Thrombotic events in patients with multiple myeloma and their impact on overall survival

Thrombotic events (TEs) are common and severe complications of newly diagnosed multiple myeloma (NDMM). However, the impact of thrombosis on the survival of myeloma patients remains controversial. The aim of our study was to identify independent high-risk factors for thrombosis as well as to explore the association between the incidence of TEs and survival in patients with NDMM.

We analyzed the clinical characteristics, laboratory results, and survival information of 181 patients with NDMM who were treated at Shanghai Jing'an District Zhabei Central Hospital between July 2020 and March 2024.

Twenty patients (11.0%) developed TEs, including 15 cases (8.28%) of venous thrombosis and 5 cases (2.76%) of arterial thrombosis. Patients who developed TEs were significantly older than those who did not develop TEs (64 vs. 70 years, p = 0.018). The association of TEs with age demonstrated by univariate analysis (HR 1.061, 95% CI 1.010-1.115, p = 0.019) was maintained in multivariable analysis adjusted for interphase fluorescence in situ hybridization, sex, lactate dehydrogenase levels, M protein types, induction regimens, and the International Staging System (HR 1.103, 95% CI 1.018-1.195, p = 0.016). In addition, TEs adversely affect patients' overall survival (27 months vs. not reached, p = 0.01), especially those with arterial thrombosis (16 months vs. not reached, p = 0.06).

Age is an independent high-risk factor for TEs in patients with NDMM. The occurrence of TEs shortens the overall survival of myeloma patients, and arterial thrombosis has more severe impact than venous thrombosis. Effective management of thromboprophylaxis is needed for NDMM patients, especially for elderly patients.