Derivation and validation of a risk assessment model for immunomodulatory drug-associated thrombosis among patients with multiple myeloma

Ang Li, Qian Wu, Suhong Luo, Greg S. Warnick, Neil A. Zakai, Edward N. Libby, Brian F. Gage, David A. Garcia, Gary H. Lyman, Kristen M. Sanfilippo

Research output: Contribution to journalArticlepeer-review

30 Scopus citations

Abstract

Background: Although venous thromboembolism (VTE) is a significant complication for patients with multiple myeloma (MM) receiving immunomodulatory drugs (IMiDs), no validated clinical model predicts VTE in this population. This study aimed to derive and validate a new risk assessment model (RAM) for IMiD-associated VTE. Methods: Patients with newly diagnosed MM receiving IMiDs were selected from the SEER-Medicare database (n=2,397) to derive a RAM and then data fromthe Veterans Health Administration database (n=1,251) were used to externally validate the model. A multivariable causespecific Cox regression model was used for model development. Results: The final RAM, named the "SAVED" score, included 5 clinical variables: prior surgery, Asian race, VTE history, age ≥80 years, and dexamethasone dose. The model stratified approximately 30% of patients in both the derivation and the validation cohorts as high-risk. Hazard ratios (HRs) were 1.85 (P<.01) and 1.98 (P<.01) for highversus low-risk groups in the derivation and validation cohorts, respectively. In contrast, the method of stratification recommended in the current NCCN Guidelines for Cancer-Associated Venous Thromboembolic Disease had HRs of 1.21 (P=.17) and 1.41 (P=.07) for the corresponding risk groups in the 2 datasets. Conclusions: The SAVED score outperformed the current NCCN Guidelines in risk-stratification of patients with MM receiving IMiD therapy. This clinical model can help inform providers and patients of VTE risk before IMiD initiation and provides a simplified clinical backbone for further prognostic biomarker development in this population.

Original languageEnglish
Pages (from-to)840-847
Number of pages8
JournalJNCCN Journal of the National Comprehensive Cancer Network
Volume17
Issue number7
DOIs
StatePublished - 2019

Fingerprint

Dive into the research topics of 'Derivation and validation of a risk assessment model for immunomodulatory drug-associated thrombosis among patients with multiple myeloma'. Together they form a unique fingerprint.

Cite this