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Thromboprophylaxis in multiple myeloma: a case-based review with practical guidelines

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Abstract

Venous thromboembolism (VTE) poses a significant challenge in the context of multiple myeloma, with an incidence of up to 10% in newly diagnosed patients and varying frequency in the relapsed/refractory setting. Accurate VTE risk assessment and personalized thromboprophylaxis strategies are important parts of supportive care in myeloma. There are three validated risk assessment models for prediction of VTE risk in newly diagnosed myeloma-SAVED, IMPEDE-VTE, and PRISM. In this review, we delve into the practical applications of VTE risk prediction models in the context of current therapies. By emphasizing the necessity of a tailored approach, we underscore the importance of considering patient-specific, disease-specific, and treatment-specific risk factors in each clinical scenario, and using that data to complement the output from risk assessment models. We also provide a summary of currently available data on VTE thromboprophylaxis in myeloma, and highlight specific situations where direct oral anticoagulants should be strongly considered. Our objective is to fill the critical gaps in VTE prophylaxis and management through the analysis of specific patient cases and provide a practical overview for clinicians.

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Authors and Affiliations

  1. Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA

    Charalampos Charalampous & Shaji Kumar

  2. Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA

    Darshi Shah

  3. Multiple Myeloma and Amyloidosis Program, Columbia University Irving Medical Center, Herbert Irving Comprehensive Cancer Center, New York, NY, USA

    Rajshekhar Chakraborty

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  1. Charalampos Charalampous
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  2. Darshi Shah
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  4. Rajshekhar Chakraborty
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C.C. and R.C. conceived the study. C.C. and D.S. wrote the first draft of the manuscript. S.K. and R.C. provided critical feedback and approved the final version of the manuscript.

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Correspondence to Rajshekhar Chakraborty.

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Charalampous, C., Shah, D., Kumar, S. et al. Thromboprophylaxis in multiple myeloma: a case-based review with practical guidelines. Ann Hematol (2024). https://doi.org/10.1007/s00277-024-05733-9

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