Characterisation of haematological profiles and low risk of thromboembolic events with bortezomib in patients with relapsed multiple myeloma

Sagar Lonial, Paul G. Richardson, Jesús San Miguel, Pieter Sonneveld, Michael W. Schuster, Joan Bladé, Jamie Cavenagh, S. Vincent Rajkumar, Andrzej J. Jakubowiak, Dixie Lee Esseltine, Kenneth C. Anderson, Jean Luc Harousseau

Research output: Contribution to journalArticlepeer-review

79 Scopus citations

Abstract

Haematological toxicities and thromboembolic (TE) events are common complications of myeloma therapy. TE risk may be elevated with combination regimens, notably thalidomide/lenalidomide plus high-dose dexamethasone; concomitant erythropoietin appears to further increase the risk with lenalidomide-dexamethasone. We characterised thrombocytopenia and neutropenia in the phase 3 APEX (Assessment of Proteasome Inhibition for Extending Remissions) study of bortezomib versus high-dose dexamethasone in relapsed myeloma, and calculated the incidences of deep-vein thrombosis (DVT)/pulmonary embolism (PE) with: bortezomib or dexamethasone ± erythropoietin in APEX; bortezomib ± dexamethasone ± erythropoietin in two phase 2 studies of relapsed/refractory myeloma. Bortezomib-associated thrombocytopenia and neutropenia were transient, predictable and manageable; mean platelet and neutrophil counts followed a cyclical pattern, and improved over the treatment course. Grade 3/4 thrombocytopenia incidence was higher with bortezomib versus dexamethasone (26%/4% vs. 5%/1%), but significant bleeding events were comparable (4% vs. 5%). DVT/PE incidence was low (≤3.1%) in all analyses; addition of dexamethasone/erythropoietin did not affect TE risk. In APEX, TE risk appeared lower with bortezomib versus dexamethasone. Bortezomib caused transient and cyclical thrombocytopenia and was not associated with elevated TE risk, alone or with dexamethasone ± erythropoietin. Preliminary data suggest bortezomib may reduce the thrombogenic potential of combination regimens via inhibition of platelet function or other mechanism-specific effects on coagulation.

Original languageEnglish (US)
Pages (from-to)222-229
Number of pages8
JournalBritish journal of haematology
Volume143
Issue number2
DOIs
StatePublished - Oct 2008

Keywords

  • Bortezomib
  • Haematological toxicity
  • Multiple myeloma
  • Thromboembolic event

ASJC Scopus subject areas

  • Hematology

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