Prophylactic low-dose aspirin is effective antithrombotic therapy for combination treatments of thalidomide or lenalidomide in myeloma.
Multiple myeloma (MM) patients have a propensity for thromboembolic events (TE), and treatment with thalidomide/dexamethasone or lenalidomide/dexamethasone increases this risk. This report describes the use of low-dose aspirin (81 mg) as primary thromboprophylaxis in three series of MM patients receiving thalidomide or lenalidomide with other drugs. In the first regimen (clarithromycin, thalidomide, dexamethasone), initiation of low-dose aspirin negated the occurrence of any further TE. In a second study, prophylactic aspirin given with thalidomide/dexamethasone resulted in a rate of TE similar to that seen with dexamethasone alone (without aspirin). A third study (n = 72) evaluated thrombosis rates with aspirin and a lenalidomide-containing regimen (clarithromycin, lenalidomide, dexamethasone). Of nine occurrences of thromboembolism, five were associated with aspirin interruption or poor compliance. Low-dose aspirin appears to reduce the incidence of thrombosis with these regimens. Routine use of aspirin as antithrombotic prophylaxis in MM patients receiving immunomodulatory drugs with corticosteroids is warranted.
Niesvizky
Ruben
R
Center of Excellence for Lymphoma and Myeloma, Department of Medicine, Weill Medical College of Cornell University, New York, NY 10021, USA. run9001@med.cornell.edu
Martínez-Baños
Déborah
D
Jalbrzikowski
Jessica
J
Christos
Paul
P
Furst
Jessica
J
De Sancho
Maria
M
Mark
Tomer
T
Pearse
Roger
R
Mazumdar
Madhu
M
Zafar
Faiza
F
Pekle
Karen
K
Leonard
John
J
Jayabalan
David
D
Coleman
Morton
M
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001241:Aspirin / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D000077269:Lenalidomide; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy*; D012189:Retrospective Studies; D013792:Thalidomide / Q000008:administration & dosage / Q000009:adverse effects* / Q000031:analogs & derivatives*; D013927:Thrombosis / Q000517:prevention & control*
D000970:Antineoplastic Agents; D006495:Heparin, Low-Molecular-Weight; D013792:Thalidomide; D000077269:Lenalidomide; D001241:Aspirin