(034) Clinical Utility of a Modified Risk Score for Venous Thromboembolism Risk in Patients with Multiple Myeloma Receiving Immunomodulatory Drugs

Poster Abstract:

Background: The pathogenesis of venous thromboembolism (VTE) in Multiple Myeloma (MM) is complex and only partially understood. Immunomodulatory drugs (IMiDs) are frequently utilized for the treatment of MM and contribute to the risk of VTE. There are three validated risk scores that are now available to quantify risk of VTE in patients with MM on IMiD-based regimens: SAVED, IMPEDE-VTE, and PRISM. Based on limitations of currently validated VTE risk scoring models, a modified version is utilized at Emory Winship Cancer Institute which incorporates variables from both the SAVED and IMPEDE Risk Score. The purpose of this study is to evaluate the efficacy and safety of a modified IMPEDE-SAVED VTE risk score at our institution and its impact on patient outcomes.
Objective(s): The primary outcome is cumulative incidence of VTE at 6 months in patients with newly initiated IMiD-based treatment. Secondary outcomes include incidence of VTE at 12 months, incidence of deep vein thrombosis at 6 and 12 months, incidence of pulmonary embolism at 6 and 12 months, incidence of major bleeding or minor bleeding and rate of adherence to the NCCN guidelines based on calculated VTE risk score.

Methods: A single-center, retrospective chart review was conducted of randomly chosen adult patients with MM receiving IMiD-based regimens at Emory Winship Cancer Institute from January 1, 2022, and May 31, 2022. Patients were included if they were initiated on VTE prophylaxis including aspirin, low molecular weight heparin, warfarin, edoxaban, apixaban, or rivaroxaban. The primary outcome was estimated using a cumulative incidence function, and a 95% confidence interval was reported. Statistical significance was assessed at the 0.05 level.

Results: A total of 51 patients were included in this study. Preliminary results showed the incidence of VTE at 6 months with newly initiated IMiD-based treatment was 13.7 % which is lower than the incidence of VTE that we anticipated. Majority of the patients received aspirin for VTE prophylaxis and lenalidomide was the most prescribed IMiD. The rate of adherence to the NCCN guidelines based on calculated risk scores was higher with SAVED (37.3 %) compared to IMPEDE (3.9 %). The modified risk score had the highest rate of adherence at 82.4%.
Conclusion/

Discussion: Overall, the incidence of VTE at 6 months in this study was lower than what we anticipated based on previous clinical trials. These results show favorable safety and efficacy results when using the modified IMPEDE-SAVED VTE risk score.

References (must also be included in final poster): 1. Covut F, Sanfilippo KM. Mitigating the risk of venous thromboembolism in patients with multiple
myeloma receiving immunomodulatory-based therapy. Hematology. 2022;2022(1):363-367.
doi:10.1182/hematology.2022000414
2. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Multiple Myeloma. Version 3.2023.
3. Bradbury CA, Craig Z, Cook G, et al. Thrombosis in patients with myeloma treated in the Myeloma IX and Myeloma XI phase 3 randomized controlled trials. Blood. 2020;136(9):1091-1104. doi:10.1182/blood.2020005125
4. Chakraborty R, Rybicki L, Wei W, et al. Abnormal metaphase cytogenetics predicts venous thromboembolism in myeloma: derivation and validation of the PRISM score. Blood. 2022;140(23):2443-2450. doi:10.1182/blood.2022015727