Thromboembolic Events in Multiple Myeloma Patients- Incidence in 235 Patients

Research Article

Ann Hematol Oncol. 2017; 4(2): 1134.

Thromboembolic Events in Multiple Myeloma Patients- Incidence in 235 Patients

Alves C1*, Ramalheira S², Tavares M², Simas A³, Rosales M¹, Milheiro MJ¹, Domingues N², Chacim S², Santos LL¹ and Mariz JM²

1Department of Imuno-Hemotherapy, Instituto Português de Oncologia do Porto Francisco Gentil, Portugal

2Department of Hemathology, Instituto Português de Oncologia do Porto Francisco Gentil, Portugal

3Department of Medical Oncology, Instituto Português de Oncologia do Porto Francisco Gentil, Portugal

*Corresponding author: Alves C, Department of Imuno-Hemotherapy, Instituto Português de Oncologia do Porto Francisco Gentil, EPE, Rua Dr. António Bernardino de Almeida, 4200 Porto, Portuga

Received: January 05, 2017; Accepted: February 13, 2017; Published: February 16, 2017


Background: Cancer patients are more likely to develop venous thrombotic events (VTE). The incidence is higher in patients with hematologic malignancies and in patients with multiple myeloma (MM). The incidence of VTE in cancer patients with MM varies from 3 to 10%, which is associated with a poor prognosis and a decreased quality of life.

Patients and Methods: A single centre retrospective analysis of patients with MM, diagnosed between 2009 and 2014, was made with the intention to identify the VTE which had occurred.

Results: We identified 235 patients with MM and registered 19 VTE-13 deep venous thrombosis (DVT), 4 pulmonary embolisms (PE), 1 superficial venous thrombosis (SVT) and 1 stroke. The incidence of VTE was 8%. No significant individual risk factors were found. Nine patients were not on prophylactic therapeutics, 6 were doing ASA, 3 were under low molecular weight heparin (LMWH) and 1 was doing acenocoumarol. The mean time between diagnosis and VTE was 8.5 months.

Conclusion: The 8% VTE incidence found for this cohort highlights the need for VTE prophylaxis in these patients with MM.

Keywords: Incidence; Multiple myeloma; Prophylaxis; Risk factors; Thrombosis


ASA: Acetylsalicylic Acid; DVT: Deep Venous Thrombosis; LMWH: Low Molecular Weight Heparin; MM: Multiple Myeloma; MPT: Melphalan, Prednisone, Thalidomide; PE: Pulmonary Embolism; SVT: Superficial Venous; TaCyDex: Thalidomide Cyclophosphamide Dexamethasone; TD: Thalidomide Dexamethasone; VMP: Bortezomib Melphalan Prednisone; VTD-PACE: Bortezomib Thalidomide Dexamethasone Cisplatin Cyclophosphamide Etoposide Doxorrubicin; vTD: Bortezomib Thalidomide Dexamethasone; VTE: Venous Thromboembolic Events


Cancer is an independent and major risk factor for VTE and is described as the second leading cause of death in these patients [1]. The association between cancer and thrombosis is well established and known since 1865 when Armand Trousseau first described it [1-3]. Cancer associated thrombosis affects cancer patients lives significantly and is an increasing factor of morbidity and mortality [2-4]. VTE is defined as DVT or PE, and reported in up to 20% of cancer patients, 78% of which occur in outpatient settings [1,5,6]. In hospitalized cancer patients, several studies have noticed an incidence of VTE of 0.6% to 7.8% [5]. There are some risk factors that can enhance the incidence of VTE in cancer patients. The highest rates of VTE events are associated with the stage and type of cancer, presence of metastatic disease, use of antineoplastic therapy, as well as individual risk factors. Pancreas, brain, ovary, uterus, kidney, stomach, colon, rectum and lung cancers have the highest incidence.

However, hematologic malignancies, in particular, leukaemia, Hodgkin disease, non Hodgkin lymphoma and MM, have high rates of VTE, ranging from 4.2% to 5%. The risk of VTE varies over time after the diagnosis of cancer and is higher early after the diagnosis [5,7]. Furthermore, VTE has serious clinical consequences such as an increased risk of recurrence, post-thrombotic syndrome, pulmonary hypertension, bleeding complications related to treatment and overuse of health resources [1,5]. As can be understood, the risk of VTE in cancer patients and the consequences of DVT or PE in this population, accentuates the need for healthcare professionals to carefully assess patient-, cancer-, and treatment-related factors when treating patients with medical oncology settings [5].

MM is an independent risk factor for VTE and, ever since the introduction of the immunomodulatory drugs, thalidomide and/ or lenalidomide, the risk for VTE has increased, particularly in new diagnosed patients and when combined with dexamethasone or chemotherapy. Higher doses of corticotherapy, erythropoietin, presence of central venous catheter, infections, immobilization due to skeletal pain and hospitalization are factors that also contribute to the increase of VTE in MM [8-11].

The goal of this study is to evaluate and characterize the VTE in MM patients in our institution.

Materials and Methods

This study is a descriptive and retrospective analysis of the medical records of all consecutive patients with newly diagnosed MM and VTE, between January of 2009 and December of 2014, at Instituto Português de Oncologia do Porto (IPO Porto). IPO do Porto, is a fourth level hospital located in northern Portugal and specialized in oncology patients. It receives a mean of 10,000 new patients/year from all northern regions of the country and 500 of them are hematologic patients.

We characterized our study population for sex distribution, median age, date of diagnosis and the treatment regimen applied. In our institution, at the time of the diagnosis of MM, all the patients were assessed for risk factors, individual and related to MM, with Palumbo, et al. [11] risk assessment model (Table 1) in order to apply the adequate prophylactic therapeutic measures, we analysed the patients with MM and VTE concerning the prophylactic therapeutic used. This analyse was not applied to the remaining MM patients because it was out of the field of this study.