来那度胺方案治疗初治多发性骨髓瘤患者血栓事件发生率分析

Thromboembolism in newly diagnosed multiple myeloma patients treated with lenalidomide-based regimens: A retrospective analysis

  • 摘要:
      背景  多发性骨髓瘤(multiple myeloma,MM)患者接受以来那度胺为基础的治疗方案时血栓风险较高,目前的指南和临床实践关于血栓预防策略并不一致,血栓事件(thrombotic events,TEs)发生率的报道差异很大。
      目的  观察解放军总医院第一医学中心初治的MM患者接受含来那度胺方案治疗相关血栓事件的发生率。
      方法  回顾性分析2010年1月- 2020年12月解放军总医院第一医学中心46例接受含来那度胺治疗方案的初治MM患者病例资料,分析TEs的发生率。
      结果  46例患者中男性27例,女性19例,确诊时平均年龄(60.0±12.7)岁,来那度胺用药中位时间为16(5 ~ 90)个月。有32例(69.6%)患者接受预防血栓治疗,其中31例患者接受阿司匹林抗血小板治疗,1例接受利伐沙班抗凝治疗。用药期间观察到6例TEs,占全部病例的13.04%,均为深静脉血栓栓塞事件,其中1例合并肺栓塞。另有1例发生上消化道出血事件。所有血栓事件都得到了及时处理,无患者因血栓事件停药或死亡。
      结论  接受含来那度胺方案治疗的MM患者血栓发生率较高,临床治疗中须加强预防。

     

    Abstract:
      Background  Multiple myeloma (MM) patients have a higher risk of thrombotic events (TEs) when treated with lenalidomide-based regimens. However, there is a discrepancy between current guidelines and clinical practice in thromboprophylaxis and the varied incidence of TEs.
      Objective  To observe the incidence of multiple myeloma related thrombotic events (TEs) in patients treated with lenalidomide-based regimens.
      Methods  From January 2010 to December 2020, a retrospective study was performed in 46 newly diagnosed MM patients who received lenalidomide-based regimens in the Second Medical Center of Chinese PLA General Hospital, and the incidence of TEs was analyzed.
      Results  The mean age of 46 patients (27 males and 19 females) at diagnosis was 60.0 ± 12.7 years, with the median duration of lenalidomide use of 16 (5-90) months. A total of 32 patients (69.6%) received thromboprophylaxis, of which 31 patients received aspirin antiplatelet therapy, and 1 case received rivaroxaban anticoagulant therapy. TEs were observed in 6 cases (13.04%, 6/46), and all of them was deep venous thromboembolism, including 1 case of pulmonary embolism. Upper gastrointestinal bleeding occurred in 1 case. All the patients with bleeding or TEs were treated appropriately in time, and no one died or stop medication.
      Conclusion  MM patients receiving lenalidomide-based regimens have a higher incidence of TEs, so prevention should be strengthened in clinical treatment.

     

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