Rates of venous thromboembolism in multiple myeloma patients undergoing immunomodulatory therapy with thalidomide or lenalidomide: a systematic review and meta-analysis

被引:151
作者
Carrier, M. [2 ]
Le Gal, G. [3 ]
Tay, J. [4 ]
Wu, C. [5 ]
Lee, A. Y. [1 ]
机构
[1] Univ British Columbia, Div Hematol, Diamond Hlth Care Ctr, Thrombosis Program,Dept Med, Vancouver, BC V5Z 1M9, Canada
[2] Univ Ottawa, Dept Med, Div Hematol, Thrombosis Program, Ottawa, ON, Canada
[3] Brest Univ Hosp, Dept Internal Med & Chest Dis, EA3878, Brest, France
[4] Univ Ottawa, Malignant Hematol Program, Div Hematol, Dept Med, Ottawa, ON, Canada
[5] McMaster Univ, Dept Med, Hamilton, ON, Canada
关键词
multiple myeloma; thromboprophylaxis; venous thromboembolism; STEM-CELL TRANSPLANTATION; LOW-DOSE THALIDOMIDE; PREDNISONE PLUS THALIDOMIDE; PREVIOUSLY TREATED PATIENTS; PHASE-II; COMBINATION THERAPY; ELDERLY-PATIENTS; ORAL MELPHALAN; LIPOSOMAL DOXORUBICIN; THROMBOTIC COMPLICATIONS;
D O I
10.1111/j.1538-7836.2011.04215.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Introduction: The incidence of venous thromboembolism (VTE) in patients with multiple myeloma (MM) treated with thalidomide-and lenalidomide-based regimens is high. Recent observational studies have suggested that thromboprophylaxis might be efficacious in decreasing the risk of VTE in this population. Purpose: To determine the absolute rates of VTE with and without different thromboprophylactic agents in patients with newly diagnosed or previously treated MM receiving thalidomide-or lenalidomide-based regimens. Results: Patients with newly diagnosed MM treated with thalidomide in combination with dexamethasone have a VTE risk of 4.1 (95% CI, 2.8-5.9) per 100 patient-cycles. Therapeutic doses of anticoagulants seem to provide the largest absolute risk reduction of VTE. The rate of VTE in patients with previously treated MM receiving thalidomide in combination with dexamethasone is 0.8 (95% CI, 0.1-2.1) per 100 patient months. A combination of lenalidomide and dexamethasone is associated with of risk of VTE of 0.8 (95% CI, 0.07-2.0) per 100 patient-cycles and 0.7 (95% CI, 0.4-0.9) per 100 patient-cycles in patients with newly diagnosed and previously treated MM, respectively. Similarly, the rates of VTE in patients also receiving thromboprophylaxis with aspirin were 0.9 (95% CI, 0.5-1.5) and 0.6 (95% CI, 0.01-2.1), respectively. Conclusion: Patients with newly diagnosed or previously treated MM receiving thalidomide-or lenalidomide-based regimens in combination with dexamethasone are at high risk of VTE. The benefit of various types of thromboprophylaxis is difficult to quantify in patients with MM receiving immunomodulatory therapy, especially in those receiving lenalidomide-based therapy or who have previously treated MM. Randomized controlled trials are needed to address this important clinical need.
引用
收藏
页码:653 / 663
页数:11
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