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Am J Hematol. 2019 Nov;94(11):1176-1184. doi: 10.1002/ajh.25603. Epub 2019 Aug 19.

Predicting venous thromboembolism in multiple myeloma: development and validation of the IMPEDE VTE score.

Author information

1
Division of Hematology/Oncology, Veterans Administration St. Louis Health Care System, St. Louis, Missouri.
2
Division of Hematology, Washington University School of Medicine Saint Louis, St. Louis, Missouri.
3
Division of Hematology, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio.
4
Division of Oncology, Washington University School of Medicine Saint Louis, St. Louis, Missouri.
5
Division of Hematology/Oncology, Saint Louis University, St. Louis, Missouri.
6
Applied Cancer Research and Drug Discovery,Translational Genomics Research Institute (TGen), City of Hope Cancer Center, Duarte, California.
7
Advanced Cancer Research Group, University of Washington, Seattle, Washington.
8
Division of Hematology/Oncology, Veterans Administration Portland Health Care System, Portland, Oregon.
9
Flatiron Health, New York, New York.
10
Division of General Medical Sciences, Washington University School of Medicine Saint Louis, St. Louis, Missouri.

Abstract

Venous thromboembolism (VTE) is a common cause of morbidity and mortality among patients with multiple myeloma (MM). The International Myeloma Working Group (IMWG) developed guidelines recommending primary thromboprophylaxis, in those identified at high-risk of VTE by the presence of risk factors. The National Comprehensive Cancer Network (NCCN) has adopted these guidelines; however, they lack validation. We sought to develop and validate a risk prediction score for VTE in MM and to evaluate the performance of the current IMWG/NCCN guidelines. Using 4446 patients within the Veterans Administration Central Cancer Registry, we used time-to-event analyses to develop a risk score for VTE in patients with newly diagnosed MM starting chemotherapy. We externally validated the score using the Surveillance, Epidemiology, End Results (SEER)-Medicare database (N = 4256). After identifying independent predictors of VTE, we combined the variables to develop the IMPEDE VTE score (Immunomodulatory agent; Body Mass Index ≥25 kg/m2 ; Pelvic, hip or femur fracture; Erythropoietin stimulating agent; Dexamethasone/Doxorubicin; Asian Ethnicity/Race; VTE history; Tunneled line/central venous catheter; Existing thromboprophylaxis). The score showed satisfactory discrimination in the derivation cohort, c-statistic = 0.66. Risk of VTE significantly increased as score increased (hazard ratio 1.20, P = <.0001). Within the external validation cohort, IMPEDE VTE had a c-statistic of 0.64. For comparison, when evaluating the performance of the IMWG/NCCN guidelines, the c-statistic was 0.55. In summary, the IMPEDE VTE score outperformed the current IMWG/NCCN guidelines and could be considered as the new standard risk stratification for VTE in MM.

PMID:
31379000
DOI:
10.1002/ajh.25603

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