High Incidence of Arterial Thrombosis in Young Patients Treated for Multiple Myeloma: Results of a Prospective Cohort Study
Blood. 2010 Jul 15;116(1):22-26, EJ Libourel, P Sonneveld, B van der Holt, MPM de Maat, FWG Leebeek
ABSTRACT
This prospective study evaluated the risk of arterial thrombosis in 195 consecutive patients aged 18-65 years with newly diagnosed multiple myeloma (MM). All patients were treated with 3 cycles of VAD (vincristine, doxorubicin and dexamethasone) or TAD (thalidomide-AD) or PAD (bortezomib-AD) in national trials, followed by high dose melphalan and autologous stem cell transplantation. Over a period of 522 patient-years 11 of the 195 patients (5.6%) developed arterial thrombosis. The highest incidence was seen during induction chemotherapy courses. Median age at onset of arterial thrombosis was 59 (43-65). Hypertension and smoking were significantly associated with arterial thrombosis with a relative risk of 11.7 (2.23-61.2) and 15.2 (1.78-130), respectively. FVIII:C correlated significantly with age (p=0.02) and higher ISS stage (p=0.001). A higher FVIII:C was associated with arterial thrombosis, HR = 1.85 (95% CI = 0.99-3.47) after adjustment for age, ISS score and assigned treatment arm. MM patients have an increased risk for arterial thrombotic events during and following induction chemotherapy. Hypertension, smoking and high factor VIII levels, possibly reflecting disease activity, contribute to the risk of arterial thrombosis.
