(028) Characterization of VTE Prophylaxis in Multiple Myeloma Patients Receiving Immunomodulator Therapy

Poster Abstract:

Background: Multiple myeloma (MM) is a hematologic malignancy where malignant plasma cells accumulate in the bone marrow. The accumulation in monoclonal proteins may lead to hyper viscosity of the serum which can cause downstream clot formation (1). Immunomodulator (IMiD) therapy has become the cornerstone in the treatment of MM, but it is associated with an increased risk of venous thromboembolism (VTE). The National Comprehensive Cancer Network (NCCN) Guidelines recommend utilizing a VTE risk stratification scoring system such as IMPEDE or SAVED to predict a patient’s VTE risk for multiple myeloma (2,3,4). The IMPEDE score predicts risk for developing VTE within six months of treatment initiation (based on the score identifies appropriate prophylaxis based on patient’s individual risk factors in addition to myeloma risk factors). Unlike the SAVED scoring system, the IMPEDE scoring system assigns various weights to myeloma risk factors which provides a better VTE prediction (3,5,6). This retrospective study aims to provide valuable insights into the optimal VTE prophylaxis strategies for multiple myeloma undergoing immunomodulator therapy. By stratifying patients based on their IMPEDE score, we hope to tailor prophylactic approaches and improve patient outcomes.

Objectives:
Primary

Objective: To describe the utilization of VTE prophylaxis in multiple myeloma patients receiving immunomodulator therapy, stratified by the IMPEDE score.
Secondary

Objectives: To evaluate the safety and efficacy of VTE prophylaxis including incidence of VTE events and incidence of bleeding events. To identify barriers or challenges in implementing VTE prophylaxis recommendations.

Methods: Data will be collected retrospectively from electronic medical records. Patients will be stratified into two groups based on their IMPEDE score: low risk and high risk. The high-risk group includes any patients with the following therapy-related risk factors: dexamethasone ≥ 480 mg monthly, doxorubicin, or multiagent chemotherapy, or if they had ≥ 2 of the following individual risk factors: prior VTE, obesity (BMI > 25), central venous catheter or pacemaker, cardiac disease, chronic renal disease, diabetes, acute infection, sepsis, paralysis/hemiplegia, recent general surgery or anesthesia, traumatic injury, erythropoietin treatment or coagulopathy. Missing data will prompt a manual chart review. If unable to find via manual chart review, subjects will be excluded.

Results: Results pending.

Discussion/

Conclusions: Pending on results.

References (must also be included in final poster): 1.Sanfilippo KM, Luo S, Wang TF, Fiala M, Schoen M, Wildes TM, Mikhael J, Kuderer NM, Calverley DC, Keller J, Thomas T, Carson KR, Gage BF. Predicting venous thromboembolism in multiple myeloma: development and validation of the IMPEDE VTE score. Am J Hematol. 2019 Nov;94(11):1176-1184. doi: 10.1002/ajh.25603. Epub 2019 Aug 19. PMID: 31379000; PMCID: PMC7058359.
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4.Key NS, Khorana AA, Kuderer NM, Bohlke K, Lee AYY, Arcelus JI, Wong SL, Balaban EP, Flowers CR, Francis CW, Gates LE, Kakkar AK, Levine MN, Liebman HA, Tempero MA, Lyman GH, Falanga A. Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: ASCO Clinical Practice Guideline Update. J Clin Oncol. 2020 Feb 10;38(5):496-520. doi: 10.1200/JCO.19.01461. Epub 2019 Aug 5. PMID: 31381464.
5.De Stefano V, Larocca A, Carpenedo M, Cavo M, Di Raimondo F, Falanga A, Offidani M, Petrucci MT, Ruggeri M, Santi RM, Barosi G. Thrombosis in multiple myeloma: risk stratification, antithrombotic prophylaxis, and management of acute events. A consensus-based position paper from an ad hoc expert panel. Haematologica. 2022 Nov 1;107(11):2536-2547. doi: 10.3324/haematol.2022.280893. PMID: 35861017; PMCID: PMC9614522.
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