapy (mSMART): consensus statement. Mayo Clin Proc 82:323–341

    Article  CAS  PubMed  Google Scholar 

  19. Chew HK, Wun T, Harvey D et al (2006) Incidence of venous thromboembolism and its effect on survival among patients with common cancers. Arch Intern Med 166:458–464

    Article  PubMed  Google Scholar 

  20. Hattori Y, Okamoto S, Shimada N et al (2008) Single-institute phase 2 study of thalidomide treatment for refractory or relapsed multiple myeloma: prognostic factors and unique toxicity profile. Cancer Sci 99:1243–1250

    Article  CAS  PubMed  Google Scholar 

  21. Murakami H, Handa H, Abe M et al (2007) Low-dose thalidomide plus low-dose dexamethasone therapy in patients with refractory multiple myeloma. Eur J Haematol 79:234–239

    Article  CAS  PubMed  Google Scholar 

  22. Anagnostopoulos A, Weber D, Rankin K et al (2003) Thalidomide and dexamethasone for resistant multiple myeloma. Br J Haematol 121:768–771

    Article  CAS  PubMed  Google Scholar 

  23. Bataille R, Durie BG, Grenier J, Sany J (1986) Prognostic factors and staging in multiple myeloma: a reappraisal. J Clin Oncol 4:80–87

    CAS  PubMed  Google Scholar 

  24. Greipp PR, San Miguel J, Durie BG et al (2005) International staging system for multiple myeloma. J Clin Oncol 23:3412–3420

    Article  PubMed  Google Scholar 

  25. Kim JK, Kim YJ, Lee SY (2006) Defining criteria for obesity management using optimal body mass index. Journal of Korean Society for the Study of Obesity 10:10

    Google Scholar 

  26. Ho CH, Chau WK, Hsu HC et al (2000) Causes of venous thrombosis in fifty Chinese patients. Am J Hematol 63:74–78

    Article  CAS  PubMed  Google Scholar 

  27. Shen MC, Lin JS, Tsay W (2000) Protein C and protein S deficiencies are the most important risk factors associated with thrombosis in Chinese venous thrombophilic patients in Taiwan. Thromb Res 99:447–452

    Article  CAS  PubMed  Google Scholar 

  28. Johnson DC, Corthals S, Ramos C et al (2008) Genetic associations with thalidomide mediated venous thrombotic events in myeloma identified using targeted genotyping. Blood 112(13):4924–4934

    Article  CAS  PubMed  Google Scholar 

  29. White RH, Zhou H, Murin S, Harvey D (2005) Effect of ethnicity and gender on the incidence of venous thromboembolism in a diverse population in California in 1996. Thromb Haemost 93:298–305

    CAS  PubMed  Google Scholar 

  30. Stein PD, Kayali F, Olson RE, Milford CE (2004) Pulmonary thromboembolism in Asians/Pacific Islanders in the United States: analysis of data from the National Hospital Discharge Survey and the United States Bureau of the Census. Am J Med 116:435–442

    Article  PubMed  Google Scholar 

  31. Kobayashi T, Nakamura M, Sakuma M et al (2006) Incidence of pulmonary thromboembolism (PTE) and new guidelines for PTE prophylaxis in Japan. Clin Hemorheol Microcirc 35:257–259

    PubMed  Google Scholar 

  32. Mannucci PM (2007) Thrombosis and bleeding disorders outside Western countries. J Thromb Haemost 5(Suppl 1):68–72

    Article  PubMed  Google Scholar 

  33. Geerts WH, Bergqvist D, Pineo GF et al (2008) Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 133:381S–453S

    Article  CAS  PubMed  Google Scholar 

  34. Jang MJ, Choi WI, Bang SM, Lee T, Kim YK, Ageno W, Oh D (2009) Metabolic syndrome is associated with venous thromboembolism in the Korean population. Arterioscler Thromb Vasc Biol 29(3):311–315

    Article  CAS  PubMed  Google Scholar 

  35. Verhovsek M, Douketis JD, Yi Q et al (2008) Systematic review: D-dimer to predict recurrent disease after stopping anticoagulant therapy for unprovoked venous thromboembolism. Ann Intern Med 149:481–490 W494

    PubMed  Google Scholar 

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Acknowledgment

We specially thank all members of the Korean Multiple Myeloma Working Party.

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Authors and Affiliations

  1. Department of Internal medicine, Seoul National University Hospital, Seoul, South Korea

    Youngil Koh & Sung-Soo Yoon

  2. Department of Internal Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeongi-do, 463-707, South Korea

    Soo-Mee Bang

  3. Department of Internal Medicine, Gachon University Gil Hospital, Incheon, South Korea

    Jae Hoon Lee

  4. Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, South Korea

    Hwi-Joong Yoon

  5. Department of Internal Medicine, Dongsan Medical Center, Daegu, South Korea

    Young-Rok Do

  6. Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, South Korea

    Hun-Mo Ryoo

  7. Department of Internal Medicine, Chonbuk National University Hospital, Jeonju, South Korea

    Nari Lee

  8. Department of Internal Medicine, Samsung Medical Center, Seoul, South Korea

    Seok Jin Kim & Kihyun Kim

  9. Department of Internal Medicine, Soon Chun Hyang University Hospital, Seoul, South Korea

    Jong-Ho Won

  10. Department of Internal Medicine, Ewha Women’s University College of Medicine, Seoul, South Korea

    Yeung-Chul Mun

  11. Department of Internal Medicine, Inha University Hospital, Incheon, South Korea

    Moon-Hee Lee

  12. Department of Internal Medicine, Holy Family Hospital, Bucheon, South Korea

    Ki-Hyun Rhee

  13. Department of Internal medicine, Hallym University Medical Center, Anyang, South Korea

    Hyo-Jung Kim

  14. Special Cancer Clinic, National Cancer Center, Goyang, South Korea

    HyeonSeok Eom

  15. Department of Internal Medicine, Yeungnam University Medical Center, Daegu, South Korea

    Min Kyoung Kim

  16. Department of Internal Medicine, Hallym University Chuncheon Hospital, Chuncheon, South Korea

    Hyun Chun Shin

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  1. Youngil Koh
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  2. Soo-Mee Bang
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  3. Jae Hoon Lee
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  6. Hun-Mo Ryoo
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  7. Nari Lee
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  8. Seok Jin Kim
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  10. Sung-Soo Yoon
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  11. Jong-Ho Won
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  12. Yeung-Chul Mun
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  13. Moon-Hee Lee
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  14. Ki-Hyun Rhee
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  15. Hyo-Jung Kim
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  16. HyeonSeok Eom
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  17. Min Kyoung Kim
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  18. Hyun Chun Shin
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Korean Multiple Myeloma Working Party

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Correspondence to Soo-Mee Bang.

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Koh, Y., Bang, SM., Lee, J.H. et al. Low incidence of clinically apparent thromboembolism in Korean patients with multiple myeloma treated with thalidomide. Ann Hematol 89, 201–206 (2010). https://doi.org/10.1007/s00277-009-0807-6

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  • DOI: https://doi.org/10.1007/s00277-009-0807-6

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