Thromboembolic Events Associated With Novel Therapies in Patients With Multiple Myeloma: Consensus Statement of the IMF Nurse Leadership Board

Abstract

Patients with myeloma are at risk for serious and life-threatening thromboembolic events because of their disease, individual risk factors, and antimyeloma or other medications. The International Myeloma Foundation's Nurse Leadership Board developed this consensus statement for assessment and prevention of thromboembolic events. Prophylactic measures are categorized as mechanical, regimen related, and antithrombotic drug, based on individual and myeloma-related risk factors. Aspirin is suggested for patients with no or one risk factor, low-molecular-weight heparin or full-dose warfarin for patients with two or more risk factors, and low-molecular-weight heparin or full-dose warfarin for all patients with therapy-related risks, including high-dose dexamethasone, doxorubicin, or multiagent chemotherapy.

Steroid-Associated Side Effects in Patients With Multiple Myeloma: Consensus Statement of the IMF Nurse Leadership Board

“…However, dose reductions for dexamethasone should be based on the clinician's experience and the patient's symptoms. Reducing the dose of dexamethasone may reduce the risk of thromboembolic events, particularly if administered in combination with other antimyeloma agents, such as lenalidomide and thalidomide (Rome et al, 2008). Patients should be advised about adjusting their activity schedules to deal with associated fatigue (Mitchell, Beck, Hood, Moore, & Tanner, 2006).…”

Myeloma: making sense of a complex blood cancer

“…Although myeloma patients are at risk of thromboemboletic events (deep vein thrombosis and pulmonary embolism) due to the nature of this disease and individual factors, the use of lenalidomide and thalidomide in the treatment of myeloma has been associated with an increased risk (Rome et al, 2008). However, this risk appears to be attributed to the use of either thalidomide or lenalidomide in combination with chemotherapy, steroids and erythopoeitin (Kumar et al, 2009).…”

“…However, this risk appears to be attributed to the use of either thalidomide or lenalidomide in combination with chemotherapy, steroids and erythopoeitin (Kumar et al, 2009). Myeloma patients' risk of thromboemboletic events can be monitored by nurses using the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) and patients should receive prophylaxis for thromboembolic events if indicated (Rome et al, 2008).…”

Myelosuppression Associated With Novel Therapies in Patients With Multiple Myeloma: Consensus Statement of the IMF Nurse Leadership Board

“…Nursing assessment and education of patients play a vital 10-12 g/dl (grade 1) < 10 g/dl (grade 2) < 8.0 g/dl or symptomatic anemia (grade 3) Table 3. Rome et al (2008) addresses these topics in detail. Concomitant use of ESAs with some antimyeloma therapies may increase the risk of thromboembolic events (Amgen Inc., 2007a.…”