title: Characterisation of haematological profiles and low risk of thromboembolic events with bortezomib in patients with relapsed multiple myeloma.
abstract: Haematological toxicities and thromboembolic (TE) events are common complications of myeloma therapy. TE risk may be elevated with combination regimens, notably thalidomide/lenalidomide plus high-dose dexamethasone; concomitant erythropoietin appears to further increase the risk with lenalidomide-dexamethasone. We characterised thrombocytopenia and neutropenia in the phase 3 APEX (Assessment of Proteasome Inhibition for Extending Remissions) study of bortezomib versus high-dose dexamethasone in relapsed myeloma, and calculated the incidences of deep-vein thrombosis (DVT)/pulmonary embolism (PE) with: bortezomib or dexamethasone +/- erythropoietin in APEX; bortezomib +/- dexamethasone +/- erythropoietin in two phase 2 studies of relapsed/refractory myeloma. Bortezomib-associated thrombocytopenia and neutropenia were transient, predictable and manageable; mean platelet and neutrophil counts followed a cyclical pattern, and improved over the treatment course. Grade 3/4 thrombocytopenia incidence was higher with bortezomib versus dexamethasone (26%/4% vs. 5%/1%), but significant bleeding events were comparable (4% vs. 5%). DVT/PE incidence was low (< or =3.1%) in all analyses; addition of dexamethasone/erythropoietin did not affect TE risk. In APEX, TE risk appeared lower with bortezomib versus dexamethasone. Bortezomib caused transient and cyclical thrombocytopenia and was not associated with elevated TE risk, alone or with dexamethasone +/- erythropoietin. Preliminary data suggest bortezomib may reduce the thrombogenic potential of combination regimens via inhibition of platelet function or other mechanism-specific effects on coagulation.
authors: Emory University, Atlanta, GA 30322, USA. sloni01@emory.edu
authors: Sagar
authors: S
authors: Lonial
authors: Paul G
authors: PG
authors: Richardson
authors: Jesús
authors: J
authors: San Miguel
authors: Pieter
authors: P
authors: Sonneveld
authors: Michael W
authors: MW
authors: Schuster
authors: Joan
authors: J
authors: Bladé
authors: Jamie
authors: J
authors: Cavenagh
authors: S Vincent
authors: SV
authors: Rajkumar
authors: Andrzej J
authors: AJ
authors: Jakubowiak
authors: Dixie-Lee
authors: DL
authors: Esseltine
authors: Kenneth C
authors: KC
authors: Anderson
authors: Jean-Luc
authors: JL
authors: Harousseau
mesh_terms: D001897:Boronic Acids / Q000627:therapeutic use*; D000069286:Bortezomib; D002986:Clinical Trials as Topic; D003907:Dexamethasone / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004921:Erythropoietin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000097:blood / Q000188:drug therapy*; D011480:Protease Inhibitors / Q000627:therapeutic use*; D011655:Pulmonary Embolism / Q000150:complications; D011719:Pyrazines / Q000627:therapeutic use*; D011994:Recombinant Proteins; D012008:Recurrence; D012306:Risk; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000150:complications
chemical_list: D001897:Boronic Acids; D007166:Immunosuppressive Agents; D011480:Protease Inhibitors; D011719:Pyrazines; D011994:Recombinant Proteins; D004921:Erythropoietin; D000069286:Bortezomib; D003907:Dexamethasone