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Does Low-Molecular-Weight Heparin Influence the Antimyeloma Effects of Thalidomide? A Retrospective Analysis of Data from the GIMEMA, Nordic and Turkish Myeloma Study Groups

Beksac, Meral; Waage, Anders; Bringhen, Sara; Kristinsson, Sigurdur Y.; Sucak, Gulsan Turkoz; Gimsing, Peter; Lupparelli, Giulia; Firatli-Tuglular, Tulin; Juliusson, Gunnar LU and Turesson, Ingemar LU , et al. (2015) In Acta Haematologica 133(4). p.372-380
Abstract
Background/Aim: Low-molecular-weight heparin (LMWH) has been shown to prolong survival among patients with solid tumors, but its role among myeloma patients is unknown. Patients: Data from the GIMEMA (Gruppo Italiano Malattie Ematologiche dell'Adulto), Nordic and Turkish myeloma study groups comparing melphalan and prednisolone with (MPT, n: 404) or without thalidomide (MP, n: 393) are analyzed for effects of LMWH. Forty percent (159/394) of the patients on MPT and 7.4% (29/390) in the MP arm received LMWH. Results: Thalidomide improved response and progression-free survival (PFS). Regardless of thalidomide treatment, response rate was higher among those receiving LMWH vs. none vs. other anticoagulants (58.1 vs. 44.9 vs. 50.4%, p = 0.01).... (More)
Background/Aim: Low-molecular-weight heparin (LMWH) has been shown to prolong survival among patients with solid tumors, but its role among myeloma patients is unknown. Patients: Data from the GIMEMA (Gruppo Italiano Malattie Ematologiche dell'Adulto), Nordic and Turkish myeloma study groups comparing melphalan and prednisolone with (MPT, n: 404) or without thalidomide (MP, n: 393) are analyzed for effects of LMWH. Forty percent (159/394) of the patients on MPT and 7.4% (29/390) in the MP arm received LMWH. Results: Thalidomide improved response and progression-free survival (PFS). Regardless of thalidomide treatment, response rate was higher among those receiving LMWH vs. none vs. other anticoagulants (58.1 vs. 44.9 vs. 50.4%, p = 0.01). PFS was significantly longer (median 32 vs. 21 and 17 vs. 17 months, p = 0.004) only among international scoring system (ISS) I patients receiving MPT +/- LMWH vs. MP +/- LMWH. The group of MPT patients who also received LMWH had a better OS compared to those who did not [45 months, 95% confidence interval (CI) 27.7-62.3, vs. 32 months, 95% CI 26.1-37.9; p = 0.034]. When multivariate analysis was repeated in subgroups, thalidomide was no longer a significant factor (response, PFS) among those receiving LMWH. Conclusion: Addition of LMWH to MPT, in particular in patients with low ISS, suggests additive effects, but the results are limited by the retrospective design of our study. (C) 2015 S. Karger AG, Basel (Less)
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Contribution to journal
publication status
published
subject
keywords
Anticoagulation, Heparin, Low-molecular-weight heparin, Multiple, myeloma, Thalidomide
in
Acta Haematologica
volume
133
issue
4
pages
372 - 380
publisher
Karger
external identifiers
  • wos:000355013700008
  • scopus:84926228042
ISSN
1421-9662
DOI
10.1159/000370023
language
English
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yes
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cfd37ce1-05c1-41c3-a126-c2304205bc93 (old id 7422512)
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2015-07-03 07:03:52
date last changed
2017-01-01 03:41:15
@article{cfd37ce1-05c1-41c3-a126-c2304205bc93,
  abstract     = {Background/Aim: Low-molecular-weight heparin (LMWH) has been shown to prolong survival among patients with solid tumors, but its role among myeloma patients is unknown. Patients: Data from the GIMEMA (Gruppo Italiano Malattie Ematologiche dell'Adulto), Nordic and Turkish myeloma study groups comparing melphalan and prednisolone with (MPT, n: 404) or without thalidomide (MP, n: 393) are analyzed for effects of LMWH. Forty percent (159/394) of the patients on MPT and 7.4% (29/390) in the MP arm received LMWH. Results: Thalidomide improved response and progression-free survival (PFS). Regardless of thalidomide treatment, response rate was higher among those receiving LMWH vs. none vs. other anticoagulants (58.1 vs. 44.9 vs. 50.4%, p = 0.01). PFS was significantly longer (median 32 vs. 21 and 17 vs. 17 months, p = 0.004) only among international scoring system (ISS) I patients receiving MPT +/- LMWH vs. MP +/- LMWH. The group of MPT patients who also received LMWH had a better OS compared to those who did not [45 months, 95% confidence interval (CI) 27.7-62.3, vs. 32 months, 95% CI 26.1-37.9; p = 0.034]. When multivariate analysis was repeated in subgroups, thalidomide was no longer a significant factor (response, PFS) among those receiving LMWH. Conclusion: Addition of LMWH to MPT, in particular in patients with low ISS, suggests additive effects, but the results are limited by the retrospective design of our study. (C) 2015 S. Karger AG, Basel},
  author       = {Beksac, Meral and Waage, Anders and Bringhen, Sara and Kristinsson, Sigurdur Y. and Sucak, Gulsan Turkoz and Gimsing, Peter and Lupparelli, Giulia and Firatli-Tuglular, Tulin and Juliusson, Gunnar and Turesson, Ingemar and Palumbo, Antonio},
  issn         = {1421-9662},
  keyword      = {Anticoagulation,Heparin,Low-molecular-weight heparin,Multiple,myeloma,Thalidomide},
  language     = {eng},
  number       = {4},
  pages        = {372--380},
  publisher    = {Karger},
  series       = {Acta Haematologica},
  title        = {Does Low-Molecular-Weight Heparin Influence the Antimyeloma Effects of Thalidomide? A Retrospective Analysis of Data from the GIMEMA, Nordic and Turkish Myeloma Study Groups},
  url          = {http://dx.doi.org/10.1159/000370023},
  volume       = {133},
  year         = {2015},
}