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Impact of Time-Varying Treatment Exposures on the Risk of Venous Thromboembolism in Multiple Myeloma

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Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, KY 40536, USA
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Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, FL 32610, USA
*
Author to whom correspondence should be addressed.
Academic Editor: Sampath Parthasarathy
Healthcare 2016, 4(4), 93; https://doi.org/10.3390/healthcare4040093
Received: 12 October 2016 / Revised: 9 December 2016 / Accepted: 14 December 2016 / Published: 20 December 2016
Multiple myeloma (MM) has one of the highest risks of venous thromboembolism (VTE) of all cancers due to pathologic changes and treatment-related exposures. This study assessed the one-year incidence of VTE in newly diagnosed MM and to determine the baseline and time-varying treatment-related factors associated with VTE risk in a U.S.-based cohort. MM patients were identified and age, gender, and baseline comorbidities were determined. Treatment-related exposures included thalidomide derivatives (IMIDs), proteasome inhibitors, cytotoxic chemotherapy, steroids, erythropoietin-stimulating agents (ESAs), stem cell transplants (SCT), hospitalizations, infection, and central venous catheters (CVC). Multiple statistical models were used including a baseline competing risks model, a time-varying exposure Cox proportional hazard (CPH) model, and a case-time-control analysis. The overall incidence of VTE was 107.2 per 1000 person-years with one-half of the VTEs occurring in the first 90 days. The baseline model showed that increasing age, heart failure, and hypertension were associated with one-year incidence of VTE. MM-specific IMID treatment had lower than expected associations with VTE based on prior literature. Instead, exposure to ESAs, SCT, CVC, and infection had higher associations. Based on these results, VTE risk in MM may be less straightforward than considering only chemotherapy exposures, and other treatment-related exposures should be considered to determine patient risk. View Full-Text
Keywords: multiple myeloma; venous thromboembolism; deep vein thrombosis; competing risks; case-time-control study design multiple myeloma; venous thromboembolism; deep vein thrombosis; competing risks; case-time-control study design
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Brown, J.D.; Adams, V.R.; Moga, D.C. Impact of Time-Varying Treatment Exposures on the Risk of Venous Thromboembolism in Multiple Myeloma. Healthcare 2016, 4, 93.

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