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Updated: Jun 7, 2025
An Organotypic High Throughput System for Characterization of Drug Sensitivity of Primary Multiple Myeloma Cells
Published on: July 15, 2015
Multiple myeloma: retrospective assessment of routine thromboprophylaxis and utility of thrombotic risk scores
Omar Eduardo Fernandez-Vargas1, Isabel Amezcua1, Beatriz Cabello1
1Department of Hematology, Instituto Nacional de Cancerología, Mexico City, Mexico.
Background:
The high risk of venous thromboembolism (VTE) in multiple myeloma (MM) warrants primary thromboprophylaxis for most patients. Myeloma-specific thrombotic risk scores (TRSs), such as IMPEDE-VTE, SAVED, and PRISM, were developed to improve risk assessment and guide antithrombotic strategies. Their performance is variable and has not yet been tested in Latin America.
Objectives:
We aimed to assess the use of primary thromboprophylaxis, the incidence of VTE and bleeding events, and the effectiveness of TRSs in patients with newly diagnosed MM.
Methods:
This was a retrospective, single-center study. Cumulative VTE rates and TRS performance were analyzed using survival and receiver operating characteristic curves.
Results:
The study included 250 newly diagnosed MM patients; the vast majority (98.6%) received aspirin as thromboprophylaxis. VTE occurred in 8% within the initial 6 months, increasing to 14.8% over a median follow-up of 19 months. High rates of major bleeding (4.8%) and clinically relevant nonmajor bleeding (4.4%) events were documented. A minimal proportion (0.8%, 0.5%, and 1.2%) of patients were classified as low risk by IMPEDE-VTE, PRISM, and SAVED scores, respectively. Only IMPEDE-VTE exhibited a trend for distinguishing between intermediate-risk (7.14%) and high-risk (13.2%) groups (P = .09). PRISM and SAVED scores showed limited utility. VTE did not impact survival.
Conclusion:
Aspirin as primary thromboprophylaxis carries an unacceptable risk of VTE and bleeding in patients at intermediate or high thrombotic risk. The IMPEDE-VTE score performed best, although without reaching statistical significance. We confirm that VTE does not portend poor overall survival in MM.
Insights
Aspirin prophylaxis for multiple myeloma (MM) patients carries high risks of venous thromboembolism (VTE) and bleeding. The IMPEDE-VTE score showed potential for risk stratification, but further validation is needed.
Area of Science:
- Hematology
- Oncology
- Clinical Thrombosis
Background:
- Multiple myeloma (MM) patients face a high risk of venous thromboembolism (VTE), necessitating primary thromboprophylaxis.
- Existing myeloma-specific thrombotic risk scores (TRSs) like IMPEDE-VTE, SAVED, and PRISM aim to refine risk assessment but show variable performance and lack testing in Latin American populations.
Purpose of the Study:
- To evaluate the utilization of primary thromboprophylaxis in newly diagnosed MM patients.
- To determine the incidence of VTE and bleeding events in this cohort.
- To assess the effectiveness of IMPEDE-VTE, SAVED, and PRISM scores in predicting VTE risk.
Main Methods:
- A retrospective, single-center study analyzed data from 250 newly diagnosed MM patients.
- Cumulative VTE rates were calculated using survival analysis.
- Receiver operating characteristic (ROC) curves were employed to evaluate TRS performance.
Main Results:
- Aspirin was the primary thromboprophylaxis for 98.6% of patients.
- VTE occurred in 8% within 6 months and 14.8% over 19 months median follow-up.
- High rates of major bleeding (4.8%) and clinically relevant nonmajor bleeding (4.4%) were observed. IMPEDE-VTE showed a trend in risk stratification (P=.09), while PRISM and SAVED had limited utility.
Conclusions:
- Aspirin as primary thromboprophylaxis presents an unacceptable risk of VTE and bleeding in intermediate-to-high risk MM patients.
- The IMPEDE-VTE score demonstrated the best performance among tested TRSs, though not statistically significant.
- VTE events were not found to negatively impact overall survival in MM patients.
