Immunomodulator drug-based therapy in myeloma and the occurrence of thrombosis

Figures & data

Figure 1. Proposed management of the venous thromboembolic risk based on current knowledge in multiple myeloma patients treated with immunomodulator drug-based therapy.

LMWH: Low-molecular-weight heparin.

Table 1. Incidence of thrombotic events in multiple myeloma patients treated with immunomodulator drugs single agent.

Study (year)	Trial phase	n	VTE prophylaxis	Venous thrombosis (%)	Ref.
Thalidomide
At diagnosis
Weber et al. (2003)	II	28	Coumadine/LMWH	4	[21]
Rajkumar et al. (2003)	II	31	None	3	[16]
Relapse or refractory
Schey (2002)	II	69	–	4	[19]
Mileshkin et al. (2003)	II	75	None	4	[14]
Neben et al. (2002)	II	83	None	4	[15]
Barlogie et al. (2001)	II	169	None	2	[13]
Lenalidomide
At diagnosis
Attal et al. (2012)	III	307	None	6	[22]
McCarthy et al. (2012)	III	231	None	1	[23]
Relapse or refractory
Richardson et al. (2002)	II	27	None	0	[17]
Pomalidomide
Relapse or refractory
Schey et al. (2011)	I	24	None	16	[18]
Streetly et al. (2008)	I	20	None	0	[20]

LMWH: Low-molecular-weight heparin; VTE: Venous thromboembolism.

Table 2. Incidence of venous thrombosis events in multiple myeloma patients treated with thalidomide-based regimens.

Study (year)	Trial phase	n	VTE prophylaxis	Venous thrombosis (%)	Ref.
Thalidomide and dexamethasone
At diagnosis
Rajkumar et al. (2006)	III	102	LMWH/therapeutic warfarin	17	[62]
Cavo et al. (2004)	II	71	LMWH/none (19 patients)	16	[63]
Relapse or refractory
Anagnostopoulos et al. (2003)	Retrospective	47	None	8	[64]
Corso et al. (2004)	II	13	None	8	[10]
Osman et al. (2001)	II	45	None	7	[3]
Thalidomide and anthracyclines
At diagnosis
Schutt et al. (2005)	II	31	None	26	[65]
Zervas et al. (2004)	II	69	None	6	[66]
Zangari et al. (2001)	III	50	None	28	[30]
Barlogie et al. (2006)	II	162	None	34	[67]
Relapse or refractory
Zangari et al. (2002)	Retrospective	192	None	16	[9]
Urbauer et al. (2002)	II	14	None	21	[29]

LMWH: Low-molecular-weight heparin; VTE: Venous thromboembolism.

Table 3. Incidence of venous thrombosis events in multiple myeloma patients treated with lenalidomide- or pomalidomide-based regimens.

Study (year) and regimen	Trial phase	n	VTE prophylaxis	Venous thrombosis (%)	Ref.
Lenalidomide
At diagnosis
Zonder (2006) (len–dex)	II	21	None	75	[61]
Relapse or refractory
Dimopoulos et al. (2007) (len–dex)	III	176	None	11	[32]
Weber et al. (2007) (len–dex)	III	177	None	15	[33]
Morgan et al. (2007) (len–cyclophosphamide)	II	21	Asprin/LMWH/warfarin	14	[68]
Richardson et al. (2005) (len–bortezomib)	I	28	None	0	[69]
Pomalidomide
Relapse or refractory
Lacy et al. (2011) (pom–dex)	II	60	Aspirin 325 mg	0	[36]

Dex: Dexamethasone; Len: Lenalidomide; LMWH: Low-molecular-weight heparin; Pom: Pomalidomide; VTE: Venous thromboembolism.

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