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Almansour SA, Alqudah MAY, Abuhelwa Z, Al-Shamsi HO, Alhuraiji A, Semreen MH, Bustanji Y, Alzoubi KH, Modi ND, Mckinnon RA, Sorich MJ, Hopkins AM, Abuhelwa AY. Antithrombotic utilization, adverse events, and associations with treatment outcomes in multiple myeloma: pooled analysis of three clinical trials. Ther Adv Med Oncol 2024; 16:17588359241275387. [PMID: 39229471 PMCID: PMC11369879 DOI: 10.1177/17588359241275387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 07/30/2024] [Indexed: 09/05/2024] Open
Abstract
Background Patients with multiple myeloma (MM) are at risk of venous thromboembolism (VTE), worsened by immunomodulatory drugs. Although antithrombotics are recommended for prophylaxis, existing guidelines are suboptimal and treatment outcomes remain unclear. Objectives This study aimed to investigate adverse events, antithrombotic utilization, and their associations with survival outcomes in patients with MM initiating multi-drug immunomodulatory combinations. Design A posthoc analysis of individual-participant level data (IPD). Methods IPD from three daratumumab clinical trials (MAIA, POLLUX, and CASTOR) were pooled. Adverse events incidence and antithrombotic utilization were assessed. Logistic and Cox regression were utilized to examine associations between antithrombotics use with adverse events and survival outcomes at the baseline and 6-month landmark. Results Among 1804 patients, VTE occurred in 10%, bleeding in 14%, ischemic heart disease in 4%, and stroke in 2%. Patients with these adverse events demonstrated elevated rates of any grade ⩾3 events. Antiplatelet (primarily aspirin) and anticoagulant (primarily LMWH and direct oral anticoagulants) prescriptions have seen an increase from baseline (25% and 14%, respectively) to 6 months (35% and 31%). The primary indication for their use was prophylaxis. Anticoagulant use within 6 months was associated with reduced VTE (OR (95% CI) = 0.45 (0.26-0.77), p = 0.004), while antiplatelet use showed no associations with any evaluated adverse events. Antithrombotics and survival outcomes had no significant associations. Conclusion This study underscores the complexities of antithrombotic therapy and adverse events in MM and highlights the need for vigilant and proactive management due to increased grade ⩾3 adverse events. While anticoagulant use was associated with reduced VTE risk, further research is needed to optimize thromboprophylaxis guidelines and explore antithrombotic efficacy and safety in patients with MM. Trial registration MAIA (NCT02252172), POLLUX (NCT02076009), CASTOR (NCT02136134).
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Affiliation(s)
- Sara A. Almansour
- Department of Pharmacy Practice and Pharmacotherapeutics, University of Sharjah, Sharjah, United Arab Emirates
| | - Mohammad A. Y. Alqudah
- Department of Pharmacy Practice and Pharmacotherapeutics, University of Sharjah, Sharjah, United Arab Emirates
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Ziad Abuhelwa
- Department of Hematology and Medical Oncology, University of South Florida/H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Humaid O. Al-Shamsi
- Department of Oncology, Burjeel Cancer Institute, Burjeel Medical City, Abu Dhabi, United Arab Emirates
- College of Medicine, Ras Al Khaimah Medical and Health Sciences University, Ras Al Khaimah, United Arab Emirates
- Emirates Oncology Society, Dubai, United Arab Emirates
- Gulf Medical University, Ajman, United Arab Emirates
- Gulf Cancer Society, Alsafa, Kuwait
| | - Ahmad Alhuraiji
- Department of Haematology, Kuwait Cancer Control Center, Kuwait
| | - Mohammad H. Semreen
- Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Department of Medicinal Chemistry, University of Sharjah, Sharjah, United Arab Emirates
| | - Yasser Bustanji
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
- School of Pharmacy, The University of Jordan, Amman, Jordan
| | - Karem H. Alzoubi
- Department of Pharmacy Practice and Pharmacotherapeutics, University of Sharjah, Sharjah, United Arab Emirates
- Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Natansh D. Modi
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Ross A. Mckinnon
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Michael J. Sorich
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Ashley M. Hopkins
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Ahmad Y. Abuhelwa
- Department of Pharmacy Practice and Pharmacotherapeutics, University of Sharjah, Sharjah, United Arab Emirates
- Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
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Frenzel L, Decaux O, Macro M, Belhadj-Merzoug K, Manier S, Touzeau C, Leleu X, Frère C, Lecompte T, Perrot A, Avet-Loiseau H, Moreau P, Chalayer E. Venous thromboembolism prophylaxis and multiple myeloma patients in real-life: Results of a large survey and clinical guidance recommendations from the IFM group. Thromb Res 2024; 233:153-164. [PMID: 38064842 DOI: 10.1016/j.thromres.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/30/2023] [Accepted: 11/20/2023] [Indexed: 01/01/2024]
Abstract
Venous thromboembolism (VTE) remains a critical issue in the management of patients with multiple myeloma (MM), particularly when immunomodulatory drugs (IMiDs) combined with dexamethasone therapy are being prescribed as first-line and relapse therapy. One possible explanation for the persistent high rates of VTE, is the use of inappropriate thromboprophylaxis strategies for patients starting antimyeloma treatment. To tackle the issue, the Intergroupe francophone du myélome (IFM) offered convenient guidance for VTE thromboprophylaxis in MM patients initiating systemic therapy. This guidance is mainly supported by the results of a large survey on the clinical habits regarding VTE of physicians who are substantially involved in daily care of MM patients. VTE prophylaxis should be considered for all patients treated with IMiDs in combination with dexamethasone, in the absence of significant comorbidities, such as renal failure or bleeding risk. Anticoagulant should be preferred to antiplatelet agents for thromboprophylaxis. Despite the absence of large randomized controlled trials comparing those attitudes/options, available data on direct oral anticoagulants, which are already used in daily management of MM patients, are consistent with their potential usefulness for VTE prophylaxis in such patients. However, in order to implement a personalized continuous improvement strategy, clinicians must to be organized to collect all the data regarding this management. In other situations, thromboprophylaxis should be evaluated by using risk models and after careful evaluation of the risk/benefit ratio.
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Affiliation(s)
- Laurent Frenzel
- Service d'Hématologie Adulte et unité d'hémostase clinique, Hôpital Necker, Institut IMAGINE - INSERM U 1163/CNRS ERL 8254, Paris, France.
| | | | - Margaret Macro
- Institut d'Hématologie de Basse Normandie (IHBN), CHU Côte de Nacre, Caen, France
| | | | - Salomon Manier
- Hematology department, CHU Lille, Lille University, INSERM UMR-S1277, Lille, France
| | - Cyrille Touzeau
- Department of Hematology, University Hospital Hôtel-Dieu, 44093 Nantes, France; Centre de Recherche en Cancérologie et Immunologie Intégrée Nantes Angers, INSERM UMR 1307, CNRS UMR 6075, Nantes, France
| | - Xavier Leleu
- Hématologie Biologique, Hôpital Pontchaillou University Hospital of Rennes, Rennes, France
| | - Corinne Frère
- Service d'Hématologie Biologique, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | | | - Aurore Perrot
- Institut Universitaire du Cancer de Toulouse-Oncopole and Centre de Recherches en Cancerologie de Toulouse Institut National de la Sante et de la Recherche Medicale, Toulouse, France
| | - Hervé Avet-Loiseau
- Institut Universitaire du Cancer de Toulouse-Oncopole and Centre de Recherches en Cancerologie de Toulouse Institut National de la Sante et de la Recherche Medicale, Toulouse, France
| | - Philippe Moreau
- Department of Hematology, University Hospital Hôtel-Dieu, 44093 Nantes, France; Centre de Recherche en Cancérologie et Immunologie Intégrée Nantes Angers, INSERM UMR 1307, CNRS UMR 6075, Nantes, France
| | - Emilie Chalayer
- Hématologie clinique, Institut de Cancérologie Hématologie Universitaire, CHU St Etienne Unité INSERM SAINBIOSE, U1059, Université Jean Monnet, St-Etienne, France
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