Abstract
Abstract only
7549
Background: Cancer patients experiencing thromboembolic disease have a poor prognosis. We report the effect on survival of treatment-associated DVT in myeloma patients. Methods: 668 newly diagnosed patients with progressive or symptomatic MM were enrolled in our Total Therapy 2 study, which included induction phase with VAD, DCEP, CAD and DCEP followed by high dose chemotherapy and tandem transplants. Patients were randomly assigned to receive Thalidomide or not during the whole treatment. Both arms otherwise received identical chemotherapy. Patients were followed and when clinically indicated underwent radiological studies to confirm a suspected DVT. If present, they were treated with low-molecular weight heparin followed by warfarin. Results: With a median follow up of 47 months a total of 158 patients experienced DVT; the median age was 57 years, 59% were male, 24% were IgA, 197 patients (30%) had abnormal cytogenetics (CA) including 100 patients with deletion of chromosome 13. The baseline characteristics were balanced between patients with and without DVT, with the exception of female gender, which was more prominent in the non DVT group (32% vs 46%, p = .018) on thalidomide, whereas CRP ≥ 8 mg/dl (57% vs 33%, p = .001), and IL6 > 9 pg/ml (47% vs 14%, p < .001) were more frequently observed in the DVT group on no thalidomide. Within each arm of the trial no significant differences in prognostic factors for survival (chromosomal abnormalities, low albumin level, β2-microglobulin, CRP) were seen. DVT status did not affect EFS (p = .3) or OS (p = .3) for the entire group, but a statistically longer EFS (p = .03) was observed in patients who developed a thromboembolic episode in the non thalidomide arm. No effect on survival (EFS p = .3; OS p = .95) was seen in the thalidomide arm. Conclusions: Development of DVT in newly diagnosed myeloma patients treated with chemotherapy ± thalidomide, does not affect overall survival. Patients not exposed to thalidomide who developed thrombosis during chemotherapy had significantly longer EFS. Our observation supports a survival benefit associated with anticoagulation therapy in cancer patients.
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