TY - JOUR
T1 - Prevention of thalidomide- and lenalidomide-associated thrombosis in myeloma
AU - Palumbo, A.
AU - Rajkumar, S. V.
AU - Dimopoulos, M. A.
AU - Richardson, P. G.
AU - San Miguel, J.
AU - Barlogie, B.
AU - Harousseau, J.
AU - Zonder, J. A.
AU - Cavo, M.
AU - Zangari, M.
AU - Attal, M.
AU - Belch, A.
AU - Knop, S.
AU - Joshua, D.
AU - Sezer, O.
AU - Ludwig, H.
AU - Vesole, D.
AU - Bladé, J.
AU - Kyle, R.
AU - Westin, J.
AU - Weber, D.
AU - Bringhen, S.
AU - Niesvizky, R.
AU - Waage, A.
AU - von Lilienfeld-Toal, M.
AU - Lonial, S.
AU - Morgan, G. J.
AU - Orlowski, R. Z.
AU - Shimizu, K.
AU - Anderson, K. C.
AU - Boccadoro, M.
AU - Durie, B. G.
AU - Sonneveld, P.
AU - Hussein, M. A.
N1 - Funding Information:
1Division of Hematology, University of Turin, Azienda Ospedaliera S. Giovanni Battista, Torino, Italy; 2Division of Hematology, Mayo Clinic College of Medicine, Rochester, MN, USA; 3Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece; 4Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; 5Department of Hematology, Hospital Clinico Universitario de Salamanca, Servicio de Hematologia, Salamanca, Spain; 6Division of Hematology/Oncology, Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AK, USA; 7Service d’Hématologie, Hôpital Hotel-Dieu, Nantes, France; 8Division of Hematology-Oncology, Karmanos Cancer Center, Wayne State University School of Medicine, Detroit, MI, USA; 9Institute of Hematology and Medical Oncology [Seràgnoli], University of Bologna, Bologna, Italy; 10Service d’Hématologie, Hôpital Purpan, Toulouse, France; 11Department of Medical Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada; 12Tuebingen University Hospital, Department of Hematology/Oncology, Tuebingen, Germany; 13Institute of Hematology, Royal Prince Alfred Hospital, Sydney, Australia; 141st Department of Medicine, Center for Oncology and Hematology, Wilhelminenspital, Vienna, Austria; 15Department of Medicine, St Vincent’s Comprehensive Cancer Center, New York, NY, USA; 16Hematology Department, Institute of Hematology and Oncology, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain; 17Division of Hematology, Laboratory Medicine, Mayo Medical School, Rochester, MN, USA; 18Division of Hematology, Department of Medicine, University of Lund, Lund, Sweden; 19Department of Lymphoma/Myeloma, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA; 20Center of Excellence for Lymphoma and Myeloma, Division of Hematology and Medical Oncology, Weill Medical College of Cornell University, New York Presbytarian Hospital-Cornell Medical Center, New York, NY, USA; 21Department of Hematology, University Hospital Trondheim, Trondheim, Norway; 22Bone Marrow Transplant Unit, St James’s University Hospital, Leeds, UK; 23Division of Hematology-Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA; 24Section of Haemato-Oncology, Royal Marsden Hospital and Institute of Cancer Research, London, UK; 25Division of Hematology/Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; 26Department of Medicine, Nagoya City Midori General Hospital, Nagoya, Japan; 27Aptium Oncology, Cedars-Sinai Comprehensive Cancer Center, Los Angeles, CA, USA; 28Department of Hematology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands; 29Department of Interdisciplinary Oncology, Multiple Myeloma Multidisciplinary Clinical Research Program, Cleveland Clinic Taussig Cancer Center, Ohio, OH, USA and 30Department of Hematology and Oncology, Charité - Universitaetsmedizin Berlin, Berlin 10117, Germany
PY - 2008/2
Y1 - 2008/2
N2 - The incidence of venous thromboembolism (VTE) is more than 1‰ annually in the general population and increases further in cancer patients. The risk of VTE is higher in multiple myeloma (MM) patients who receive thalidomide or lenalidomide, especially in combination with dexamethasone or chemotherapy. Various VTE prophylaxis strategies, such as low-molecular-weight heparin (LMWH), warfarin or aspirin, have been investigated in small, uncontrolled clinical studies. This manuscript summarizes the available evidence and recommends a prophylaxis strategy according to a risk-assessment model. Individual risk factors for thrombosis associated with thalidomide/lenalidomide-based therapy include age, history of VTE, central venous catheter, comorbidities (infections, diabetes, cardiac disease), immobilization, surgery and inherited thrombophilia. Myeloma-related risk factors include diagnosis and hyperviscosity. VTE is very high in patients who receive high-dose dexamethasone, doxorubicin or multiagent chemotherapy in combination with thalidomide or lenalidomide, but not with bortezomib. The panel recommends aspirin for patients with ≤1 risk factor for VTE. LMWH (equivalent to enoxaparin 40mg per day) is recommended for those with two or more individual/myeloma-related risk factors. LMWH is also recommended for all patients receiving concurrent high-dose dexamethasone or doxorubicin. Full-dose warfarin targeting a therapeutic INR of 2-3 is an alternative to LMWH, although there are limited data in the literature with this strategy. In the absence of clear data from randomized studies as a foundation for recommendations, many of the following proposed strategies are the results of common sense or derive from the extrapolation of data from many studies not specifically designed to answer these questions. Further investigation is needed to define the best VTE prophylaxis.
AB - The incidence of venous thromboembolism (VTE) is more than 1‰ annually in the general population and increases further in cancer patients. The risk of VTE is higher in multiple myeloma (MM) patients who receive thalidomide or lenalidomide, especially in combination with dexamethasone or chemotherapy. Various VTE prophylaxis strategies, such as low-molecular-weight heparin (LMWH), warfarin or aspirin, have been investigated in small, uncontrolled clinical studies. This manuscript summarizes the available evidence and recommends a prophylaxis strategy according to a risk-assessment model. Individual risk factors for thrombosis associated with thalidomide/lenalidomide-based therapy include age, history of VTE, central venous catheter, comorbidities (infections, diabetes, cardiac disease), immobilization, surgery and inherited thrombophilia. Myeloma-related risk factors include diagnosis and hyperviscosity. VTE is very high in patients who receive high-dose dexamethasone, doxorubicin or multiagent chemotherapy in combination with thalidomide or lenalidomide, but not with bortezomib. The panel recommends aspirin for patients with ≤1 risk factor for VTE. LMWH (equivalent to enoxaparin 40mg per day) is recommended for those with two or more individual/myeloma-related risk factors. LMWH is also recommended for all patients receiving concurrent high-dose dexamethasone or doxorubicin. Full-dose warfarin targeting a therapeutic INR of 2-3 is an alternative to LMWH, although there are limited data in the literature with this strategy. In the absence of clear data from randomized studies as a foundation for recommendations, many of the following proposed strategies are the results of common sense or derive from the extrapolation of data from many studies not specifically designed to answer these questions. Further investigation is needed to define the best VTE prophylaxis.
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U2 - 10.1038/sj.leu.2405062
DO - 10.1038/sj.leu.2405062
M3 - Article
C2 - 18094721
AN - SCOPUS:39149109289
SN - 0887-6924
VL - 22
SP - 414
EP - 423
JO - Leukemia
JF - Leukemia
IS - 2
ER -