Abstract
Background: Guidelines recommend thromboprophylaxis for patients with multiple myeloma (MM) at high risk for venous thromboembolism (VTE). However, the optimal risk prediction model for VTE in MM remains unclear. Khorana et al developed a VTE risk score (Khorana score) in ambulatory cancer patients receiving chemotherapy. We aimed to evaluate the predictive ability of the Khorana score in patients with MM. Methods: We identified patients with MM within the Veterans Affairs health care system between 2006 and 2013. The Khorana score was calculated before treatment initiation. Using logistic regression, the relationship between risk group and VTE was assessed at 3 and 6 months. We tested model discrimination using the concordance statistic. Results: In the cohort of 2870 patients with MM, there were 1328 at low risk (0 points), 1521 at intermediate risk (1-2 points), and 21 at high risk (≥3 points) for VTE by the Khorana score. The 6-month cumulative incidence of VTE was 5.1% (95% confidence interval [CI], 4.0%-6.4%) in low risk, 3.9% (95% CI, 3.0%-5.0%) in intermediate risk, 4.8% (95% CI, 0.3%-20.2%) in high risk. The Khorana score did not strongly discriminate between patients who did and did not develop VTEs at 3 or 6 months (concordance statistic, 0.58; 95% CI, 0.54-0.63; and 0.53, 95% CI, 0.50-0.57, respectively. Conclusions: In conclusion, in this cohort of 2870 patients with MM, the Khorana score did not predict VTE. Our study supports the need to use myeloma-specific risk models to predict VTE risk in patients with MM.
| Original language | English (US) |
|---|---|
| Article number | e12634 |
| Journal | Research and Practice in Thrombosis and Haemostasis |
| Volume | 6 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 2022 |
Funding
This work was supported by the National Heart, Lung, and Blood Institute at the National Institutes of Health (1K01HL136893‐01, 5K12 HL087107‐95, and the NIH Loan Repayment Program to KMS). KMS declares the following conflicts of interest: research funds from AstraZeneca and Astellas Pharma Global paid to the institution and outside the scope of the submitted work; advisory board fees from Pfizer Inc. and Bayer HealthCare Pharmaceuticals Inc. outside the scope of the submitted work; expert review for Covington & Burling LLP and Luther & Associates outside the scope of the submitted work; and travel funds from Pfizer Inc., AstraZeneca Pharmaceuticals LP, and Bayer HealthCare Pharmaceuticals Inc., all outside the scope of this study. TFW reports research funds from the ISTH outside the scope of this study; and advisory board fees from Pfizer Inc. and Servier outside the scope of this study. NMK reports personal fees from G1 Therapeutics, Invitae, Beyond Spring, Spectrum, Bristol‐Myers Squibb, Janssen, and Total Health outside of the submitted work. KMS, KC, TFW, SL, NMK, JK, and BFG developed and validated the IMEPDE VTE score for prediction of VTE risk in MM. KMS and BFG helped developed the SAVED score for prediction of VTE risk in MM. All other authors have nothing to disclose.
Keywords
- Khorana score
- cancer-associated thrombosis
- multiple myeloma
- risk prediction
- venous thromboembolism
ASJC Scopus subject areas
- Hematology
