Low incidence of thromboembolism in relapsed/refractory myeloma patients treated with thalidomide without thromboprophylaxis in Taiwan

Abstract

Thromboembolism (TE) is a common complication in patients with multiple myeloma (MM). Immunomodulatory agents, e.g., thalidomide, have expanded the therapeutic options for treating myeloma; however, Western countries report a high incidence of thrombosis in thalidomide-treated MM patients who lack thromboprophylaxis. A Korean trial reported low TE incidence in thalidomide-treated myeloma patients (39% were given aspirin prophylactically). We aimed to elucidate the TE frequency in MM patients in Taiwan who were treated with thalidomide without TE prophylaxis. We retrospectively collected the records of MM patients who had used thalidomide from a single institute between 2004 and 2010, combined these records with two other Taiwanese studies, and compared all three with the Korean trial. In the current Taiwanese series, five of 144 patients (3.5%) developed TE as follows: three (2.1%) were venous and two (1.3%) were arterial. Only 6.1% of the patients had undergone TE prophylaxis, which is less than in the Korean trial (38.9%, p < 0.05). Of the patients in the relapsed/refractory cohort (n = 114) who were given thalidomide alone, none (0/52) developed venous TE (VTE); however, two patients (2/35, 5.7%) who were given thalidomide-dexamethasone as a salvage treatment developed VTE. In the thrombosis cohort, four patients (80%) were treated with thalidomide plus dexamethasone. In conclusion, the frequency of thalidomide-related TE in myeloma patients without effective TE prophylaxis was low in Taiwan. In relapsed/refractory myeloma patients, the VTE frequency was slightly lower compared with Western patients irrespective of treatment with thalidomide alone or combined with dexamethasone. Even in low TE incidence areas, thalidomide combined with dexamethasone was more thrombogenic compared with others.

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). We performed a retrospective case control study involving patients treated at the University Hospitals Case Medical Center (CWRU) in the United States, and the Prince of Wales Hospital (PWH) in the Chinese University of Hong Kong, comparing the incidence and patterns of venous (VTE) and arterial thromboembolism (ATE) in patients with MM of African American (AA) or Chinese (C) race.…”

Clinical profiles of multiple myeloma in Asia—An Asian Myeloma Network study

“…There have been reports describing the clinical profiles as well as the cytogenetic characteristics of MM in Asia, with some studies revealing unique findings in their national cohorts. There have also been reports describing unique drug toxicity profiles such as interstitial pneumonitis among Japanese bortezomib users , as well as lower incidence of thromboembolism among thalidomide users in some Asian countries, even without antithrombotic prophylaxis, strongly suggesting differences in pharmacogenomics . Although several studies on the clinical features of MM in Asian countries have been published, all of them were nationwide studies that did not include a variety of Asian ethnicities and did not incorporate recent changes in epidemiology and medical practices.…”

Risk of stroke in patients with newly diagnosed multiple myeloma: a retrospective cohort study

“…In addition, a retrospective study investigating the frequency of thromboembolism in Taiwanese MM patients with thalidomide‐containing therapy found that the majority in this study were refractory or relapsed myeloma patients. The results included 3 venous thromboses and 2 arterial thromboses (1 myocardial infarction and 1 anterior tibial artery thrombosis) of 144; no stroke events were reported …”

“…As a result, we do not have a complete record about types of Af (valvular and nonvalvular) in our patients. In Taiwan, prophylactic aspirin is not routinely given in thalidomide combination treatment because of the low incidence of VTE (2.1%) . In addition, mortality is a major competing risk.…”