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Nízkomolekulární hepariny v tromboprofylaxi během indukční chemoterapie u pacientů s mnohočetným myelomem


Authors: P. Kessler 1;  L. Pour 2;  E. Gregora 3;  M. Zemanová 4;  M. Penka 5;  M. Brejcha 6;  Z. Adam 2;  J. Bacovsky 4;  M. Fenclova 7;  H. Fraňková 1,8;  P. Hausdorf 9;  L. Walterová 10;  V. Heinzová 11;  M. Holikova 12;  M. Krejci 2;  K. Kubackova 13;  E. Langrová 7;  V. Maisnar 14;  I. Meluzinova 15;  Y. Stavarova 16;  J. Straub 17;  V. Scudla 4;  J. Gumulec 18;  J. Ullrychová 19;  R. Hájek 2;  For The Czech Myeloma Group
Authors‘ workplace: Department of Hematology and Transfusion Medicine, Hospital Pelhrimov, Czech Republic 1;  Department of Internal Medicine – Hematooncology, University Hospital Brno, Czech Republic 2;  Department of Haematology, University Hospital Kralovske Vinohrady Praha, Czech Republic 3;  Third Department of Internal Medicine, University Hospital Olomouc, Czech Republic 4;  Department of Haematology, University Hospital Brno, Czech Republic 5;  Department of Haematology, Centre for Thrombosis and Haemostasis, Hospital Novy Jicin, Czech Republic 6;  Department of Haematology, Hospital Kladno, Czech Republic 7;  Department of Haematology, Hospital Trebic, Czech Republic 8;  Department of Internal Medicine, Hospital Cesky Krumlov, Czech Republic 9;  Department of Haematology, Regional Hospital, Liberec, Czech Republic 10;  Department of Haematology, Hospital Opava, Czech Republic 11;  Department of Oncology, Regional Hospital, Liberec, Czech Republic 12;  Department of Oncology, Charles University Hospital Motol Praha, Czech Republic 13;  Department of Haematology, Charles University Hospital Hradec Kralove, Czech Republic 14;  Department of Haematology, Hospital Boskovice, Czech Republic 15;  Department of Haematology, T. Bata’s Regional Hospital, Zlin, Czech Republic 16;  First Department of Internal Medicine, General Faculty Hospital, Prague, Czech Republic 17;  Department of Haematology, University Hospital Ostrava, Czech Republic 18;  Department of Haematology, Hospital Decin, Czech Republic 19
Published in: Klin Onkol 2011; 24(4): 281-286
Category: Original Articles

Overview

Východiska:
Pacienti s mnohočetným myelomem mají vysoké riziko tromboembolické nemoci (TEN), zejména během indukční chemoterapie. Cílem studie bylo zjištění vlivu profylaxe nízkomolekulárním heparinem (LMWH) na incidenci tromboembolických komplikací.

Pacienti a metody:
Analyzovali jsme incidenci tromboembolických příhod u 258 pacientů léčených indukční terapií obsahující vinkristin, doxorubicin nebo idarubicin a dexametazon, následovanou stimulační chemoterapií cyklofosfamidem a G-CSF, a vysokodávkovanou chemoterapií melfalanem. Byly porovnány dvě skupiny těchto pacientů podle praktikované tromboprofylaxe. Pacienti v první skupině (kontrolní, n = 140) buď nebyli léčeni, nebo byli léčeni antikoagulační terapií jen po krátkou dobu, zatímco pacienti ve druhé skupině (profylaktická, n = 118) dostávali standardní profylaxi LMWH po celou dobu indukční chemoterapie. U 102 pacientů byl vyhodnocen profylaktický účinek různých dávek LMWH a porovnán s pacienty bez léčby.

Výsledky:
Standardní profylaxe LMWH významně (p < 0,007) snížila riziko TEN ve srovnání s pacienty bez této profylaxe (3,4 % vs 12,9  %). V analýze podskupiny 102 pacientů bylo zjištěno, že vyšší dávka LMWH (> 70 IU/ kg denně) vedla k 100% účinné profylaxi u 28 pacientů, zatímco nižší dávky byly méně efektivní, 3 pacienti z 39 (7,7 %) prodělali hlubokou žilní trombózu. Naproti tomu TEN byla diagnostikována u 5 z 35 (14,3 %) pacientů bez profylaxe.

Závěr:
Profylaxe LMWH vede k významné redukci rizika tromboembolických komplikací během indukční chemoterapie u pacientů s mnohočetným myelomem. Profylaktický efekt LMWH je závislý na dávce.

Klíčová slova:
mnohočetný myelom – tromboembolická nemoc – prevence – nízkomolekulární heparin


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