Among younger patients with multiple myeloma (MM) and those with a high white cell count (WCC), higher-intensity thromboprophylaxis may be necessary for reducing the risk of venous thromboembolism (VTE), according to research published in the Journal of Clinical Medicine.

Patients with MM have as much as a 9-fold increased risk of VTE compared with the general population. Although risk factors for VTE have previously been established, including history of VTE, obesity, and treatment-related events, patients who have been treated with lenalidomide, thalidomide, or other immunomodulatory drugs are known to have a VTE risk of up to 11.8%.

Furthermore, while thromboprophylaxis is commonly used to reduce patient risk of VTE, these events may still occur. For this retrospective study, researchers aimed to evaluate the effectiveness of the widely used Khorana score for predicting VTE in this patient population, and to determine whether any other patient or disease characteristics may aid in VTE prediction.

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Overall, data from 332 patients were included, among whom 32 (9.6%) had a VTE; the median time from MM diagnosis to VTE was 13.5 months. Among patients who developed a VTE vs those who did not, 68.8% vs 62.7% were male, respectively, the median age at MM diagnosis was 63.9 vs 70.7 years, and the median WCC at diagnosis was 7.4 x 109/L vs 6.4 x 109/L, respectively.

Among the 24 patients with available prophylaxis data who developed a VTE, 45.8% were not receiving thromboprophylaxis, while 25% each were receiving aspirin or low-molecular-weight heparin.

Patients who developed a VTE had an odds ratio for mortality of 3.3 (95% CI: 2.4-4.5) compared with aged-matched patients with MM without a VTE.

On univariate analysis, younger age at MM diagnosis was associated with VTE risk (P =.002). Median WCC at diagnosis was also higher among patients who developed VTE, though this finding missed significance on univariate analysis (P =.06).

“We conclude that patients with MM should be fully risk assessed for VTE at diagnosis and that this is dynamically reassessed throughout their disease course, with possible consideration of higher-intensity thromboprophylaxis in young patients with a high WCC,” the authors wrote.


Barrett A, Quinn J, Lavin M, et al. Validation of risk-adapted venous thromboembolism prediction in multiple myeloma patients. J Clin Med. 2021;10(16):3536. doi:10.3390/jcm10163536