Inflammatory Biomarkers for Thrombotic Risk Assessment in Multiple Myeloma Patients on IMiD/aCD38-Based Regimens:
Cirino Botta1, Anna Maria Corsale1, Claudia Cammarata1
1Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, 90127 Palermo, Italy.
Biomolecules
|November 27, 2025
Summary
Thrombosis risk in multiple myeloma patients treated with immunomodulatory drugs (IMiDs) and anti-CD38 antibodies is explored. Aspirin prophylaxis may be less effective in patients with lower inflammation, suggesting new hypotheses for thrombotic event prevention.
Area of Science:
- Hematology
- Oncology
- Immunology
Background:
- Thrombosis is a frequent complication in multiple myeloma (MM) patients undergoing treatment with immunomodulatory drugs (IMiDs).
- Combining IMiDs with anti-CD38 monoclonal antibodies enhances treatment efficacy but may elevate the risk of thrombotic events (TEs).
- This risk necessitates further investigation to optimize patient management and prevent treatment delays.
Purpose of the Study:
- To conduct an exploratory analysis of thrombotic events (TEs) in MM patients treated with IMiD and anti-CD38 antibody combinations.
- To identify potential clinical and laboratory parameters associated with TE occurrence.
- To generate hypotheses regarding the influence of inflammatory signatures on thrombotic risk and prophylaxis efficacy.
Main Methods:
- Prospective, mono-institutional study (MMVision) including 53 MM patients initiating IMiD plus anti-CD38 therapy.
- Patients received lenalidomide, thalidomide, or pomalidomide combined with daratumumab or isatuximab.
- Thromboprophylaxis was administered according to guidelines, with exploratory analysis of 27 clinical/laboratory parameters and cytokine profiling in select cases.
Main Results:
- Five patients (9.4%) developed venous thromboembolism (VTE) after a median of 48 days, despite thromboprophylaxis (mainly aspirin).
- Exploratory analysis suggested potential associations between VTE and lower levels of beta-2 microglobulin, ferritin, intact/free lambda light chains, and monocyte-to-lymphocyte ratio.
- Four VTEs occurred in patients without lytic bone disease; cytokine profiling in two cases indicated altered immune-inflammatory pathways.
Conclusions:
- Aspirin prophylaxis might be less effective in MM patients with lower inflammatory burden receiving IMiD/anti-CD38 therapy, potentially increasing VTE risk.
- Distinct immune-inflammatory pathways may contribute to TEs in this patient population.
- These exploratory findings require validation in larger cohorts to refine understanding of thrombotic risk and prophylaxis strategies in MM.
