The incidence of thromboembolism for lenalidomide versus thalidomide in older patients with newly diagnosed multiple myeloma

  • Ang LiEmail author
  • Qian Wu
  • Greg Warnick
  • Shan Li
  • Edward N. Libby
  • David A. Garcia
  • Gary H. Lyman
Original Article


It is uncertain if different immunomodulatory drugs (IMID) pose distinct thrombotic risk in patients with newly diagnosed multiple myeloma (MM). Among 2397 MM patients from the SEER-Medicare database from 2007 to 2013, 78% received lenalidomide, and 22% received thalidomide. After inverse probability weighting to balance confounders, the 12-month incidences of venous thromboembolism (VTE 10%) and arterial thromboembolism (ATE 5%) were similarly high in both groups. Lenalidomide versus thalidomide had a subdistribution hazard ratio of 1.11 (0.59–2.02) for VTE and a subdistribution hazard ratio of 0.96 (0.45–1.98) for ATE. Overall survival was not significantly different with a hazard ratio of 0.88 (0.60–1.18) for lenalidomide versus thalidomide. Concurrent anticoagulant prophylaxis was infrequently prescribed in < 20% of both groups. Our study demonstrates that despite improvement in myeloma-directed therapy and supportive care, thrombosis remains an important consideration for all IMID-treated MM patients. Appropriate risk stratification and vigilant thromboprophylaxis remain essential to prevent this complication.


Multiple myeloma Thromboembolism Venous thrombosis Arterial thrombosis 



AL performed the research, designed the study, analyzed the data, and wrote the paper. DAG and GHL performed the research, designed the study, and wrote the paper. QW and GW analyzed the data. SL and ENL contributed essential tools and wrote the paper.

Compliance with ethical standards

Conflict of interest

The current study itself was conducted without funding from industry. AL reports grant funding from the Conquer Cancer Foundation Young Investigator Award, Hemostasis and Thrombosis Research Society Mentored Research Award supported by an independent medical educational grant from Shire, and National Hemophilia Foundation Shire Clinical Fellowship Award. Other authors report no relevant financial interests, activities, relationships, or affiliations.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Statement of informed consent

Informed consent was not obtained because this was a de-identified aggregate national claims database study where individual patient could not be identified and informed consent could not be obtained. The study was reviewed and considered exempt by the University of Washington Institutional Review Board.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of HematologyUniversity of Washington School of MedicineSeattleUSA
  2. 2.Clinical Research DivisionFred Hutchinson Cancer Research CenterSeattleUSA
  3. 3.Public Health Sciences DivisionFred Hutchinson Cancer Research CenterSeattleUSA
  4. 4.Hematology Oncology Clinical PharmacySeattle Cancer Care AllianceSeattleUSA
  5. 5.Division of Medical OncologyUniversity of Washington School of MedicineSeattleUSA

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