VTE prophylaxis in multiple myeloma

Development and Validation of a Predictive Nomogram for Venous Thromboembolism Risk in Multiple Myeloma Patients: A Single-Center Cohort Study in China

Objectives: Venous thromboembolism (VTE) is a significant complication in patients with multiple myeloma (MM) that adversely affects morbidity, mortality, and treatment outcomes. This study aimed to develop and validate a predictive nomogram for assessing VTE risk in MM patients using clinicopathological factors. Methods: Clinical data, including 25 candidate risk factors, were collected. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for VTE. The nomogram was constructed using these variables, and its performance was evaluated by plotting receiver operating characteristic (ROC) curves, calculating the area under the curve (AUC), and conducting calibration and decision curve analysis (DCA). Additionally, an online calculator was developed for clinical use. Results: In total, 148 patients (17.5%) developed VTE in this study. The independent risk factors included age, Karnofsky performance status (KPS), anticoagulation therapy, erythropoietin use, and hemoglobin (Hb), platelet (PLT), calcium (Ca), activated partial thromboplastin time (APTT), and D-dimer levels. The nomogram demonstrated robust discriminative ability, with a C-index of 0.811 in the training cohort and 0.714 in the validation cohort. The calibration curves exhibited a high level of agreement between the predicted and observed probabilities. DCA confirmed the nomogram's clinical utility across various threshold ranges, outperforming the "treat all" and "treat none" strategies. Conclusions: This study successfully developed and validated a nomogram for predicting VTE risk in MM patients, demonstrating substantial predictive accuracy and clinical applicability. The nomogram and accompanying online calculator provide valuable tools for individualized VTE risk assessment and informed clinical decision-making.

Cancer-associated venous thrombosis in adults (second edition): A British Society for Haematology Guideline

A shared decision on the most appropriate agent for the treatment of cancer-associated thrombosis should consider the following factors, which should be reassessed as patients continue along their cancer care pathway: risk of bleeding; tumour site; suitability of oral medications; potential for drug-drug interactions; and patient preference and values regarding choice of drug. Continuing anticoagulation beyond 6 months in patients with cancer-associated venous thromboembolism and active cancer is recommended.

Validation of the IMPEDE VTE score for prediction of venous thromboembolism in Chinese patients with multiple myeloma: A single-center retrospective cohort study

Multiple myeloma (MM) significantly increases the risk of venous thromboembolism (VTE) within 6 months of treatment initiation. The IMPEDE VTE score is a VTE risk prediction model which is recently incorporated into the National Comprehensive Cancer Network (NCCN) guidelines, but it lacks validation among Asians, including Chinese MM patients. We performed a retrospective chart review of 405 Chinese with newly diagnosed MM who started therapy at Beijing Jishuitan Hospital between April 2013 to October 2022. The 6-month cumulative incidence of VTE was 3.8 % (95 % CI:1.6-7.6), 8.6 % (95 % CI: 5.3-21.9) and 40.5 % (95 % CI: 24.9-55.7) in the low-, intermediate- and high-risk groups (P < 0.001), respectively. The C-statistic of the IMPEDE VTE scores for predicting VTE within 6 months of treatment initiation was 0.74 (95 % CI: 0.65-0.83). Of note, in this single-center cohort study, we propose that the anticoagulant LMWH may be more effective than the antiplatelet aspirin in potentially preventing VTE in newly diagnosed MM patients. Our findings suggest that the IMPEDE VTE score is a valid evidence-based risk stratification tool in Chinese patients with newly diagnosed MM.