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Prepublished online as a Blood First Edition Paper on April 30, 2002; DOI 10.1182/blood-2002-01-0335.
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Blood, 15 August 2002, Vol. 100, No. 4, pp. 1168-1171
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Thrombogenic activity of doxorubicin in myeloma
patients receiving thalidomide: implications for therapy
Maurizio Zangari,
Eric Siegel,
Bart Barlogie,
Elias Anaissie,
Fariba Saghafifar,
Athanasios Fassas,
Christopher Morris,
Louis Fink, and
Guido Tricot
From the Central Arkansas Veterans Healthcare System;
and University of Arkansas for Medical Sciences, Little Rock, AR.
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/cyclophos- phanide/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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