low incidence of thromboembolism in multiple myeloma patients receiving immunomodulatory drugs; a retrospective single-institution analysis

Anti-platelet agents or anticoagulants are administered for patients with multiple myeloma (mm) receiving immunomodulatory drugs (imids) to prevent thrombotic events (tes). however, there is a discrepancy between current guidelines and clinical practice in thromboprophylaxis and the varied incidence of tes depending on patient cohort. therefore, a consensus on the optimal thromboprophylactic strategy is needed. to determine an appropriate strategy for the prevention of tes in mm patients receiving imids, we performed a retrospective single-institution analysis. in total, 95 mm patients (62% male, median age 65 years, range 30–85 years) from 2008 to 2018 were recruited, and 140 cases were analyzed in the medical-record-based study. thromboprophylactic drugs were given to 69% of patients, anti-platelet agents to 66%, and anticoagulants to 3.0%. seven tes (5.0%) and six bleeding events (4.3%) were observed, but no patients died from thrombohemorrhage. the median follow-up period was 184 days (range 21–2224), and the cumulative te incidence was 1.7% at 3 months, 7.0% at 1 year, and 12.5% at 3 years. multivariate analysis determined that age > 70 years (p = 0.012) and bmi < 18.5 kg/m2 (p = 0.042) were the significant risk factors of te. a low incidence of tes was observed despite the low adherence to guideline recommendations for anticoagulant administration. these results suggest that anti-platelet agents are sufficient for thromboprophylaxis. a high-risk group of tes in mm patients receiving imids was identified, and a larger study is needed to confirm these findings.