Aangepaste IMWG- en IMPEDE-cutoffs verbeteren trombosetrisage bij multipel myeloom

OBJECTIVE: To validate the predictive ability of the International Myeloma Working Group (IMWG) venous thromboembolism (VTE) scoring system, the IMPEDE VTE scoring system, and the SAVED scoring system for VTE in Chinese multiple myeloma (MM) patients. METHODS: A total of 415 patients with MM who visited The First Affiliated Hospital of Soochow University from January 1, 2019 to June 30, 2023 were included in the research cohort, and a retrospective analysis of their data was conducted. These patients were scored according to the IMWG, IMPEDE, and SAVED thrombosis risk models, respectively, and the predictive value of these three scoring models for VTE events was evaluated. RESULTS: The cumulative incidence of VTE events was 7.0% in the 415 patients. Both the IMWG score and the IMPEDE score demonstrated predictive value for VTE events. Each 1-point increase in the IMWG score was significantly associated with VTE events after treatment initiation (HR=3.41, 95%CI : 2.48-4.69, P < 0.001). Similarly, each 1-point increase in the IMPEDE score was also significantly associated with VTE events after treatment initiation (HR=2.46, 95%CI : 1.95-3.10, P < 0.001). In contrast, the SAVED score did not show significant predi- ctive value for VTE events in Chinese MM patients (P =0.693). However, according to the IMWG risk stratification, the vast majority of patients (97.3%) were classified into the high-risk group; in contrast, only 1 case (0.2%) was categorized into the high-risk group based on the IMPEDE risk stratification, indicating that these two risk stratification criteria are not suitable for Chinese patients. Therefore, patients were regrouped according to the IMWG score: ≤2 points as low-risk (163 cases), 3-4 points as intermediate-risk (214 cases), and ≥5 points as high-risk (38 cases); The 6-month cumulative incidence of VTE events in the high-risk group was 36.8%, which was significantly higher than that in the intermediate- and low-risk groups (P < 0.001, log-rank test). Patients were regrouped according to the IMPEDE score: ≤3 points as low-risk (265 cases), 4-5 points as intermediate-risk (131 cases), and ≥6 points as high-risk (19 cases); The 6-month cumulative incidence of VTE events in the high-risk group was 42.1%, which was significantly higher than that in the intermediate- and low-risk groups (P < 0.001, log-rank test). CONCLUSION: The IMWG score and the IMPEDE score have predictive value for VTE events in Chinese patients with MM, but restratification of patients based on these scores is required, while the SAVED score is not applicable to Chinese MM patients.