Contrary to other reports, a retrospective study found that carfilzomib plus lenalidomide and dexamethasone (KRd) did not increase the risk of venous thromboembolism (VTE) compared with bortezomib plus lenalidomide and dexamethasone (VRd) as induction therapy for patients with multiple myeloma (MM). The results of this study were published in the journal Clinical Lymphoma, Myeloma and Leukemia.

The single-center, retrospective study evaluated data from 209 patients with MM who were treated between 2019 and 2020 and were followed for at least 6 months after initiation of induction therapy with KRd or VRd. VTE included deep vein thrombosis and pulmonary embolism. There were no routine scans to identify VTE, but VTE was confirmed via imaging.

Both groups had similar VTE risk scores as determined by the IMPEDE VTE tool, with a median of 4 for each group. Thromboprophylaxis with aspirin or an alternative agent was administered to 96% and 87% of patients in the KRd and VRd groups, respectively (P =.14). There were 9% of patients who had a history of VTE.

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VTE occurred at similar rates between the therapies. The overall rate of VTE was 9%, with 7% of patients in the KRd group developing VTE and 9% in the VRd group (P =.80). A multivariate analysis also demonstrated no increased risk with KRd compared with VRd (hazard ratio [HR], 0.74; 95% CI, 0.26-2.08; P =.57), including when adjusted for use of thromboprophylaxis or IMPETE VTE risk score.

However, thromboprophylaxis decreased the number of VTE events. There were 7% of patients receiving thromboprophylaxis who developed VTE compared with 24% of patients not on thromboprophylaxis (adjusted HR, 0.24; 95% CI, 0.08-0.69; P =.01).

“In this cohort,” the authors concluded, “carfilzomib may have similar thrombogenicity compared to bortezomib. Further research exploring the relationship between exposure to carfilzomib and thrombosis is needed.”

Disclosures: Some of the study authors declared affiliations with biotech, pharmaceutical, or device companies. Please see the original reference for a full list of disclosures.


Loncharich AJ, Fiala MA, Slade MJ, et al. Venous thromboembolism risk in patients with newly diagnosed multiple myeloma treated with carfilzomib or bortezomib in combination with lenalidomide and dexamethasone. Cancer Med. Published online July 22, 2023. doi: 10.1016/j.clml.2023.07.009