Evaluation of the Khorana score for prediction of venous thromboembolism in patients with multiple myeloma
Abstract Background Guidelines recommend thromboprophylaxis for patients with multiple myeloma (MM) at high risk for venous thromboembolism (VTE). However, the optimal risk prediction model for VTE in MM remains unclear. Khorana et al developed a VTE risk score (Khorana score) in ambulatory cancer p...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2022-01-01
|
| Series: | Research and Practice in Thrombosis and Haemostasis |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/rth2.12634 |
| _version_ | 1827847024364486656 |
|---|---|
| author | Kristen M. Sanfilippo Kenneth R. Carson Tzu‐Fei Wang Suhong Luo Natasha Edwin Nicole Kuderer Jesse M. Keller Brian F. Gage |
| author_facet | Kristen M. Sanfilippo Kenneth R. Carson Tzu‐Fei Wang Suhong Luo Natasha Edwin Nicole Kuderer Jesse M. Keller Brian F. Gage |
| author_sort | Kristen M. Sanfilippo |
| collection | DOAJ |
| description | Abstract Background Guidelines recommend thromboprophylaxis for patients with multiple myeloma (MM) at high risk for venous thromboembolism (VTE). However, the optimal risk prediction model for VTE in MM remains unclear. Khorana et al developed a VTE risk score (Khorana score) in ambulatory cancer patients receiving chemotherapy. We aimed to evaluate the predictive ability of the Khorana score in patients with MM. Methods We identified patients with MM within the Veterans Affairs health care system between 2006 and 2013. The Khorana score was calculated before treatment initiation. Using logistic regression, the relationship between risk group and VTE was assessed at 3 and 6 months. We tested model discrimination using the concordance statistic. Results In the cohort of 2870 patients with MM, there were 1328 at low risk (0 points), 1521 at intermediate risk (1‐2 points), and 21 at high risk (≥3 points) for VTE by the Khorana score. The 6‐month cumulative incidence of VTE was 5.1% (95% confidence interval [CI], 4.0%‐6.4%) in low risk, 3.9% (95% CI, 3.0%‐5.0%) in intermediate risk, 4.8% (95% CI, 0.3%‐20.2%) in high risk. The Khorana score did not strongly discriminate between patients who did and did not develop VTEs at 3 or 6 months (concordance statistic, 0.58; 95% CI, 0.54‐0.63; and 0.53, 95% CI, 0.50‐0.57, respectively. Conclusions In conclusion, in this cohort of 2870 patients with MM, the Khorana score did not predict VTE. Our study supports the need to use myeloma‐specific risk models to predict VTE risk in patients with MM. |
| first_indexed | 2024-03-12T09:23:52Z |
| format | Article |
| id | doaj.art-113ae2b1ee5345e4ad565ab4976b3933 |
| institution | Directory Open Access Journal |
| issn | 2475-0379 |
| language | English |
| last_indexed | 2024-03-12T09:23:52Z |
| publishDate | 2022-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Research and Practice in Thrombosis and Haemostasis |
| spelling | doaj.art-113ae2b1ee5345e4ad565ab4976b39332023-09-02T14:19:06ZengElsevierResearch and Practice in Thrombosis and Haemostasis2475-03792022-01-0161n/an/a10.1002/rth2.12634Evaluation of the Khorana score for prediction of venous thromboembolism in patients with multiple myelomaKristen M. Sanfilippo0Kenneth R. Carson1Tzu‐Fei Wang2Suhong Luo3Natasha Edwin4Nicole Kuderer5Jesse M. Keller6Brian F. Gage7Washington University School of Medicine in St. Louis St. Louis Missouri USARush University Medical Center Chicago Illinois USAUniversity of Ottawa at The Ottawa Hospital and Ottawa Hospital Research Institute Ottawa Ontario CanadaWashington University School of Medicine in St. Louis St. Louis Missouri USAThedaCare Regional Cancer Center Appleton Wisconsin USAAdvanced Cancer Research Group Kirkland Washington USAWashington University School of Medicine in St. Louis St. Louis Missouri USAWashington University School of Medicine in St. Louis St. Louis Missouri USAAbstract Background Guidelines recommend thromboprophylaxis for patients with multiple myeloma (MM) at high risk for venous thromboembolism (VTE). However, the optimal risk prediction model for VTE in MM remains unclear. Khorana et al developed a VTE risk score (Khorana score) in ambulatory cancer patients receiving chemotherapy. We aimed to evaluate the predictive ability of the Khorana score in patients with MM. Methods We identified patients with MM within the Veterans Affairs health care system between 2006 and 2013. The Khorana score was calculated before treatment initiation. Using logistic regression, the relationship between risk group and VTE was assessed at 3 and 6 months. We tested model discrimination using the concordance statistic. Results In the cohort of 2870 patients with MM, there were 1328 at low risk (0 points), 1521 at intermediate risk (1‐2 points), and 21 at high risk (≥3 points) for VTE by the Khorana score. The 6‐month cumulative incidence of VTE was 5.1% (95% confidence interval [CI], 4.0%‐6.4%) in low risk, 3.9% (95% CI, 3.0%‐5.0%) in intermediate risk, 4.8% (95% CI, 0.3%‐20.2%) in high risk. The Khorana score did not strongly discriminate between patients who did and did not develop VTEs at 3 or 6 months (concordance statistic, 0.58; 95% CI, 0.54‐0.63; and 0.53, 95% CI, 0.50‐0.57, respectively. Conclusions In conclusion, in this cohort of 2870 patients with MM, the Khorana score did not predict VTE. Our study supports the need to use myeloma‐specific risk models to predict VTE risk in patients with MM.https://doi.org/10.1002/rth2.12634cancer‐associated thrombosisKhorana scoremultiple myelomarisk predictionvenous thromboembolism |
| spellingShingle | Kristen M. Sanfilippo Kenneth R. Carson Tzu‐Fei Wang Suhong Luo Natasha Edwin Nicole Kuderer Jesse M. Keller Brian F. Gage Evaluation of the Khorana score for prediction of venous thromboembolism in patients with multiple myeloma Research and Practice in Thrombosis and Haemostasis cancer‐associated thrombosis Khorana score multiple myeloma risk prediction venous thromboembolism |
| title | Evaluation of the Khorana score for prediction of venous thromboembolism in patients with multiple myeloma |
| title_full | Evaluation of the Khorana score for prediction of venous thromboembolism in patients with multiple myeloma |
| title_fullStr | Evaluation of the Khorana score for prediction of venous thromboembolism in patients with multiple myeloma |
| title_full_unstemmed | Evaluation of the Khorana score for prediction of venous thromboembolism in patients with multiple myeloma |
| title_short | Evaluation of the Khorana score for prediction of venous thromboembolism in patients with multiple myeloma |
| title_sort | evaluation of the khorana score for prediction of venous thromboembolism in patients with multiple myeloma |
| topic | cancer‐associated thrombosis Khorana score multiple myeloma risk prediction venous thromboembolism |
| url | https://doi.org/10.1002/rth2.12634 |
| work_keys_str_mv | AT kristenmsanfilippo evaluationofthekhoranascoreforpredictionofvenousthromboembolisminpatientswithmultiplemyeloma AT kennethrcarson evaluationofthekhoranascoreforpredictionofvenousthromboembolisminpatientswithmultiplemyeloma AT tzufeiwang evaluationofthekhoranascoreforpredictionofvenousthromboembolisminpatientswithmultiplemyeloma AT suhongluo evaluationofthekhoranascoreforpredictionofvenousthromboembolisminpatientswithmultiplemyeloma AT natashaedwin evaluationofthekhoranascoreforpredictionofvenousthromboembolisminpatientswithmultiplemyeloma AT nicolekuderer evaluationofthekhoranascoreforpredictionofvenousthromboembolisminpatientswithmultiplemyeloma AT jessemkeller evaluationofthekhoranascoreforpredictionofvenousthromboembolisminpatientswithmultiplemyeloma AT brianfgage evaluationofthekhoranascoreforpredictionofvenousthromboembolisminpatientswithmultiplemyeloma |