Low incidence of clinically apparent thromboembolism in Korean patients with multiple myeloma treated with thalidomide

Abstract

The frequency of thromboembolic events (TE) in Caucasian patients with multiple myeloma (MM) receiving thalidomide as the initial treatment has been reported to be 10~58% without prophylactic anticoagulation. Korean MM patients treated with thalidomide were studied to determine the frequency of TE and associated risk factors. A retrospective medical record review of the Korean MM registry from 25 centers in Korea between 2003 and 2007 was performed. We assessed the incidence of arterial and venous TE and the associated clinical parameters. Three hundred and sixty MM patients (median age 61 years, range 32-88 years) received thalidomide treatment. Fourteen patients (3.9%) developed TE: 12 had venous and two had arterial locations. The sites for the venous TE included lungs (seven), lower extremities (four), upper extremities (one), and neck (one). Arterial TE developed in cerebral and peripheral arteries each. No single clinical parameter such as prerequisite for the metabolic syndrome, disease status, and treatment regimen were predictive for the development of TE. The frequency of TE in patients who received thalidomide as initial therapy (7/155) was not different from those who received thalidomide for progressive or relapsed disease (7/205, p = 0.592). The frequency of TE during thalidomide treatment in Korean patients with MM was low. No significant clinical factor was found to be a risk factor. The subgroup requiring thromboprophylaxis among the Korean patients with MM, receiving thalidomide, needs to be clarified.

Retrospective study of the incidence and patterns of arterial and venous thrombosis in Chinese versus African American patients with multiple myeloma

“…The 9Á2% incidence of ATE in our Chinese cohort is higher than the previously reported incidence of 5Á2% in newly diagnosed non-Chinese MM patients and compared to historical data in the Asians (Libourel et al, 2010). While the rate of thromboprophylaxis in our study was lower than in the Korean study, it was higher than in the Taiwanese study suggesting that this may not be the only factor (Koh et al, 2010;Wu et al, 2012). Overall, the Chinese had a significantly lower incidence of arterial risk factors.…”

“…A lower incidence of thrombosis has been noted in Asians with multiple myeloma (MM), although direct comparisons to other races are lacking (Koh et al, 2010;Kristinsson et al, 2010;Carrier et al, 2011). Thromboprophylaxis is not routinely administered to MM patients when treated with immunomodulators in many Asian centres (Musallam et al, 2009;Palumbo et al, 2011;Liew et al, 2012;Wu et al, 2012).…”

A Combination of Melphalan, Prednisone, and 50 mg Thalidomide Treatment in Non-Transplant-Candidate Patients with Newly Diagnosed Multiple Myeloma

“…The risk is generally greatest in patients treated with thalidomide as a first-line therapy, as opposed to patients treated after relapse [18]. The percentage of thromboembolic events with thalidomide therapy in our study (10%) was higher than previously reported in Korean patients in general (3.9%) [19]. However, this incidence was lower than data from Western cohorts, which showed 6-17% incidences of VTE [5,6,8] after MPT treatment.…”

The Singapore Myeloma Study Group Consensus Guidelines for the management of patients with multiple myeloma

“…It is noteworthy that the incidence of venous thromboembolism in Asian MM patients on thalidomide and lenalidomide may be less than that of their western counterparts. (38,39) These recommendations should, therefore, be considered in this context, and the risk and benefi t of anticoagulation assessed on a caseby-case basis.…”