Predicting venous thromboembolism in multiple myeloma: development and validation of the IMPEDE VTE score

Am J Hematol. 2019 Nov;94(11):1176-1184. doi: 10.1002/ajh.25603. Epub 2019 Aug 19.


Venous thromboembolism (VTE) is a common cause of morbidity and mortality among patients with multiple myeloma (MM). The International Myeloma Working Group (IMWG) developed guidelines recommending primary thromboprophylaxis, in those identified at high-risk of VTE by the presence of risk factors. The National Comprehensive Cancer Network (NCCN) has adopted these guidelines; however, they lack validation. We sought to develop and validate a risk prediction score for VTE in MM and to evaluate the performance of the current IMWG/NCCN guidelines. Using 4446 patients within the Veterans Administration Central Cancer Registry, we used time-to-event analyses to develop a risk score for VTE in patients with newly diagnosed MM starting chemotherapy. We externally validated the score using the Surveillance, Epidemiology, End Results (SEER)-Medicare database (N = 4256). After identifying independent predictors of VTE, we combined the variables to develop the IMPEDE VTE score (Immunomodulatory agent; Body Mass Index ≥25 kg/m2 ; Pelvic, hip or femur fracture; Erythropoietin stimulating agent; Dexamethasone/Doxorubicin; Asian Ethnicity/Race; VTE history; Tunneled line/central venous catheter; Existing thromboprophylaxis). The score showed satisfactory discrimination in the derivation cohort, c-statistic = 0.66. Risk of VTE significantly increased as score increased (hazard ratio 1.20, P = <.0001). Within the external validation cohort, IMPEDE VTE had a c-statistic of 0.64. For comparison, when evaluating the performance of the IMWG/NCCN guidelines, the c-statistic was 0.55. In summary, the IMPEDE VTE score outperformed the current IMWG/NCCN guidelines and could be considered as the new standard risk stratification for VTE in MM.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.
  • Validation Study

MeSH terms

  • Aged
  • Anticoagulants / therapeutic use
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Body Mass Index
  • Catheterization, Central Venous / adverse effects
  • Combined Modality Therapy
  • Comorbidity
  • Databases, Factual
  • Dexamethasone / administration & dosage
  • Dexamethasone / adverse effects
  • Female
  • Follow-Up Studies
  • Glomerular Filtration Rate
  • Hematopoietic Stem Cell Transplantation
  • Humans
  • Male
  • Medicare
  • Middle Aged
  • Multiple Myeloma / complications*
  • Multiple Myeloma / drug therapy
  • Multiple Myeloma / therapy
  • Retrospective Studies
  • Risk Assessment / methods
  • Risk Factors
  • SEER Program
  • United States
  • Vena Cava Filters
  • Venous Thromboembolism / etiology*
  • Venous Thromboembolism / prevention & control


  • Anticoagulants
  • Dexamethasone