title: Increased risk of deep-vein thrombosis in patients with multiple myeloma receiving thalidomide and chemotherapy.
abstract: The occurrence of deep-vein thrombosis (DVT) in patients with newly diagnosed multiple myeloma, who were randomly assigned to receive identical induction chemotherapy with or without thalidomide, are reported in this study. The 2 study arms were comparable with respect to key myeloma prognostic factors and known risk factors for DVT. One hundred patients received induction chemotherapy including 4 cycles of continuous infusion of combinations of dexamethasone, vincristine, doxorubicin, cyclophosphamide, etoposide, and cisplatin, and each patient completed at least one induction cycle. DVT developed in 14 of 50 patients (28%) randomly assigned to receive thalidomide but in only 2 of 50 patients (4%) not given the agent (P =.002). All episodes of DVT occurred during the first 3 cycles of induction. Administration of thalidomide was resumed safely in 75% of patients receiving anticoagulation therapy. Thus, thalidomide given in combination with multiagent chemotherapy and dexamethasone is associated with a significantly increased risk of DVT, which appears to be safely treated with anticoagulation and does not necessarily warrant discontinuation of thalidomide.
authors.affiliation: Central Arkansas Veterans Healthcare System and the University of Arkansas for Medical Sciences, Little Rock, AR, USA. zangarimaurizio@uams.edu
authors.forename: M
authors.initials: M
authors.lastname: Zangari
authors.forename: E
authors.initials: E
authors.lastname: Anaissie
authors.forename: B
authors.initials: B
authors.lastname: Barlogie
authors.forename: A
authors.initials: A
authors.lastname: Badros
authors.forename: R
authors.initials: R
authors.lastname: Desikan
authors.forename: A V
authors.initials: AV
authors.lastname: Gopal
authors.forename: C
authors.initials: C
authors.lastname: Morris
authors.forename: A
authors.initials: A
authors.lastname: Toor
authors.forename: E
authors.initials: E
authors.lastname: Siegel
authors.forename: L
authors.initials: L
authors.lastname: Fink
authors.forename: G
authors.initials: G
authors.lastname: Tricot
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D001779:Blood Coagulation Factors / Q000032:analysis; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D003907:Dexamethasone / Q000008:administration & dosage / Q000009:adverse effects; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications / Q000188:drug therapy*; D012306:Risk; D012307:Risk Factors; D013792:Thalidomide / Q000008:administration & dosage / Q000009:adverse effects*; D020246:Venous Thrombosis / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D000925:Anticoagulants; D001779:Blood Coagulation Factors; D013792:Thalidomide; D014750:Vincristine; D005047:Etoposide; D003907:Dexamethasone; D004317:Doxorubicin; D003520:Cyclophosphamide; D002945:Cisplatin