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Low incidence of thromboembolism in multiple myeloma patients receiving immunomodulatory drugs; a retrospective single-institution analysis

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Abstract

Anti-platelet agents or anticoagulants are administered for patients with multiple myeloma (MM) receiving immunomodulatory drugs (IMiDs) to prevent thrombotic events (TEs). However, there is a discrepancy between current guidelines and clinical practice in thromboprophylaxis and the varied incidence of TEs depending on patient cohort. Therefore, a consensus on the optimal thromboprophylactic strategy is needed. To determine an appropriate strategy for the prevention of TEs in MM patients receiving IMiDs, we performed a retrospective single-institution analysis. In total, 95 MM patients (62% male, median age 65 years, range 30–85 years) from November 2008 to January 2018 were recruited, and 140 cases were analyzed in the medical-record-based study. Thromboprophylactic drugs were given to 69% of patients, anti-platelet agents to 66%, and anticoagulants to 3.0%. Seven TEs (5.0%) and six bleeding events (4.3%) were observed, but no patients died from thrombohemorrhage. The median follow-up period was 184 days (range 21–2224), and the cumulative TE incidence was 1.7% at 3 months, 7.0% at 1 year, and 12.5% at 3 years. Multivariate analysis determined that age > 70 years (p = 0.012) and BMI < 18.5 kg/m2 (p = 0.042) were the significant risk factors of TE. A low incidence of TEs was observed despite the low adherence to guideline recommendations for anticoagulant administration. These results suggest that anti-platelet agents are sufficient for thromboprophylaxis. A high-risk group of TEs in MM patients receiving IMiDs was identified, and a larger study is needed to confirm these findings.

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Authors and Affiliations

  1. Department of Hematology, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan

    Koji Takaishi, Shokichi Tsukamoto, Chikako Ohwada, Masahiro Takeuchi, Yurie Nagai, Tatsuzo Mishina, Miki Yamazaki, Yusuke Isshiki, Kensuke Kayamori, Kenji Kimura, Yutaro Hino, Nagisa Oshima-Hasegawa, Shio Mitsukawa, Yusuke Takeda, Naoya Mimura, Tohru Iseki, Chiaki Nakaseko & Emiko Sakaida

  2. Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan

    Yohei Kawasaki

  3. Department of Transfusion Medicine and Cell Therapy, Chiba University Hospital, Chiba, Japan

    Shio Mitsukawa, Naoya Mimura & Tohru Iseki

  4. Department of Hematology, International University of Health and Welfare School of Medicine, Narita, Japan

    Chiaki Nakaseko

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  1. Koji Takaishi
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Contributions

KT, ST, and ES designed the study. KT enrolled the patients and collected the data. KT, ST, CO, and YK performed the statistical analysis. KT and ST wrote the paper. All authors reviewed and edited the manuscript, which was exclusively and critically revised by CN and ES.

Corresponding author

Correspondence to Emiko Sakaida.

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The authors declare that they have no conflict of interest.

Ethical approval

This retrospective study was approved by the Ethics Committee of Chiba University School of Medicine. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Research involving animal studies

This article does not contain any studies with animals performed by any of the authors.

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Takaishi, K., Tsukamoto, S., Ohwada, C. et al. Low incidence of thromboembolism in multiple myeloma patients receiving immunomodulatory drugs; a retrospective single-institution analysis. J Thromb Thrombolysis 48, 141–148 (2019). https://doi.org/10.1007/s11239-019-01809-w

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