Erythropoietin Therapy and Venous Thromboembolic Events in Patients with Multiple Myeloma Receiving Chemotherapy with or without Thalidomide.

Background: The association between the use of recombinant human erythropoietin (rHUEPO) and venous thromboembolic events (VTE) has been described in cancer patients treated with chemotherapy. A higher risk of VTE has also been observed with the concurrent use of erythropoiesis-stimulating agents and chemotherapy.

Methods: We retrospectively analyzed VTE incidence and concurrent use of erythropoiesis-stimulating agents in patients with multiple myeloma (MM) enrolled in our Total Therapy 2 (TT2) study. TT2 included 4 monthly cycles of induction chemotherapy followed by tandem transplant. Patients were randomly assigned to receive Thalidomide or not during the whole treatment. Both arms otherwise received identical chemotherapy.

Results: The charts of 599 of a total of 668 patients enrolled (90%) were reviewed; 284 patients received Thalidomide, 315 did not. With median age was 57 years, 59% were male, 24% had IgA myeloma. 62% of patients received erythropoietin (erythropoietin alpha 40000 U SQ/week) during the first 4 months of treatment. In thalidomide treated patients, VTE occurred in 33 out of 166 (20%) patients who concomitantly received administration of erythropoietic agents and in 38 out of 118 (32%) patients who did not receive erythropoietin (p=.025). Among patients not receiving thalidomide, VTE occurred in 18 out of 203 (8%) patients who received concomitant administration of erythropoietic agents and in 17 out of 112 (15%) patients who did not receive erythropoietin (p=.10).

Conclusions: The development of thrombosis in patients enrolled on TTII protocol was not increased by the concomitant use of erythropoiesis-stimulating agents and thalidomide. Similarly, erythropoiesis-stimulating therapy did not affect VTE incidence in newly diagnosed myeloma patients treated with intensive chemotherapy without thalidomide.