Researchers Find Simple Way to Predict and Prevent Dangerous Blood Clots in Patients Treated for Multiple Myeloma
PLYMOUTH MEETING, Pa., July 18, 2019 /PRNewswire/ -- New research from the Hutchinson Institute for Cancer Outcomes Research (HICOR)--which is based at Fred Hutchinson Cancer Research Center--along with the University of Washington and the Seattle Cancer Care Alliance, identifies a simple way to help cancer doctors caring for patients with multiple myeloma to predict blood clots in order to take preventive action. The researchers established a set of risk factors that every doctor can use to determine which patients are most-likely to need blood thinners (anticoagulants) to prevent the dangerous side effect of blood clots associated with some of the newer treatments for this disease.
Venous thromboembolism (VTE)--blood clots in the veins--has been shown to be associated with treatment by an immunomodulatory drug (IMiD) in combination with a moderate-to-high dose of steroids.(1 )The results of this study, which were published in the July 2019 issue of JNCCN--Journal of the National Comprehensive Cancer Network, could have immediate implications for clinical practice and improve patient care.
"VTE is an under-recognized but frequently encountered complication to certain types of cancers and some treatment regimens," said Ang Li, MD, University of Washington. "VTE is common in patients with multiple myeloma receiving IMiDs, and can cause disability, delay or complicate chemotherapy, and--in rare cases--be fatal."
"We're surprised that prophylactic anticoagulation, in any form, is under-utilized despite of its inclusion in the NCCN Guidelines for Cancer-Associated VTE for more than 10 years now," said Kristen M. Sanfilippo, MD, MPHS, the study's senior author from Washington University and Siteman Cancer Center in St. Louis. "We think this study may help health care providers identify which newly-diagnosed multiple myeloma patients receiving IMiDs should receive preventive treatment with blood thinners."
The researchers used two different databases--featuring different populations--to derive and confirm risk factors for VTE in multiple myeloma patients. They looked at data from 2,397 patients in the SEER-Medicare database and another 1,251 from the Veterans Health Administration, all of whom were prescribed IMiDs within 12 months of their multiple myeloma diagnosis. They determined five factors associated with likelihood of VTE: a prior history of VTE, surgery within 90 days, being 80 years of age or older, high steroid dose, and non-Asian race; and assigned different points to each of these factors. Within the SEER-Medicare group, patients with a score of 2 or higher experienced VTE at 3 and 6 months at a rate of 7% and 12% respectively, versus 4% and 7% for those with a score of 1 or lower. The results were similar for the Veterans Health Administration group.
"With the increasing use of IMiDs for treating multiple myeloma, VTE risk is an ever-present and growing concern," said Bjorn Holmstrom, MD, Moffitt Cancer Center, Vice-Chair of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines(®)) Panel for Cancer-Associated Venous Thromboembolic Disease, who was not a member of the research team. "Providers need to vigilantly prescribe VTE prophylaxis to minimize risk of thrombosis. This study provided a simplified stratification tool to help guide providers to those patients with the highest risk of thrombosis. This type of risk assessment model will hopefully allow adherence and compliance to remain high."
The researchers had a word of caution about this new risk assessment model, despite the fact that it outperformed current recommendations. Until it can be prospectively validated, they only recommend that oncologists use it as a tool to supplement clinical decision-making.
Visit JNCCN.org, to read "Derivation and Validation of a Risk Assessment Model for Immunomodulatory Drug-Associated Thrombosis among Patients with Multiple Myeloma" in its entirety. Complimentary access to the article is available until October 10, 2019.
JNCCN Increases Impact Factor
Original research, NCCN Guidelines, insights, and other content from JNCCN continue to influence and improve oncology practices. JNCCN attained an impact factor of 7.57 for 2018, according to Journal Citation Reports that provide citation and publication data of academic journals in the science and social science fields. This measurement of how frequently research from JNCCN is cited in other impactful journals demonstrates how the publication has consistently grown in influence during the last five years. With an impact factor above 6, JNCCN is in the top 5% of journals.
About JNCCN--Journal of the National Comprehensive Cancer Network
More than 25,000 oncologists and other cancer care professionals across the United States read JNCCN--Journal of the National Comprehensive Cancer Network. This peer-reviewed, indexed medical journal provides the latest information about best clinical practices, health services research, and translational medicine. JNCCN features updates on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines(®)), review articles elaborating on guidelines recommendations, health services research, and case reports highlighting molecular insights in patient care. JNCCN is published by Harborside. Visit JNCCN.org. To inquire if you are eligible for a FREE subscription to JNCCN, visit http://www.nccn.org/jnccn/subscribe.asp. Follow JNCCN on Twitter @JNCCN.
About the National Comprehensive Cancer Network
The National Comprehensive Cancer Network(®) (NCCN(®)) is a not-for-profit alliance of 28 leading cancer centers devoted to patient care, research, and education. NCCN is dedicated to improving and facilitating quality, effective, efficient, and accessible cancer care so patients can live better lives. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. By defining and advancing high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers around the world.
The NCCN Member Institutions are: Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA; Fred & Pamela Buffett Cancer Center, Omaha, NE; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; City of Hope National Medical Center, Duarte, CA; Dana-Farber/Brigham and Women's Cancer Center | Massachusetts General Hospital Cancer Center, Boston, MA; Duke Cancer Institute, Durham, NC; Fox Chase Cancer Center, Philadelphia, PA; Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, WA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Mayo Clinic Cancer Center, Phoenix/Scottsdale, AZ, Jacksonville, FL, and Rochester, MN; Memorial Sloan Kettering Cancer Center, New York, NY; Moffitt Cancer Center, Tampa, FL; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Columbus, OH; O'Neal Comprehensive Cancer Center at UAB, Birmingham, AL; Roswell Park Comprehensive Cancer Center, Buffalo, NY; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center, Memphis, TN; Stanford Cancer Institute, Stanford, CA; UC San Diego Moores Cancer Center, La Jolla, CA; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; University of Colorado Cancer Center, Aurora, CO; University of Michigan Rogel Cancer Center, Ann Arbor, MI; The University of Texas MD Anderson Cancer Center, Houston, TX; University of Wisconsin Carbone Cancer Center, Madison, WI; Vanderbilt-Ingram Cancer Center, Nashville, TN; and Yale Cancer Center/Smilow Cancer Hospital, New Haven, CT.
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(1) National Cancer Institute. NCI Comorbidity index overview. Available at: http://healthcaredelivery.cancer.gov/seermedicare/considerations/comorbidity.html.
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SOURCE National Comprehensive Cancer Network
