Low incidence of venous thromboembolism in Asian myeloma Patients Treated with thalidomide plus dexamethasone

Multiple myeloma is associated with an increase in risk for venous thromboembolic (VTE) events. Treatment with immunomodulatory agents and their combinations in chemotherapy increases the risk for VTE. Specifically, the combination of thalidomide and dexamethasone seems to present the highest risk for VTE. This phenomenon has been examined extensively through various trials conducted in North American and Europe, with suggestions of prophylactic anticoagulation in various forms after evaluation of patient risk factors. However, as the literature has suggested that Asians are at less risk for VTE in general compared with white or black ethnic groups, Asian patients should be further evaluated before initiation of prophylactic anticoagulation. With the literature from several Asian nations suggesting a lower incidence of VTE with thalidomide monotherapy or combination therapy with dexamethasone in myeloma, this review intends to examine the existing literature for such observations, and provide information on risk factors, prophylaxis, and therapy if indicated. More research is needed to evaluate the risk deduction of Asian ethnicity and the specific risk factors that accompany this ethnic group.