Real world management of multiple myeloma: initial results from the Australia and New Zealand Myeloma and Related Diseases Registry

Abstract

e190 acquired factors, including race,age,general conditions, prior history of VTE, time from diagnosis, and treatments. As VTE is supposed to influence the prognosis,IMW proposed the first guideline of thromboprophylaxis in 2008, followed by BSH, ASCO, and GFTC. However, these guidelines are based on a limited number of studies with low evidence level and extrapolation of data from studies with other disorders and varies. Thus, controversy exists about the validity of thromoprophylaxis,agents,and duration. Methods: We searched relevant studies with 200 or more patients by the PubMed on-line system since 2008. Results: 8 articles have been identified. 1 metaanalysis from Canada, 2 prospective randomized studies(PRS) without control from Italy, 1 PS without control from France, and 3 retrospective studies(RS) with control from USA, Korea, and Japan(our report), and 1 RS without control from Greece. Patient no.;200-1035 (median;524), age(y);24-93(61), follow-up period(mo); 4-29 (20), IMiDS given; thalidomide;4, lenalidomide;2, both;2, thromboprophylaxis; aspirin (ASA) 1, LMWH;1, ASA,vitamin K agonists(VKA);1, ASA or LMWH;1, ASA, VKA or LMWH;4, total VTE(%); 1.4-6.0(4.6), VTE(%) with or without thromboprophylaxis in 3 RS; 18 and 15(p1⁄40.16) (LMWH, all high risk patients, USA), 3.5 and 4.0(p1⁄40.77) (ASA, every risk patients, Korea), 1.7 and 1.2(p1⁄40.55)(ASA and VKA, every risk patients, Japan), 2 Italian studies with standard/ low risk patients without control revealed similar benefits of ASA, LMWH, and/or VKA, 3 other studies no benefits. Risk factors were inconsistent. Because of low VTE rate, PRS with thousands of patients would be necessary for each arm of control and thromboprophylaxis to obtain statistically significant results, however, it is not feasible. Conclusion: None of the thromboprophylactic agents has demonstrated a clear benefit and risk factors were inconsistent. Thus, we propose a reasonable and feasible guideline; high risk (age 65y, prior VTE history,immobility,and/or administration of erythropoietin); attending Dr’s discretion, low risk(all others); ASA or VKA(INR1⁄42-3) for Western patients. Dr’s discretion for Asian patients of any risk. Thromboprophylaxis duration; newly diagnosed patients; 1 y. Refractory/relapsed patients;Dr’s discretion depending on tumor burden.