Protective Effect of VELCADE® on Thalidomide-Associated Deep Vein Thrombosis (DVT).

Cardiovascular complications during the treatment of patients with multiple myeloma (MM) are not uncommon (10%) and the frequency clearly increases with the use of regimens containing thalidomide (T) in combination with glucocorticosteroids or chemotherapy especially adriamycin. Even with prophylactic anticoagulation, DVT still occurs in 10% of such patients. The use of full anticoagulation treatment raises considerable concern of bleeding, especially during the post chemotherapy thrombocytopenic period. We now report the incidence of DVT in MM patients treated with T containing regimens where VELCADE has been added to dexamethasone (D) and adriamycin. Results are shown in table1. The incidence of DVT was also analyzed in 24 patients enrolled on protocol UARK 2001–37, where VELCADE was administered in combination with thalidomide and dexamethasone (VTD) for a total of 98 cycles without anticoagulation. Review of the literature regarding the incidence of DVT in patients receiving DT reveals reports of 16% (Cavo, et al. Haematologica. 2004 89:826) and 12 % (Rajkumar, et al. JClinOncol. 2002 1;20: 4319). In contrast no thrombotic episodes were documented with any of these cycles. This is the first report of protective antithrombotic effect of VELCADE in a malignancy associated with a hyper-coaguable state. Further studies to elucidate the mechanism of VELCADE anticoagulant activity are currently in progress. Table 1. DVT Rates: DTPACE vs. VDTPACE