Increased risk of deep-vein thrombosis in patients with multiple myeloma receiving thalidomide and chemotherapy

The occurrence of deep-vein thrombosis (DVT) in patients with newly diagnos ed multiple myeloma, who were randomly assigned to receive identical induct ion chemotherapy with or without thalidomide, are reported In this study. T he 2 study arms were comparable with respect to key myeloma prognostic fact ors and known risk factors for DVT. One hundred patients received Induction chemotherapy including 4 cycles of continuous infusion of combinations of dexamethasone, vincristine, doxorubicin, cyclophosphamide, etoposide, and c isplatin, and each patient completed at least one induction cycle. DVT deve loped in 14 of 50 patients (28%) randomly assigned to receive thalidomide b ut In only 2 of 50 patients (4%) not given the agent (P =.002). All episode s of DVT occurred during the first 3 cycles of Induction. Administration of thalidomide was resumed safely In 75% of patients receiving anticoagulatio n therapy. Thus, thalidomide given In combination with multiagent chemother apy and dexamethasone is associated with a significantly increased risk of DVT, which appears to be safely treated with anticoagulation and does not n ecessarily warrant discontinuation of thalidomide. (C) 2001 by The American Society of Hematology.