title: Does low-molecular-weight heparin influence the antimyeloma effects of thalidomide? A retrospective analysis of data from the GIMEMA, Nordic and Turkish myeloma study groups.
abstract: OBJECTIVE
  Low-molecular-weight heparin (LMWH) has been shown to prolong survival among patients with solid tumors, but its role among myeloma patients is unknown.
  
  
  METHODS
  Data from the GIMEMA (Gruppo Italiano Malattie Ematologiche dell'Adulto), Nordic and Turkish myeloma study groups comparing melphalan and prednisolone with (MPT, n: 404) or without thalidomide (MP, n: 393) are analyzed for effects of LMWH. Forty percent (159/394) of the patients on MPT and 7.4% (29/390) in the MP arm received LMWH.
  
  
  RESULTS
  Thalidomide improved response and progression-free survival (PFS). Regardless of thalidomide treatment, response rate was higher among those receiving LMWH vs. none vs. other anticoagulants (58.1 vs. 44.9 vs. 50.4%, p = 0.01). PFS was significantly longer (median 32 vs. 21 and 17 vs. 17 months, p = 0.004) only among international scoring system (ISS) I patients receiving MPT ± LMWH vs. MP ± LMWH. The group of MPT patients who also received LMWH had a better OS compared to those who did not [45 months, 95% confidence interval (CI) 27.7-62.3, vs. 32 months, 95% CI 26.1-37.9; p = 0.034]. When multivariate analysis was repeated in subgroups, thalidomide was no longer a significant factor (response, PFS) among those receiving LMWH.
  
  
  CONCLUSIONS
  Addition of LMWH to MPT, in particular in patients with low ISS, suggests additive effects, but the results are limited by the retrospective design of our study.
authors.forename: Meral
authors.initials: M
authors.lastname: Beksac
authors.forename: Anders
authors.initials: A
authors.lastname: Waage
authors.forename: Sara
authors.initials: S
authors.lastname: Bringhen
authors.forename: Sigurdur Y
authors.initials: SY
authors.lastname: Kristinsson
authors.forename: Gülsan Türköz
authors.initials: GT
authors.lastname: Sucak
authors.forename: Peter
authors.initials: P
authors.lastname: Gimsing
authors.forename: Giulia
authors.initials: G
authors.lastname: Lupparelli
authors.forename: Tulin
authors.initials: T
authors.lastname: Fıratlı-Tuğlular
authors.forename: Gunnar
authors.initials: G
authors.lastname: Juliusson
authors.forename: Ingemar
authors.initials: I
authors.lastname: Turesson
authors.forename: Antonio
authors.initials: A
authors.lastname: Palumbo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D018572:Disease-Free Survival; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008558:Melphalan / Q000627:therapeutic use; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000401:mortality; D011241:Prednisone / Q000627:therapeutic use; D012189:Retrospective Studies; D013792:Thalidomide / Q000627:therapeutic use*; D016896:Treatment Outcome; D014421:Turkey
chemical_list: D000925:Anticoagulants; D000970:Antineoplastic Agents; D006495:Heparin, Low-Molecular-Weight; D013792:Thalidomide; D008558:Melphalan; D011241:Prednisone