Thrombosis in multiple myeloma: Risk estimation by induction regimen and association with overall survival

Area of Science:

• Hematology
• Oncology
• Clinical Medicine

Background:

• Lenalidomide-based triplet and quadruplet regimens are standard for multiple myeloma (MM).
• These regimens are associated with an increased risk of thrombosis.
• The impact of thromboembolism (TE) on survival in the current MM treatment era requires clarification.

Purpose of the Study:

• To evaluate the incidence of TE in newly diagnosed MM (NDMM) patients within the first year of diagnosis.
• To determine the association between TE and the type of induction regimen used.
• To assess the impact of TE on overall survival in NDMM patients.

Main Methods:

• Retrospective study of 672 NDMM patients receiving lenalidomide-based induction therapy at Mayo Clinic.
• Analysis of TE incidence, including deep venous thrombosis (DVT) and pulmonary embolism (PE).
• Comparison of TE risk across different regimens (KRd, quadruplets, Rd) and assessment of survival outcomes.

Main Results:

• TE occurred in 12.4% of patients; KRd regimen showed the highest TE risk (21.1%), significantly higher than other regimens.
• TE was diagnosed before treatment initiation in some patients.
• Patients who developed TE had significantly lower overall survival (66 months vs. 133 months).
• TE remained an independent predictor of reduced survival in multivariable analysis.

Conclusions:

• TE is a critical factor in MM management, with notable incidence in patients receiving novel therapies.
• The carfilzomib-Rd regimen is associated with a significantly higher risk of TE.
• Effective TE management is crucial for improving survival outcomes in the evolving landscape of MM treatment.