Skip to main content

Advertisement

SpringerLink
Log in

Comparison of three risk assessment models for thromboembolism in multiple myeloma patients receiving immunomodulators: a Brazilian historical cohort

  • Published:
Journal of Thrombosis and Thrombolysis Aims and scope Submit manuscript

Abstract

Venous thromboembolism (VTE) is among the complications of Multiple Myeloma (MM) and may occur in up to 10% of this patient population. However, medications used in MM therapy such as immunomodulators (IMID) may raise these rates. Thus, risk prediction models have been developed to quantify the risk of VTE in MM patients. The aim of this study is to compare the performance of three risk assessment models for VTE in newly diagnosed MM (NDMM) patients using immunomodulatory agents. A historical cohort study during a 10-year period in a Brazilian metropolis with NDMM treated with IMID. Data were collected from patient’s medical charts for the period of one year to calculate the scores using IMPEDE VTE, SAVED, and International Myeloma Working Group (IMWG) guidelines. The area under the curve (AUC) of the Receiver Operating Characteristic curve analysis was calculated to assess the discriminative power of three risk assessment models. We included 131 patients (9 in the VTE group versus 122 in the non VTE group). According to IMPEDE, 19.1, 62.6, and 18.3% of patients were considered low, intermediate, and high risk, respectively. SAVED classified 32.1% as high risk and 64.9% had ≥2 risk factors based on IMWG guidelines. The AUC of the IMPEDE VTE score was 0.80 (95% CI 0.66–0.95, p = 0.002), of the SAVED score was 0.69 (95% CI 0.49–0.89, p = 0.057), and of the IMWG risk score was 0.68 (95% CI 0.48–0.88, p = 0.075). IMPEDE VTE was the most accurate in predicting the development of VTE in Brazilian patients on IMID therapy. The SAVED score and the IMWG guidelines did not show discriminative ability in predicting VTE based on the population involved in this study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Malta JS, Silveira LP, de Drummond PLM, Costa NL, dos Santos RMM, Reis IA et al (2021) Validity and reliability of the QLQ-MY20 module for assessing the health-related quality of life in Brazilians with multiple myeloma. Curr Med Res Opin. 37(7):1163–1169

    Article  PubMed  Google Scholar 

  2. Fotiou D, Gavriatopoulou M, Terpos E (2020) Multiple myeloma and thrombosis: Prophylaxis and risk prediction tools. Cancers (Basel). 12(1):191

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Baker HA, Brown AR, Mahnken JD, Shireman TI, Webb CE, Lipe BC (2019) Application of risk factors for venous thromboembolism in patients with multiple myeloma starting chemotherapy, a real-world evaluation. Cancer Med 8(1):455–462

    Article  CAS  PubMed  Google Scholar 

  4. Talamo GP, Ibrahim S, Claxton D, Tricot GJ, Fink LM, Zangari M (2009) Hypercoagulable states in patients with multiple myeloma can affect the thalidomide-associated venous thromboembolism. Blood Coagul Fibrinolysis 20(5):337–339

    Article  CAS  PubMed  Google Scholar 

  5. Palmaro A, Rougé-Bugat ME, Gauthier M, Despas F, Moulis G, Lapeyre-Mestre M (2017) Real-life practices for preventing venous thromboembolism in multiple myeloma patients: a cohort study from the French health insurance database. Pharmacoepidemiol Drug Saf 26(5):578–586

    Article  CAS  PubMed  Google Scholar 

  6. Kristinsson SY, Landgren O (2012) Thromboprophylaxis in multiple myeloma: Is the evidence there? Expert Rev Anticancer Ther 12(3):291–294

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Zangari M, Barlogie B, Cavallo F, Bolejack V, Fink L, Tricot G (2007) Effect on survival of treatment-associated venous thromboembolism in newly diagnosed multiple myeloma patients. Blood Coagul Fibrinolysis 18(7):595–598

    Article  PubMed  Google Scholar 

  8. Leclerc V, Karlin L, Herledan C, Marchal L, Baudouin A, Gouraud A et al (2022) Thromboembolic events and thromboprophylaxis associated with immunomodulators in multiple myeloma patients: a real-life study. J Cancer Res Clin Oncol 148(4):975–984

    Article  CAS  PubMed  Google Scholar 

  9. Kandemir EA, Bayraktar-Ekincioglu A, Kilickap S (2021) Assessment of adherence to cancer-associated venous thromboembolism guideline and pharmacist’s impact on anticoagulant therapy. Support Care Cancer 29(3):1699–1709

    Article  PubMed  Google Scholar 

  10. Sanfilippo KM (2020) Assessing the risk of venous thromboembolism in multiple myeloma. Thromb Res 191(January):S74–S78

    Article  CAS  PubMed  Google Scholar 

  11. Anderson SM, Beck B, Sterud S, Lockhorst R, Ngorsuraches S (2019) Evaluating the use of appropriate anticoagulation with lenalidomide and pomalidomide in patients with multiple myeloma. J Oncol Pharm Pract 25(4):806–812

    Article  CAS  PubMed  Google Scholar 

  12. Carrier M, Le Gal G, Tay J, Wu C, Lee AY (2011) Rates of venous thromboembolism in multiple myeloma patients undergoing immunomodulatory therapy with thalidomide or lenalidomide: a systematic review and meta-analysis. J Thromb Haemost 9(4):653–663

    Article  CAS  PubMed  Google Scholar 

  13. Jha AK, Larizgoitia I, Audera-Lopez C, Prasopa-Plaizier N, Waters H, Bates DW (2013) The global burden of unsafe medical care: analytic modelling of observational studies. BMJ Qual Saf 22(10):809–815

    Article  PubMed  Google Scholar 

  14. Mosaad M, Elnaem MH, Cheema E, Ibrahim I, Ab Rahman J, Kori AN et al (2021) Cancer-associated thrombosis: a clinical scoping review of the risk assessment models across solid tumours and haematological malignancies. Int J Gen Med 14(May):3881–3897

    Article  PubMed  PubMed Central  Google Scholar 

  15. Sanfilippo KM, Luo S, Wang TFTF, Fiala M, Schoen M, Wildes TM et al (2019) Predicting venous thromboembolism in multiple myeloma: development and validation of the IMPEDE VTE score. Am J Hematol. 94(11):1176–84

    Article  PubMed  PubMed Central  Google Scholar 

  16. Li A, Wu Q, Luo S, Warnick GS, Zakai NA, Libby EN et al (2019) Derivation and validation of a risk assessment model for immunomodulatory drug-associated thrombosis among patients with multiple myeloma. JNCCN J Natl Compr Cancer Netw 17(7):840–847

    Article  CAS  Google Scholar 

  17. Palumbo A, Rajkumar SV, Dimopoulos MA, Richardson PG, San Miguel J, Barlogie B et al (2008) Prevention of thalidomide- and lenalidomide-associated thrombosis in myeloma. Leukemia 22(2):414–423

    Article  CAS  PubMed  Google Scholar 

  18. (IHME) I for HM and E. GBD Results. [Internet]. IHME, University of Washington. 2020. https://vizhub.healthdata.org/gbd-results/ [accessed 2022 Aug 24].

  19. de Crusoé EQ, Pimenta FCF, Maiolino A, de Castro NS, Pei H, Trufelli D et al (2021) Results of the daratumumab monotherapy early access treatment protocol in patients from Brazil with relapsed or refractory multiple myeloma. Hematol Transfus Cell Ther. 43(4):417–23

    Article  PubMed  Google Scholar 

  20. Silveira LP, de Pádua CAM, de Drummond PLM, Malta JS, dos Santos RMM, Costa NL et al (2021) Adherence to thalidomide in patients with multiple myeloma: a cross-sectional study in a Brazilian metropolis. J Oncol Pharm Pract. 28:373–380

    Article  PubMed  Google Scholar 

  21. Mandrekar JN (2010) Receiver operating characteristic curve in diagnostic test assessment. J Thorac Oncol 5(9):1315–1316

    Article  PubMed  Google Scholar 

  22. Covut F, Ahmed R, Chawla S, Ricaurte F, Samaras CJ, Anwer F et al (2021) Validation of the IMPEDE VTE score for prediction of venous thromboembolism in multiple myeloma: a retrospective cohort study. Br J Haematol 193(6):1213–1219

    Article  CAS  PubMed  Google Scholar 

  23. Bao L, Wang Y, Lu M, Zhuang J, Chu B, Shi L et al (2022) Validation of the Impede VTE score for predction of venous thromboembolism in Chinese patients with multiple myeloma: a retrospective cohort study. Blood 140(Supplement 1):5146–5147

    Article  Google Scholar 

  24. Calafiore V, Giamporcaro S, Conticello C, Romano A, Parisi M, Giuffrida G et al (2020) A real-life survey of venous thromboembolic events occurring in myeloma patients treated in third line with second-generation novel agents. J Clin Med 9(9):1–14

    Article  Google Scholar 

  25. Chalayer E, Talbot A, Frenzel L, Karlin L, Collet P, Guyotat D et al (2022) Prediction of venous thromboembolism in patients with multiple myeloma treated with lenalidomide, bortezomib, dexamethasone, and transplantation: Lessons from the substudy of IFM/DFCI 2009 cohort. J Thromb Haemost. 20:1–9

    Article  Google Scholar 

  26. Teste A, Thollot H, Tinquaut F, Sotton S, Tardy B, Moreau P et al (2021) PO-82 Impede VTE vs saved scores to predict the risk of venous thromboembolism in newly diagnosed multiple myeloma with immunomodulatory drugs: how to choose? Thromb Res 200:S61–S62

    Article  Google Scholar 

  27. Sanfilippo KM, Carson KR, Wang TF, Luo S, Edwin N, Kuderer N et al (2022) Evaluation of the Khorana score for prediction of venous thromboembolism in patients with multiple myeloma. Res Pract Thromb Haemost 6(1):1–7

    Article  Google Scholar 

  28. Hosmer D, Lemeshow S, Sturdivant R (2013) Applied logistic regression, 3rd edn. Wiley, Hoboken

    Book  Google Scholar 

  29. Oliveira JADQ, Ribeiro ALP, Ribeiro DD, Nobre V, Rocha MODC, Martins MAP (2018) Predictive ability of scores for bleeding risk in heart disease outpatients on warfarin in Brazil. PLoS ONE 13(10):1–15

    Article  Google Scholar 

  30. Kumar SK, Callander NS, Adekola K, Anderson LD Jr, Baljevic M, Campagnaro E et al (2022) Multiple myeloma. Natl Compr Cancer Netw 4(5):1–107

    Google Scholar 

  31. Baljevic M, Sborov DW, Lim MY, Hillengass J, Martin T, Castillo JJ et al (2022) Optimizing thromboembolism prophylaxis for the contemporary age of multiple myeloma. JNCCN J Natl Compr Cancer Netw 20(1):91–95

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The authors would like to thank the Empresa Brasileira de Serviços Hospitalares (Ebserh) for all the support provided.

Funding

No funding was received for conducting this study.

Author information

Authors and Affiliations

  1. Programa de Pós-Graduação em Medicamentos e Assistência Farmacêutica, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil

    Iwyson Henrique Fernandes da Costa, Cristiane Aparecida Menezes de Pádua, Paula Lana de Miranda Drummond & Adriano Max Moreira Reis

  2. Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil

    Iwyson Henrique Fernandes da Costa & Lívia Pena Silveira

  3. Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil

    Cristiane Aparecida Menezes de Pádua, Jéssica Soares Malta & Adriano Max Moreira Reis

  4. Fundação Ezequiel Dias, Belo Horizonte, Minas Gerais, Brazil

    Paula Lana de Miranda Drummond & Roberta Márcia Marques dos Santos

Authors
  1. Iwyson Henrique Fernandes da Costa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cristiane Aparecida Menezes de Pádua
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Paula Lana de Miranda Drummond
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lívia Pena Silveira
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jéssica Soares Malta
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Roberta Márcia Marques dos Santos
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Adriano Max Moreira Reis
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by IHFdC, CAMdP, and AMMR. The first draft of the manuscript was written by IHFdC and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Iwyson Henrique Fernandes da Costa.

Ethics declarations

Conflict of interest

The authors have no financial conflict of interest or relevant disclosures related to this study.

Ethical approval

The present study was designed in accordance with the ethical standards of research involving human participants of the national research committee (CNS 466/2012) and was approved by the Research Ethics Committee of the Federal University of Minas Gerais (No. 3.305.726). Patients who agreed to participate in the research signed a free and informed consent form.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

da Costa, I.H.F., de Pádua, C.A.M., de Miranda Drummond, P.L. et al. Comparison of three risk assessment models for thromboembolism in multiple myeloma patients receiving immunomodulators: a Brazilian historical cohort. J Thromb Thrombolysis 56, 147–155 (2023). https://doi.org/10.1007/s11239-023-02817-7

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11239-023-02817-7

Keywords

Search

Navigation