Researchers Identify 5 Risk Factors for Blood Clots in Patients With MM Treated With IMiDs

Venous thromboembolism (VTE) is a significant complication for patients with multiple myeloma (MM) who are being treated with immunomodulatory drugs (IMiDs), and a new assessment model may help to predict VTE in this population.

The findings were published in the Journal of the National Comprehensive Cancer Network and identified 5 specific risk factors for treatment-associated blood clots.

“VTE is an under-recognized but frequently encountered complication to certain types of cancers and some treatment regimens,” Ang Li, MD, University of Washington, said in a statement. “VTE is common in patients with multiple myeloma receiving IMiDs, and can cause disability, delay or complicate chemotherapy, and—in rare cases—be fatal.”

The researchers studied 2397 patients from the Surveillance, Epidemiology and End Results registries and linked Medicare databases, as well as 1251 patients from the Veterans Health Administration. Using these databases, the researchers identified and confirmed 5 risk factors for VTE in MM:

• A prior history of VTE
• Surgery within 90 days
• Being 80 years of age or older
• High steroid dose
• Non-Asian race

In both groups, patients with a score of 2 or higher had a VTE rate of 7% at 3 months and 12% at 6 months compared with 4% and 7%, respectively, for patients with a score of 1 or lower. The risk assessment model, called SAVED, outperformed the current National Comprehensive Cancer Network Guidelines in risk-stratification of patients, according to the authors.

The authors identified several limitations of the study, including lack of access to patient-level data and the fact that the model was derived from patients older than age 65.

“We are hopeful that this clinical tool will aid informed shared decision-making between providers and patients with MM regarding VTE risk before IMiD initiation,” the authors concluded. “Future prospective studies are needed to define the best VTE prevention strategy for patients with MM within a given risk stratum.”

Reference

Li A, Wu Q, L Suhong, et al. Derivation and validation of a risk assessment model for immunomodulatory drug—associated thrombosis among patients with multiple myeloma. J Natl Compr Canc Netw. 2019;17(7):840-847. doi: 10.6004/jnccn.2018.7273.