Venous thromboembolism in relapsed or refractory multiple myeloma patients treated with lenalidomide plus dexamethasone
Lenalidomide plus dexamethasone (LD) is currently the mainstay of treatment for both untreated and relapsed or refractory multiple myeloma (RRMM). Although lenalidomide-associated venous thromboembolism (VTE) is a major clinical concern, its incidence and prognostic impact have not been delineated. In this nationwide retrospective cohort study, we aimed to determine the cumulative incidence of VTE and its prognostic value using two consecutive cohorts of LD-treated RRMM patients: the KMM151 cohort (N = 542) and the HIRA cohort (N = 1559). Data were collected from medical records for the KMM151 cohort and healthcare insurance claims database for the HIRA cohort. Throughout the study period, 24 patients (4.4%) in the KMM151 cohort and 80 patients (5.1%) in the HIRA cohort developed VTE. The cumulative incidence reached a plateau approximately 2 years after LD initiation. The 2-year incidence was 4.9% in the KMM151 cohort and 8% in the HIRA cohort. Higher starting dose of lenalidomide, previous history of VTE, and older age were associated significantly with an increased VTE risk. Early-onset VTE was associated significantly with poor survival. In conclusion, VTE occurred in 5–8% of RRMM patients treated with LD over 2 years, and early-onset VTE was a strong indicator of poor prognosis.
KeywordsMultiple myeloma Venous thromboembolism Lenalidomide Incidence Survival
The authors thank the Korean Multiple Myeloma Working Party for developing and managing the KMM151 database and the KMM151 Investigators for contributing the data. We also thank Ju Hyun Lee, a data analyst at Seoul National University Bundang Hospital, for performing the statistical analysis. This work was supported by grants from the Korean Society on Thrombosis and Hemostasis (KSTH 2016-002) and Seoul National University Bundang Hospital (04-2012-003). This manuscript was edited by native English-speaking experts from BioScience Writers, Houston, TX, USA.
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Conflict of interest
The authors declare that they have no conflict of interest.
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