Increased risk of arterial thromboembolic events with combination lenalidomide/dexamethasone therapy for multiple myeloma

Expert Rev Anticancer Ther. 2017 Jul;17(7):585-591. doi: 10.1080/14737140.2017.1330153. Epub 2017 May 23.

Abstract

Cancer associated thrombosis is a leading cause of morbidity and mortality. Research and guidelines have focused on venous thromboembolic events (VTE). Within the past decade, combination lenalidomide and dexamethasone has become a standard of therapy for multiple myeloma and is now widely used. In these patients, the risk of arterial thromboembolic events (ATE) has not been addressed to the same extent as VTE. Areas discussed: Presented is a targeted review of published data on ATE in MM patients on combination lenalidomide/dexamethasone therapy. Incidence, clinical presentations, prognosis, mechanisms and thromboprophylaxis are discussed. A framework for approaching ATE/VTE in these patients is suggested. Expert commentary: There is an increased incidence of ATE in this population, primarily cerebrovascular and cardiovascular events. ATE is associated with poorer prognosis and its prevention must be an important goal of management. It is suggested that on initiating treatment, a combined VTE/ATE risk assessment should be performed and thromboprophylaxis initiated for a minimum of 6 months. As newer immunomodulatory therapies are developed, thromboembolic risk must be assessed early on. Further studies are needed to determine the optimal strategy to reducing both VTE and ATE in this population.

Keywords: Adverse effects; arterial thromboembolic events; dexamethasone; lenalidomide; multiple myeloma; stroke; thromboprophylaxis; thrombosis; venous thromboembolic events.

Publication types

  • Review

MeSH terms

  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects*
  • Dexamethasone / administration & dosage
  • Humans
  • Lenalidomide
  • Multiple Myeloma / complications
  • Multiple Myeloma / drug therapy*
  • Prognosis
  • Risk
  • Risk Assessment / methods
  • Thalidomide / administration & dosage
  • Thalidomide / analogs & derivatives
  • Thromboembolism / epidemiology
  • Thromboembolism / etiology*
  • Thromboembolism / pathology

Substances

  • Thalidomide
  • Dexamethasone
  • Lenalidomide