Thrombogenic activity of doxorubicin in myeloma patients receiving thalidomide: Implications for therapy

Central Arkansas Veterans Healthcare System and University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Blood (Impact Factor: 10.45). 09/2002; 100(4):1168-71. DOI: 10.1182/blood-2002-01-0335
Source: PubMed


Ten percent of newly diagnosed myeloma patients treated with any type of chemotherapy develop deep venous thrombosis (DVT). Thalidomide has proven activity in refractory multiple myeloma (MM), and although single-agent thalidomide has minimal prothrombogenic activity, its combination with cytotoxic chemotherapy is associated with a significantly increased risk of DVT. We analyzed the incidence of DVT in 232 MM patients who received a combination of chemotherapy and thalidomide on 2 protocols that differed only by the inclusion of doxorubicin in one. DT-PACE (dexamethasone/thalidomide/cisplatin/doxorubicin/cyclophosphamide/etoposide) was offered to patients with preceding standard dose therapy, but no prior autotransplantation, while DCEP-T (dexamethasone/cyclophosphamide/etoposide/cisplatin/thalidomide) was administered for relapse after transplantation. If there were signs or symptoms suggestive of DVT, patients received additional investigations, including Doppler ultrasonography, followed by venography if indicated. Only patients on DT-PACE but not DCEP-T experienced an increased incidence of DVT. A statistical association between the incidence of DVT and combination chemotherapy including doxorubicin (P =.02) was observed; this association was confirmed on multivariate analysis. MM patients treated with thalidomide and doxorubicin have a high risk of developing DVT.

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    • "[12] However, it was seen that incidence of VTE in MM doesn't increase solely with Thalidomide. [13] When Thalidomide is combined with chemotherapeutic agents such as Doxorubicin or melphalan with prednisone, there was a sharp increase in the incidence of VTE [14] [15]. MM usually presents with end organ damage like bone symptoms such as pain, pathologic fracture, renal dysfunction, chronic fatigue from anemia or symptoms of hypercalcemia. "
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    06/2015; 3(3 8):244-246. DOI:10.12691/ajmcr-3-8-6
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    • "The incidence of DVT (21%) was high among patients in the current study. The risk of DVT is known to be high with cancer (Naess et al., 2007), with central venous catheters (Monreal et al., 2006), and with chemotherapy and thalidomide (Zangari et al., 2003), particularly with doxorubicin and thalidomide (Zangari et al., 2002). Additional studies are being conducted using medical record reviews to compare the incidence of DVT among patients in the current study with patients who were treated with the same high-dose chemotherapy and autologous PBSCT protocol but did not receive ESA therapy according to the current study's algorithm. "
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    Oncology Nursing Forum 06/2008; 35(3):E53-61. DOI:10.1188/08.ONF.E53-E61 · 2.79 Impact Factor
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    • "This was first recognized in our initial phase II study involving 15 patients receiving concurrent thalidomide, Adriamycin, and dexamethasone, in which a 27% incidence of DVT was noted (Osman et al, 2001). This complication was confirmed in association with other regimens (Zangari et al, 2002). None of the patients in these reports received prophylactic anticoagulation. "
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