Prevention of thalidomide- and lenalidomide-associated thrombosis in myeloma
Antonio Palumbo,S V Rajkumar,Meletios A. Dimopoulos,Paul G. Richardson,J F San Miguel,Bart Barlogie,J L Harousseau,Jeffrey A. Zonder,Michele Cavo,Maurizio Zangari,M. Attal,Andrew Belch,S. Knop,Douglas E. Joshua,Orhan Sezer,Heinz Ludwig,David H. Vesole,J. Bladé,Robert A. Kyle,Jan Westin,Donna M. Weber,Sara Bringhen,Ruben Niesvizky,Anders Waage,M. von Lilienfeld-Toal,Sagar Lonial,Gareth J. Morgan,Robert Z. Orlowski,Kazuyuki Shimizu,KC Anderson,Mario Boccadoro,Brian G.M. Durie,Pieter Sonneveld,Mohamad A. Hussein +33 more
TLDR
This manuscript summarizes the available evidence and recommends a prophylaxis strategy according to a risk-assessment model for venous thromboembolism (VTE), and recommends low-molecular-weight heparin (LMWH), warfarin or aspirin.Abstract:
The incidence of venous thromboembolism (VTE) is more than 1%omicron annually in the general population and increases further in cancer patients. The risk of VTE is higher in multiple myeloma (MM) patients who receive thalidomide or lenalidomide, especially in combination with dexamethasone or chemotherapy. Various VTE prophylaxis strategies, such as low-molecular-Weight heparin (LMWH), warfarin or aspirin, have been investigated in small, uncontrolled clinical studies. This manuscript summarizes the available evidence and recommends a prophylaxis strategy according to a risk-assessment model. Individual risk factors for thrombosis associated with thalidomide/lenalidomide-based therapy include age, history of VTE, central venous catheter, comorbidities (infections, diabetes, cardiac disease), immobilization, surgery and inherited thrombophilia. Myeloma-related risk factors include diagnosis and hyperviscosity. VTE is very high in patients who receive high-dose dexamethasone, doxorubicin or multiagent chemotherapy in combination with thalidomide or lenalidomide, but not with bortezomib. The panel recommends aspirin for patients with <= 1 risk factor for VTE. LMWH (equivalent to enoxaparin 40 mg per day) is recommended for those with two or more individual/myeloma-related risk factors. LMWH is also recommended for all patients receiving concurrent high-dose dexamethasone or doxorubicin. Full-dose warfarin targeting a therapeutic INR of 2-3 is an alternative to LMWH, although there are limited data in the literature with this strategy. In the absence of clear data from randomized studies as a foundation for recommendations, many of the following proposed strategies are the results of common sense or derive from the extrapolation of data from many studies not specifically designed to answer these questions. Further investigation is needed to define the best VTE prophylaxis.read more
Citations
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Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update 2014
Gary H. Lyman,Gary H. Lyman,Kari Bohlke,Alok A. Khorana,Nicole M. Kuderer,Agnes Y.Y. Lee,Juan I. Arcelus,Edward P. Balaban,Jeffrey M. Clarke,Christopher R. Flowers,Charles W. Francis,Leigh E. Gates,Ajay K. Kakkar,Nigel S. Key,Mark Levine,Howard A. Liebman,Margaret A. Tempero,Sandra L. Wong,Mark R. Somerfield,Anna Falanga +19 more
TL;DR: Current recommendations about the prophylaxis and treatment of venous thromboembolism (VTE) in patients with cancer and oncology professionals should educate patients about the signs and symptoms of VTE.
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Cardiovascular complications of cancer therapy: incidence, pathogenesis, diagnosis, and management.
TL;DR: The incidence of cardiotoxicity caused by commonly used chemotherapeutic agents as well as the pathogenesis, diagnosis, management, and prevention of these cardiovascular side effects are reviewed.
Journal ArticleDOI
Lenalidomide plus high-dose dexamethasone versus lenalidomide plus low-dose dexamethasone as initial therapy for newly diagnosed multiple myeloma: an open-label randomised controlled trial
S. Vincent Rajkumar,Susanna Jacobus,Natalie S. Callander,Rafael Fonseca,David H. Vesole,Michael E. Williams,Rafat Abonour,David S. Siegel,Michael S. Katz,Philip R. Greipp +9 more
TL;DR: Lenalidomide plus low-dose dexamethasone is associated with better short-term overall survival and with lower toxicity than lenalidomid plus high-dose DexamethAsone in patients with newly diagnosed myeloma in this open-label non-inferiority trial.
Journal ArticleDOI
International clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer
Dominique Farge,Philippe Debourdeau,M Beckers,C. Baglin,Rupert Bauersachs,Barry M. Brenner,Dialina Brilhante,Anna Falanga,G T Gerotzafias,Nissim Haim,Ajay K. Kakkar,Alok A. Khorana,Ramón Lecumberri,Mario Mandalà,Michel Marty,Manuel Monreal,Shaker A. Mousa,Simon Noble,Ingrid Pabinger,Paolo Prandoni,Martin H. Prins,Mohammed H. Qari,Michael B. Streiff,Konstantinos N. Syrigos,Henri Bounameaux,H. R. Büller +25 more
TL;DR: The use of LMWH for VTE prevention in cancer patients undergoing laparoscopic surgery may be recommended as for laparotomy and mechanical methods are not recommended as monotherapy except when pharmacological methods are contraindicated.
Journal ArticleDOI
Management of Newly Diagnosed Symptomatic Multiple Myeloma: updated Mayo Stratification of Myeloma and Risk-Adapted Therapy (mSMART) Consensus Guidelines
Shaji Kumar,Joseph R. Mikhael,Francis K. Buadi,David Dingli,Angela Dispenzieri,Rafael Fonseca,Morie A. Gertz,Philip R. Greipp,Suzanne R. Hayman,Robert A. Kyle,Martha Q. Lacy,John A. Lust,Craig B. Reeder,Vivek Roy,Stephen J. Russell,Kristen Detweiler Short,A. Keith Stewart,Thomas E. Witzig,Steven R. Zeldenrust,Robert J. Dalton,S. Vincent Rajkumar,P. Leif Bergsagel +21 more
TL;DR: This set of recommendations represents the development of a set of consensus guidelines by a group of experts to manage patients with newly diagnosed disease based on an interpretation of the best available evidence.
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