External validation of venous thromboembolism risk prediction models in patients with multiple myeloma in a community setting: A retrospective cohort study.

Authors

Chidambaram Ramasamy

Chidambaram Ramasamy

Saint Vincent Hospital, Worcester, MA

Chidambaram Ramasamy , Abinesh Sekar , Harinivaas Shanmugavel Geetha , Madhan Srinivasan Kumar , Masood Pasha Syed , Kala Seetharaman , Ahmad Daniyal Siddiqui , George M. Abraham

Organizations

Saint Vincent Hospital, Worcester, MA, University of Pittsburgh Medical Center Cancer Center, Pittsburgh, PA, Saint Vincent Cancer and Wellness Center, Worcester, MA, Saint Vincent Hospital, Department of Hematology/Oncology, Worcester, MA, Internal Medicine, St. Vincent Hospital, Worcester, MA

Research Funding

No funding received
None.

Background: Newly diagnosed Multiple Myeloma (MM) patients have a 10 to 20 times higher risk of developing venous thromboembolism (VTE) than the general population. Three risk prediction models have been recently established to ascertain the degree of VTE risk: SAVED (Surgery, Asian race, VTE history, Elderly and Dexamethasone), IMPEDE VTE (Immunomodulatory drugs (IMiD), BMI, Pelvic fracture, Erythropoietin stimulating agent, Dexamethasone/Doxorubicin, Asian Ethnicity, VTE history, Tunneled line, Existing thromboprophylaxis) and PRISM scores (Prior VTE, Race, IMiD, Surgery, Metaphase Cytogenetics). Our primary objective was to assess the external validity of three VTE risk prediction models in a community hospital setting. Methods: All consecutive newly diagnosed MM treated at Saint Vincent Hospital from 1/1/2012 to 12/22/2022 were included in our analysis. Patients receiving therapeutic anticoagulation for other indications or a diagnosis of VTE within 6 months prior to MM diagnosis were excluded. Variables were collected by retrospective chart review at the time of MM treatment initiation. Model discrimination was assessed by calculating the area under the receiver operating characteristic curve (AUROC). Logistic regression was used to calculate the odds ratio (OR) of VTE occurrence with candidate variables in the risk prediction model. Results: The 160 patients with newly diagnosed MM and available data on VTE occurrence were included. The median age of our cohort at treatment initiation was 74 years (range 31-96); 55% were male, and 75% were Caucasians. IMiD-based induction regimen was used in 68.1 % of patients. The median SAVED score was 1 (IQR:0-2), IMPEDE VTE was 4 (IQR: 2-6), and PRISM score was 2 (IQR: 0-2). The most common thromboprophylactic agent used was aspirin (53.8%). The median time to VTE from induction was 4.8 months. The cumulative incidence of VTE at 12 months was 13.1%. Each 1-point increase in the score was associated with a significantly higher chance of VTE occurrence across all three models (Table). Factors significantly associated with the development of VTE were prior VTE history (OR:2.28, 95% CI:1.31-3.97,p = 0.003) and age greater than 80 years (OR:4.03, 95% CI:1.47-11.02,p = 0.006). Conclusions: Our findings suggest that all three PRISM (AUROC = 0.70), SAVED (AUROC = 0.72), and IMPEDE VTE (AUROC = 0.73) scores could statistically predict VTE outcomes in our patient population. The inclusion of more parameters in the IMPEDE VTE score may have led to its outperformance in risk stratification.

Comparison of VTE risk prediction models.

Increase OR for each 1-point increase in the score (95%C.I.) p-valueAUROC (95%C.I.) p-value
PRISM score1.3(1.14-1.68)<0.0010.70(0.57-0.83)=0.003
SAVED score2.27(1.42-3.6)<0.0010.72(0.60-0.84)<0.001
IMPEDE-VTE score1.31(1.11-1.55)<0.0010.73(0.62-0.84)<0.001

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Abstract Details

Meeting

2023 ASCO Annual Meeting

Session Type

Publication Only

Session Title

Publication Only: Hematologic Malignancies—Plasma Cell Dyscrasia

Track

Hematologic Malignancies

Sub Track

Multiple Myeloma

Citation

J Clin Oncol 41, 2023 (suppl 16; abstr e20027)

DOI

10.1200/JCO.2023.41.16_suppl.e20027

Abstract #

e20027

Abstract Disclosures

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