Predicting venous thromboembolism in multiple myeloma: development and validation of the IMPEDE VTE score

Area of Science:

• Hematology
• Oncology
• Epidemiology

Background:

• Venous thromboembolism (VTE) is a significant cause of morbidity and mortality in multiple myeloma (MM) patients.
• Current International Myeloma Working Group (IMWG) and National Comprehensive Cancer Network (NCCN) guidelines for VTE prophylaxis lack validation.
• There is a need for a validated risk prediction tool for VTE in MM.

Purpose of the Study:

• To develop and validate a novel risk prediction score for VTE in patients with newly diagnosed MM.
• To evaluate the performance of the existing IMWG/NCCN guidelines in predicting VTE risk.
• To establish a more accurate risk stratification tool for VTE in MM patients.

Main Methods:

• Development of a risk score using time-to-event analyses in 4446 MM patients from the Veterans Administration Central Cancer Registry.
• External validation of the developed score using the SEER-Medicare database (N=4256).
• Identification of independent VTE predictors including immunomodulatory agents, BMI, fracture history, erythropoietin, specific chemotherapy agents, ethnicity, VTE history, and central venous catheters.

Main Results:

• The developed IMPEDE VTE score demonstrated satisfactory discrimination in the derivation cohort (c-statistic = 0.66) and external validation cohort (c-statistic = 0.64).
• A higher IMPEDE VTE score was significantly associated with an increased risk of VTE (hazard ratio = 1.20, P < .0001).
• The IMWG/NCCN guidelines showed poorer performance with a c-statistic of 0.55 in comparison.

Conclusions:

• The IMPEDE VTE score is a validated tool that outperforms current IMWG/NCCN guidelines for VTE risk stratification in MM patients.
• The IMPEDE VTE score can be considered a new standard for identifying high-risk MM patients for VTE prophylaxis.
• Accurate VTE risk assessment is crucial for improving outcomes in multiple myeloma management.