Prevention of thalidomide- and lenalidomide-associated thrombosis in myeloma

Palumbo, A.; Rajkumar, S. V.; Dimopoulos, M. A.; Richardson, P. G.; Miguel, J. San; Barlogie, B.; Harousseau, J.; Zonder, J. A.; Cavo, M.; Zangari, M.; Attal, M.; Belch, A.; Knop, S.; Joshua, D.; Sezer, O.; Ludwig, H.; Vesole, D.; Blade, J.; Kyle, R.; Westin, Jan; Weber, D.; Bringhen, S.; Niesvizky, R.; Waage, A.; von Lilienfeld-Toal, M.; Lonial, S.; Morgan, G. J.; Orlowski, R. Z.; Shimizu, K.; Anderson, K. C.; Boccadoro, M.; Durie, B. G.; Sonneveld, P.; Hussein, M. A.

Prevention of thalidomide- and lenalidomide-associated thrombosis in myeloma

Mark

Palumbo, A. ; Rajkumar, S. V. ; Dimopoulos, M. A. ; Richardson, P. G. ; Miguel, J. San ; Barlogie, B. ; Harousseau, J. ; Zonder, J. A. ; Cavo, M. and Zangari, M. , et al. (2008) In Leukemia 22(2). p.414-423

Abstract: The incidence of venous thromboembolism (VTE) is more than 1%omicron 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,... (More); The incidence of venous thromboembolism (VTE) is more than 1%omicron 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 40 mg 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. (Less)

Please use this url to cite or link to this publication: https://lup.lub.lu.se/record/1196431

author

Palumbo, A. ; Rajkumar, S. V. ; Dimopoulos, M. A. ; Richardson, P. G. ; Miguel, J. San ; Barlogie, B. ; Harousseau, J. ; Zonder, J. A. ; Cavo, M. and Zangari, M. , et al. (More)

Palumbo, A. ; Rajkumar, S. V. ; Dimopoulos, M. A. ; Richardson, P. G. ; Miguel, J. San ; Barlogie, B. ; Harousseau, J. ; Zonder, J. A. ; Cavo, M. ; Zangari, M. ; Attal, M. ; Belch, A. ; Knop, S. ; Joshua, D. ; Sezer, O. ; Ludwig, H. ; Vesole, D. ; Blade, J. ; Kyle, R. ; Westin, Jan ^LU ; Weber, D. ; Bringhen, S. ; Niesvizky, R. ; Waage, A. ; von Lilienfeld-Toal, M. ; Lonial, S. ; Morgan, G. J. ; Orlowski, R. Z. ; Shimizu, K. ; Anderson, K. C. ; Boccadoro, M. ; Durie, B. G. ; Sonneveld, P. and Hussein, M. A. (Less)

organization

Stem Cell Center

publishing date

2008

type

Contribution to journal

publication status

published

subject

Cancer and Oncology

keywords

lenalidomide, thalidomide, risk factors, thrombosis, prophylaxis

in

Leukemia

volume

22

issue

2

pages

414 - 423

publisher

Nature Publishing Group

external identifiers

wos:000253166900025
scopus:39149109289

ISSN

1476-5551

DOI

10.1038/sj.leu.2405062

language

English

LU publication?

yes

id

2cb7bff0-127e-4775-8dd8-f43de871b21b (old id 1196431)

date added to LUP

2016-04-01 12:57:45

date last changed

2022-08-28 23:51:07

@article{2cb7bff0-127e-4775-8dd8-f43de871b21b,
  abstract     = {{The incidence of venous thromboembolism (VTE) is more than 1%omicron 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 &lt;= 1 risk factor for VTE. LMWH (equivalent to enoxaparin 40 mg 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.}},
  author       = {{Palumbo, A. and Rajkumar, S. V. and Dimopoulos, M. A. and Richardson, P. G. and Miguel, J. San and Barlogie, B. and Harousseau, J. and Zonder, J. A. and Cavo, M. and Zangari, M. and Attal, M. and Belch, A. and Knop, S. and Joshua, D. and Sezer, O. and Ludwig, H. and Vesole, D. and Blade, J. and Kyle, R. and Westin, Jan and Weber, D. and Bringhen, S. and Niesvizky, R. and Waage, A. and von Lilienfeld-Toal, M. and Lonial, S. and Morgan, G. J. and Orlowski, R. Z. and Shimizu, K. and Anderson, K. C. and Boccadoro, M. and Durie, B. G. and Sonneveld, P. and Hussein, M. A.}},
  issn         = {{1476-5551}},
  keywords     = {{lenalidomide; thalidomide; risk factors; thrombosis; prophylaxis}},
  language     = {{eng}},
  number       = {{2}},
  pages        = {{414--423}},
  publisher    = {{Nature Publishing Group}},
  series       = {{Leukemia}},
  title        = {{Prevention of thalidomide- and lenalidomide-associated thrombosis in myeloma}},
  url          = {{http://dx.doi.org/10.1038/sj.leu.2405062}},
  doi          = {{10.1038/sj.leu.2405062}},
  volume       = {{22}},
  year         = {{2008}},
}

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Prevention of thalidomide- and lenalidomide-associated thrombosis in myeloma