Abnormal Metaphase Cytogenetics Predicts Venous Thromboembolism in Myeloma: Derivation and Validation of the PRISM Score
Menée à partir de données portant sur 783 patients atteints d'un myélome multiple, cette étude évalue la performance d'un système de score, basé sur les antécédents de thromboembolie veineuse, les antécédents chirurgicaux, l'utilisation d'immunomodulateurs, la présence d'anomalies au niveau des résultats de l'analyse cytogénétique en métaphase et l'origine ethnique, pour identifier les patients présentant un risque élevé de thromboembolie veineuse
While venous thromboembolism (VTE) is an important treatment and disease-related complication in myeloma, a validated risk-prediction model including disease-specific variables such as cytogenetics or tumor burden is lacking. The aim of our study was to develop a new risk-prediction model for VTE in the context of modern anti-myeloma therapy. All consecutive patients diagnosed at Cleveland Clinic during 2008-2018 and with available data on baseline candidate risk-factors constituted the derivation cohort. The primary outcome was VTE (deep venous thrombosis/pulmonary embolism) within one year of treatment initiation. A multivariable model was utilized and weights were derived from subdistribution hazard ratios (sHR) to construct a risk-score. The model was validated both by internal bootstrap validation and in an external validation cohort. The derivation cohort consisted of 783 patients. A 5 component risk-prediction tool, named PRISM score, was developed, including the following variables: prior VTE, prior surgery, immunomodulatory drug (IMiD) use, abnormal metaphase cytogenetics, and Black race. The c-statistic of the model was 0.622 (95% CI, 0.567-0.674). The model stratified patients into low, intermediate, and high-risk, with 12-month cumulative VTE incidence of 2.7%, 10.8%, and 36.5% respectively. Risk of VTE increased significantly with increasing score in both derivation and external validation datasets, with the sHR per 1-point increase being 1.28 (95% CI, 1.19-1.39; p<0.001) and 1.23 (95% CI, 1.07-1.41; p=0.004) respectively. While PRISM score can guide clinicians in identifying patients at a high risk of VTE, additional external validation is necessary for incorporation into routine clinical practice.
Blood , résumé, 2021