ASCO 2025 | The incidence of VTE following induction therapy in patients with newly diagnosed multiple myeloma

So this was the data at ASCO. So we looked at our single center experience at Vanderbilt where we treated a large number of patients with induction regimens for newly diagnosed myeloma and we asked the question what was the overall incidence of venous thromboembolic events, what were patients prophylaxed with or protected with against clot formation, both venous and arterial? And what was the risk of them acquiring venous clots based on some of the accepted and standard scoring systems that we use to prognosticate the risk of venous thromboembolism, such as SAVE score or IMPEDE score? So in essence, a vast majority of patients were treated with IMiD-containing induction regimens, which we know are the main risk factor for acquiring clots, unfortunately. We noticed that the overall incidence of venous thromboembolic events was just over 21%. So this is actually the highest rate of VTE events that is known to be reported. I think this is probably present across academic and community sites. It’s just that we haven’t really looked at all the data. The vast majority of patients were protected with aspirin alone, and our data tells us that aspirin is not very successful at prophylaxing these patients. We also learned that median SAVE and IMPEDE scores from these scoring systems were very low in the low-risk category for both of these systems. So median SAVE was one point, median IMPEDE was two points. Both of these are low-risk scoring systems that otherwise would have predicted a very low rate of venous thromboembolic events and yet we have seen significant, you know, 21 plus percent. Also, it’s important to mention that the median time to onset was 7.7 months. So this is really important to highlight because our previous insights told us that the vast majority of clots normally happen within the first six months of induction therapy for newly diagnosed disease and yet we see actually that the median onset is almost eight months which argues against that dogma so the danger of catching clots is very much real beyond six months. Of course, this is so important and valuable because anytime you have a venous thromboembolic event it can be deadly. And two we are very much in the era where we’re starting to use even the word cure for some patients, you know, at least functional cure and medium progression-free survival is really long in the first few lines of therapy are really long. So I consider it and many of my colleagues who are focusing with me in this area we consider it a really important missed opportunity and unacceptable situation to lose any patients to preventable events such as venous thromboembolic events. Lastly, I’ll mention also that arterial events were very low in nature about 2% so it’s really the venous thromboembolism that’s the main issue and also among those patients that had some level of anticoagulant whether it was full dose or prophylactic dose the venous thromboembolic events tended towards a lower rate compared to aspirin so this is certainly something where we lack data in the field and it’s going to be important to try to generate this for the broader public so that we can have randomized data that informs what’s our best approach in terms of prophylaxing or protecting our patients with newly diagnosed disease against venous thromboembolic events, and hopefully not losing a single one to preventable events such as this.

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