Low incidence of thromboembolism in relapsed/refractory myeloma patients treated with thalidomide without thromboprophylaxis in Taiwan.
Thromboembolism (TE) is a common complication in patients with multiple myeloma (MM). Immunomodulatory agents, e.g., thalidomide, have expanded the therapeutic options for treating myeloma; however, Western countries report a high incidence of thrombosis in thalidomide-treated MM patients who lack thromboprophylaxis. A Korean trial reported low TE incidence in thalidomide-treated myeloma patients (39% were given aspirin prophylactically). We aimed to elucidate the TE frequency in MM patients in Taiwan who were treated with thalidomide without TE prophylaxis. We retrospectively collected the records of MM patients who had used thalidomide from a single institute between 2004 and 2010, combined these records with two other Taiwanese studies, and compared all three with the Korean trial. In the current Taiwanese series, five of 144 patients (3.5%) developed TE as follows: three (2.1%) were venous and two (1.3%) were arterial. Only 6.1% of the patients had undergone TE prophylaxis, which is less than in the Korean trial (38.9%, p < 0.05). Of the patients in the relapsed/refractory cohort (n = 114) who were given thalidomide alone, none (0/52) developed venous TE (VTE); however, two patients (2/35, 5.7%) who were given thalidomide-dexamethasone as a salvage treatment developed VTE. In the thrombosis cohort, four patients (80%) were treated with thalidomide plus dexamethasone. In conclusion, the frequency of thalidomide-related TE in myeloma patients without effective TE prophylaxis was low in Taiwan. In relapsed/refractory myeloma patients, the VTE frequency was slightly lower compared with Western patients irrespective of treatment with thalidomide alone or combined with dexamethasone. Even in low TE incidence areas, thalidomide combined with dexamethasone was more thrombogenic compared with others.
Division of Hematology/Oncology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 704, Taiwan.
Shang-Yin
SY
Wu
Yu-Min
YM
Yeh
Ya-Ping
YP
Chen
Wu-Chou
WC
Su
Tsai-Yun
TY
Chen
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use; D015331:Cohort Studies; D003907:Dexamethasone / Q000009:adverse effects / Q000627:therapeutic use; D019008:Drug Resistance, Neoplasm; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015994:Incidence; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000208:ethnology / Q000503:physiopathology*; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000208:ethnology / Q000503:physiopathology; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000009:adverse effects; D013624:Taiwan / Q000453:epidemiology; D013792:Thalidomide / Q000009:adverse effects / Q000627:therapeutic use*; D013923:Thromboembolism / Q000453:epidemiology / Q000208:ethnology / Q000209:etiology*; D054556:Venous Thromboembolism / Q000453:epidemiology / Q000208:ethnology / Q000209:etiology
D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D013792:Thalidomide; D003907:Dexamethasone