Optimizing Thromboembolism Prophylaxis for the Contemporary Age of Multiple Myeloma

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  • 1 Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee;
  • | 2 Division of Hematology and Hematologic Malignancies, University of Utah, Huntsman Cancer, Salt Lake City, Utah;
  • | 3 Roswell Park Comprehensive Cancer Center, Buffalo, New York;
  • | 4 UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California;
  • | 5 Dana-Farber/Brigham and Women’s Cancer Center, Boston, Massachusetts;
  • | 6 Division of Hematology, Department of Medicine and Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland;
  • | 7 Mayo Clinic Cancer Center, Rochester, Minnesota; and
  • | 8 University of Wisconsin Carbone Cancer Center, Madison, Wisconsin.

Venous thromboembolism (VTE) is a major complication in all patients with cancer. Compared with the general population, patients with multiple myeloma (MM) have a 9-fold increase in VTE risk, likely because of their malignancy, its treatments, and other additional patient-related factors. In MM, thromboembolism events tend to occur within 6 months of treatment initiation, regardless of treatment regimen; however, the use of immunomodulatory agents such as thalidomide or lenalidomide, especially in combination with dexamethasone or multiagent chemotherapy, is known to create a significant risk for VTE. Currently, official recommendations for VTE prophylaxis in MM outlined in various national guidelines or multidisciplinary society panels are based on expert opinion, because data from randomized controlled trials are scarce. Large studies which have mainly focused on the efficacy of thromboprophylaxis in patients with cancer at higher risk for VTE either had a very low representation of patients with MM, or excluded them all together, limiting our ability to draw evidence-based conclusions on how to effectively protect MM population from VTE. In this brief perspective, we highlight some of the greatest challenges that have hampered the field concerning the availability of high-quality clinical trial data for the formulation of best VTE prophylaxis strategies in patients with newly diagnosed MM, as well as the rationale for the latest updates in the NCCN Guidelines on this topic.

Submitted September 10, 2021; accepted for publication November 8, 2021.

Disclosures: Dr. Baljevic has disclosed serving as a consultant for Bristol-Myers Squibb/Celgene; serving as a scientific advisor for Oncopeptides, Janssen Research, Karyopharm, and Bristol-Myers Squibb/Celgene; and receiving grant/research support from Amgen and Exelixis. Dr. Sborov has disclosed serving as a consultant and as a scientific advisor for GlaxoSmithKline, Janssen, Sanofi, SkylineDx, and Legend Biotech. Dr. Lim has disclosed serving as a scientific advisor for Sanofi Genzyme, Hema Biologics, and Dova Pharmaceuticals. Dr. Hillengass has disclosed serving as a scientific advisor for Amgen, Janssen, Adaptive Biotechnologies, Oncotracker, GlaxoSmithKline, Bristol-Myers Squibb, Skyline, Oncopeptides, Sanofi, and Axxess Network; and receiving honoraria from Janssen and Curio Science. Dr. Castillo has disclosed serving as a consultant for Abbvie, Beigene, Janssen, Pharmacyclics, and Roche; serving as a scientific advisor for Abbvie and Beigene; and receiving grant/research support from Abbvie, Beigene, Pharmacyclics, and TG Therapeutics. Dr. Kumar has disclosed receiving institutional research funding from Abbvie, Amgen, Bristol-Myers Squibb, Carsgen, Janssen, AstraZeneca, Novartis, Roche/Genentech, Takeda, Tenebio, and Molecular Templates, and serving as a consultant and on advisory boards for Abbvie, Amgen, Bristol-Myers Squibb, Janssen, Roche/Genentech, Takeda, AstraZeneca, Bluebird Bio, Epizyme, Secure Biotherapeutics, Oncopeptides, Beigene, and Antengene. The remaining authors have disclosed not receiving any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Correspondence: Muhamed Baljevic, MD, Division of Hematology/Oncology, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, 2220 Pierce Avenue, Preston Research Building 777, Nashville, TN, 37232. Email: muhamed.baljevic@vumc.org
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