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Assessing Risk of Immunomodulatory Drug–Related Blood Clots in Patients With Multiple Myeloma

By: Anna Nowogrodzki
Posted: Wednesday, September 4, 2019

A new model assesses the risk of venous thromboembolism associated with immunomodulatory drug treatment in patients with multiple myeloma. Though the model outperformed the current NCCN Guidelines for risk stratification when used on retrospective data, it has not been prospectively validated. The study was published in the JNCCN–Journal of the National Comprehensive Cancer Network by Kristen M. Sanfilippo, MD, MPHS, of Washington University and Siteman Cancer Center in St. Louis, and colleagues.

“This study may help health-care providers identify which newly diagnosed multiple myeloma patients receiving immunomodulatory drugs should receive preventive treatment with blood thinners,” said Dr. Sanfilippo in an NCCN press release. However, until a prospective study is performed, the authors cautioned that the model should be used only as a supplemental tool.

The authors focused on 2,397 patients in the SEER-Medicare database to derive the model and 1,251 patients in the Veterans Health Administration database to validate the model. All patients had multiple myeloma and received immunomodulatory drugs within a year of their diagnosis.

Dr. Sanfilippo and colleagues found five risk factors for blood clots and used them to create a risk score ranging from –3 to +8 points. Patients received 3 points for a history of blood clots, 2 points for having had surgery within 90 days, 2 points for a high steroid dose or 1 point for a standard steroid dose, 1 point for being at least 80 years old, and –3 points for Asian race.

Scores of 2 or higher were classified as high risk, and scores below 2 were considered low risk. The hazard ratios were 1.85 in the SEER-Medicare group (the derivation cohort) and 1.98 in the Veterans Health Administration group (the validation cohort). These hazard ratios were both better than those for the current NCCN Guidelines, which were 1.21 for the SEER-Medicare group and 1.41 for the Veterans Health Administration group.

Disclosure: The study authors’ disclosure information may be found at

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