RESIDENTE DE HEMATOLOGIA HOSPITAL UNIVERSITARIO DE CABUEÑES, Asturias, Spain
Introduction: Lenalidomide and pomalidomide are immunomodulatory drugs (IMiDs) that have become key therapies for patients with multiple myeloma, myelodysplastic syndrome with deletion of 5q, mantle cell lymphoma, and follicular lymphoma. However, their use is associated with an increased thrombotic risk. In general, the incidence of thrombotic events ranges from 10% to 20%. However, it can vary depending on different factors such as dosage, treatment duration, and the presence of other thrombotic risk factors. The use of IMiDs has been shown to be associated with an increased thrombotic risk compared to patients not receiving this drug, as they can alter platelet function and increase coagulability. The most common thrombotic events include deep vein thrombosis (DVT ) and pulmonary embolism (PE).
Methods: Observational, descriptive, and retrospective study of patients from our center who initiated treatment with lenalidomide/pomalidomide (according to approved indications) from January 2003 to January 2023. Epidemiological, clinical, and response variables were collected. All data were treated with utmost confidentiality according to current legislation
Results: A total of 217 patients who had received a lenalidomide/pomalidomide-based regimen were included, following the therapeutic indications approved in the product label: 1) MM as maintenance treatment following autologous transplant or combined therapy in treatment-naive patients, non-transplant candidates, or those who had received at least one prior treatment. 2) Low-risk or intermediate-1 MDS associated with isolated 5q deletion in monotherapy. 3) Relapsed or refractory MCL in monotherapy. 4) FL in combination with rituximab in patients who had received prior treatment. Among patients receiving lenalidomide, 8.9% experienced a thrombotic event such as DVT in lower extremities (35.3%), PE (29.4%), myocardial infarction (23.5%), and ischemic stroke (23.5%). Among patients receiving pomalidomide, 11.1% experienced PE (66.7%) or DVT (33.3%). 96% of patients had previously received antiplatelet and/or anticoagulant therapy. The remaining 4% had grade 3-4 thrombocytopenia and were not initiated on therapy. 14.2% had other thrombotic risk factors. The median duration of treatment with lenalidomide and pomalidomide was 30 and 40 months, respectively.
Conclusions: IMiDs are highly effective therapeutic agents in the treatment of multiple hematological neoplasms. However, they have been associated with an increased thrombotic risk, which varies depending on different factors such as dosage, treatment duration, presence of other thrombotic risk factors, and the underlying disease. The exact mechanism by which they increase thrombotic risk is not fully understood, but several theories have been proposed. It is believed that they can influence different components of the coagulation system, resulting in a state of hypercoagulability.
