{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T07:01:00Z","timestamp":1771916460781,"version":"3.50.1"},"reference-count":56,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2020,9,5]],"date-time":"2020-09-05T00:00:00Z","timestamp":1599264000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Compared to the general population, patients with multiple myeloma (MM) have a nine-fold increased risk of developing venous thromboembolism (VTE). Little is known about VTE prophylaxis in relapsed\/refractory (RR) MM patients treated with next generation anti-myeloma drugs, such as pomalidomide (Poma) and carfilzomib (K), and monoclonal antibodies daratumumab (Dara) and elotuzumab (Elo), alone or in combination with dexamethasone at high- (D, 40 mg\/week) or low-dose (d, 20 mg\/week). Here, we describe the incidence of VTE in a retrospective cohort of 112 consecutive relapsed and refractory myeloma (RRMM) patients who received a third line of treatment from April 2013 to February 2020. Anti-MM regimens included combinations of pomalidomide and dexamethasone (PomaD, N = 61), carfilzomib, lenalidomide and dexamethasone (KRd, N = 31), and elotuzumab, lenalidomide and dexamethasone (EloRd, N = 10), while the remaining 10 patients received daratumumab as a single agent. According to National Comprehnsive Cancer Network (NCCN), International Myeloma Working Group (IMWG) and 2015 European Myeloma Network (EMN) guidelines, 42 patients (38%) were classified as high-risk patients. According to the IMPEDE VTE score, 32 patients (28%) were classified as low-risk, with a score \u2264 3 (most of them in the PomaD and Dara group), 70 (63%) were classified as intermediate-risk, with a score of 4\u20137 (most of them in PomaD and KRd group), and 10 (9%) were classified as high-risk, with a score \u22658 (most of them in the PomaD group). All patients received a prophylaxis, consisting generally of low-doses of acetylsalicylic acid. VTE was recorded in 9% of our patients, all of them with an intermediate or high-risk IMPEDE score, treated with low doses aspirin (ASA). No VTE occurred in patients treated with daratumumab. Thus, our real-life experience documents that (1) in RRMM patients treated with continuative regimens of third line, the incidence of VTE is similar to the setting of newly-diagnosed patients; (2) many patients in real-life received prophylaxis with ASA, irrespective of the risk classification; (3) the IMPEDE VTE score seems to be more appropriate to define the risk categories. Randomized clinical trials are required to better define the VTE prophylaxis strategy in the RRMM setting.<\/jats:p>","DOI":"10.3390\/jcm9092876","type":"journal-article","created":{"date-parts":[[2020,9,6]],"date-time":"2020-09-06T23:12:49Z","timestamp":1599433969000},"page":"2876","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["A Real-Life Survey of Venous Thromboembolic Events Occurring in Myeloma Patients Treated in Third Line with Second-Generation Novel Agents"],"prefix":"10.3390","volume":"9","author":[{"given":"Valeria","family":"Calafiore","sequence":"first","affiliation":[{"name":"Division of Hematology, AOU Policlinico, 95123 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Silvia","family":"Giamporcaro","sequence":"additional","affiliation":[{"name":"General Medicine Unit, AOU Policlinico, Department of Clinical &amp; Experimental Medicine, University of Catania, 95123 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Concetta","family":"Conticello","sequence":"additional","affiliation":[{"name":"Division of Hematology, AOU Policlinico, 95123 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6333-4433","authenticated-orcid":false,"given":"Alessandra","family":"Romano","sequence":"additional","affiliation":[{"name":"Division of Hematology, AOU Policlinico, 95123 Catania, Italy"},{"name":"Division of Hematology, Department of General Surgery and Medical-Surgical Specialties, University of Catania, 95123 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marina","family":"Parisi","sequence":"additional","affiliation":[{"name":"Division of Hematology, AOU Policlinico, 95123 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gaetano","family":"Giuffrida","sequence":"additional","affiliation":[{"name":"Division of Hematology, AOU Policlinico, 95123 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4416-8556","authenticated-orcid":false,"given":"Daniele","family":"Tibullo","sequence":"additional","affiliation":[{"name":"Section of Biochemistry, Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Di Raimondo","sequence":"additional","affiliation":[{"name":"Division of Hematology, AOU Policlinico, 95123 Catania, Italy"},{"name":"Division of Hematology, Department of General Surgery and Medical-Surgical Specialties, University of Catania, 95123 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9264-0061","authenticated-orcid":false,"given":"Salvatore Santo","family":"Signorelli","sequence":"additional","affiliation":[{"name":"General Medicine Unit, AOU Policlinico, Department of Clinical &amp; Experimental Medicine, University of Catania, 95123 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2020,9,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1097\/MBC.0b013e328341f030","article-title":"Risk of recurrent venous thromboembolism according to malignancy characteristics in patients with cancer-associated thrombosis: A systematic review of observational and intervention studies","volume":"22","author":"Louzada","year":"2011","journal-title":"Blood Coagul. Fibrinolysis"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"5412","DOI":"10.1182\/blood-2008-12-194241","article-title":"Monoclonal gammopathy of undetermined significance (MGUS) consistently precedes multiple myeloma: A prospective study","volume":"113","author":"Landgren","year":"2009","journal-title":"Blood"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"3582","DOI":"10.1182\/blood-2008-04-151076","article-title":"Deep vein thrombosis after monoclonal gammopathy of undetermined significance and multiple myeloma","volume":"112","author":"Kristinsson","year":"2008","journal-title":"Blood"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1111\/bjh.12168","article-title":"Arterial and venous thrombosis in patients with monoclonal gammopathy of undetermined significance: Incidence and risk factors in a cohort of 1491 patients","volume":"160","author":"Za","year":"2013","journal-title":"Br. J. Haematol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1080\/17474086.2019.1604214","article-title":"Updates on thrombotic events associated with multiple myeloma","volume":"12","author":"Fotiou","year":"2019","journal-title":"Expert Rev. Hematol."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Puglisi, F., Parrinello, N.L., Giallongo, C., Cambria, D., Camiolo, G., Bellofiore, C., Conticello, C., Del Fabro, V., Leotta, V., and Markovic, U. (2019). Plasticity of High-Density Neutrophils in Multiple Myeloma is Associated with Increased Autophagy via STAT3. Int. J. Mol. Sci., 20.","DOI":"10.3390\/ijms20143548"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1080\/17474086.2016.1194750","article-title":"A review of the venous thrombotic issues associated with multiple myeloma","volume":"9","author":"Fotiou","year":"2016","journal-title":"Expert Rev. Hematol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1038\/s41408-018-0135-y","article-title":"Longer procoagulant phospholipid-dependent clotting time, lower endogenous thrombin potential and higher tissue factor pathway inhibitor concentrations are associated with increased VTE occurrence in patients with newly diagnosed multiple myeloma: Results of the prospective ROADMAP-MM-CAT study","volume":"8","author":"Fotiou","year":"2018","journal-title":"Blood Cancer J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1080\/10428194.2016.1219900","article-title":"Baseline and treatment-related changes in thrombin generation in patients with multiple myeloma","volume":"58","author":"Tiong","year":"2017","journal-title":"Leuk. Lymphoma"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1177\/1076029615625825","article-title":"Plasma Thrombin Generation and Sensitivity to Activated Protein C Among Patients With Myeloma and Monoclonal Gammopathy of Undetermined Significance","volume":"22","author":"Crowley","year":"2016","journal-title":"Clin. Appl. Thromb. Hemost."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1111\/j.1365-2141.2006.06208.x","article-title":"Acquired resistance to activated protein C (aAPCR) in multiple myeloma is a transitory abnormality associated with an increased risk of venous thromboembolism","volume":"134","author":"Elice","year":"2006","journal-title":"Br. J. Haematol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1097\/MBC.0000000000000296","article-title":"Effect of serum monoclonal protein concentration on haemostasis in patients with multiple myeloma","volume":"26","author":"Huang","year":"2015","journal-title":"Blood Coagul. Fibrinolysis"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1122","DOI":"10.1038\/leu.2013.313","article-title":"Continued improvement in survival in multiple myeloma: Changes in early mortality and outcomes in older patients","volume":"28","author":"Kumar","year":"2014","journal-title":"Leukemia"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"456037","DOI":"10.1155\/2014\/456037","article-title":"Salvage therapy of multiple myeloma: The new generation drugs","volume":"2014","author":"Romano","year":"2014","journal-title":"Biomed. Res. Int."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"327","DOI":"10.2217\/imt.13.14","article-title":"Bortezomib for the treatment of previously untreated multiple myeloma","volume":"5","author":"Romano","year":"2013","journal-title":"Immunotherapy"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/j.leukres.2010.06.023","article-title":"NF-\u03baB localization in multiple myeloma plasma cells and mesenchymal cells","volume":"35","author":"Conticello","year":"2011","journal-title":"Leuk. Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1002\/cncr.20405","article-title":"Monoclonal gammopathy of undetermined significance and multiple myeloma are associated with an increased incidence of venothromboembolic disease","volume":"101","author":"Srkalovic","year":"2004","journal-title":"Cancer"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1007\/s00277-019-03860-2","article-title":"The incidence of thromboembolism for lenalidomide versus thalidomide in older patients with newly diagnosed multiple myeloma","volume":"99","author":"Li","year":"2020","journal-title":"Ann. Hematol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1002\/pds.4180","article-title":"Real-life practices for preventing venous thromboembolism in multiple myeloma patients: A cohort study from the French health insurance database","volume":"26","author":"Palmaro","year":"2017","journal-title":"Pharmacoepidemiol. Drug Saf."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1177\/2042098612452291","article-title":"Venous and arterial thrombotic risks with thalidomide: Evidence and practical guidance","volume":"3","author":"Palumbo","year":"2012","journal-title":"Ther. Adv. Drug Saf."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"7","DOI":"10.2174\/187152511794182846","article-title":"Thromboembolism with immunomodulatory agents in the treatment of multiple myeloma","volume":"9","author":"Singh","year":"2011","journal-title":"Cardiovasc. Hematol. Agents Med. Chem."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2330","DOI":"10.1080\/10428190701647887","article-title":"Prophylactic low-dose aspirin is effective antithrombotic therapy for combination treatments of thalidomide or lenalidomide in myeloma","volume":"48","author":"Niesvizky","year":"2007","journal-title":"Leuk. Lymphoma"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1640","DOI":"10.1002\/cncr.32682","article-title":"Venous thromboembolism risk with contemporary lenalidomide-based regimens despite thromboprophylaxis in multiple myeloma: A systematic review and meta-analysis","volume":"126","author":"Chakraborty","year":"2020","journal-title":"Cancer"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1007\/s12185-018-2540-1","article-title":"Venous thromboembolism in relapsed or refractory multiple myeloma patients treated with lenalidomide plus dexamethasone","volume":"109","author":"Shin","year":"2019","journal-title":"Int. J. Hematol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1177\/1078155218758500","article-title":"Evaluating the use of appropriate anticoagulation with lenalidomide and pomalidomide in patients with multiple myeloma","volume":"25","author":"Anderson","year":"2019","journal-title":"J. Oncol. Pharm. Pract."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1080\/14737140.2017.1330153","article-title":"Increased risk of arterial thromboembolic events with combination lenalidomide\/dexamethasone therapy for multiple myeloma","volume":"17","author":"Maharaj","year":"2017","journal-title":"Expert Rev. Anticancer Ther."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/j.thromres.2016.03.006","article-title":"Thromboprophylaxis in multiple myeloma patients treated with lenalidomide\u2014A systematic review","volume":"141","author":"Bermejo","year":"2016","journal-title":"Thromb. Res."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1007\/s12185-015-1838-5","article-title":"Silent venous thromboembolism in multiple myeloma patients treated with lenalidomide","volume":"102","author":"Isoda","year":"2015","journal-title":"Int. J. Hematol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1182\/blood-2011-03-344333","article-title":"Aspirin or enoxaparin thromboprophylaxis for patients with newly diagnosed multiple myeloma treated with lenalidomide","volume":"119","author":"Larocca","year":"2012","journal-title":"Blood"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1016\/j.clml.2011.03.006","article-title":"Low venous thromboembolic risk with bortezomib in multiple myeloma and potential protective effect with thalidomide\/lenalidomide-based therapy: Review of data from phase 3 trials and studies of novel combination regimens","volume":"11","author":"Zangari","year":"2011","journal-title":"Clin. Lymphoma Myeloma Leuk."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"5838","DOI":"10.1182\/blood-2010-08-303487","article-title":"Lenalidomide and high-dose dexamethasone compared with dexamethasone as initial therapy for multiple myeloma: A randomized Southwest Oncology Group trial (S0232)","volume":"116","author":"Zonder","year":"2010","journal-title":"Blood"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1007\/s00277-008-0561-1","article-title":"Effective prophylaxis of thromboembolic complications with low molecular weight heparin in relapsed multiple myeloma patients treated with lenalidomide and dexamethasone","volume":"88","author":"Klein","year":"2009","journal-title":"Ann. Hematol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1522","DOI":"10.1002\/cncr.23336","article-title":"Thromboembolic events with lenalidomide-based therapy for multiple myeloma","volume":"112","author":"Menon","year":"2008","journal-title":"Cancer"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1038\/sj.leu.2405062","article-title":"Prevention of thalidomide- and lenalidomide-associated thrombosis in myeloma","volume":"22","author":"Palumbo","year":"2008","journal-title":"Leukemia"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1505","DOI":"10.1161\/CIRCULATIONAHA.117.030687","article-title":"Ultrasound for Lower Extremity Deep Venous Thrombosis: Multidisciplinary Recommendations from the Society of Radiologists in Ultrasound Consensus Conference","volume":"137","author":"Needleman","year":"2018","journal-title":"Circulation"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"986","DOI":"10.1200\/JCO.2010.31.6844","article-title":"Aspirin, warfarin, or enoxaparin thromboprophylaxis in patients with multiple myeloma treated with thalidomide: A phase III, open-label, randomized trial","volume":"29","author":"Palumbo","year":"2011","journal-title":"J. Clin. Oncol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2822","DOI":"10.1002\/cncr.21496","article-title":"Risk factors for chemotherapy-associated venous thromboembolism in a prospective observational study","volume":"104","author":"Khorana","year":"2005","journal-title":"Cancer"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1254","DOI":"10.3324\/haematol.2014.117176","article-title":"European Myeloma Network guidelines for the management of multiple myeloma-related complications","volume":"100","author":"Terpos","year":"2015","journal-title":"Haematologica"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"iv52","DOI":"10.1093\/annonc\/mdx096","article-title":"Multiple myeloma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up","volume":"28","author":"Moreau","year":"2017","journal-title":"Ann. Oncol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"45","DOI":"10.3389\/fonc.2019.00045","article-title":"Apixaban for Primary Prevention of Venous Thromboembolism in Patients With Multiple Myeloma Receiving Immunomodulatory Therapy","volume":"9","author":"Cornell","year":"2019","journal-title":"Front. Oncol."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Parisi, M.S., Leotta, S., Romano, A., Del Fabro, V., Martino, E.A., Calafiore, V., Giubbolini, R., Markovic, U., Leotta, V., and Di Giorgio, M.A. (2019). Clinical Benefit of Long-Term Disease Control with Pomalidomide and Dexamethasone in Relapsed\/Refractory Multiple Myeloma Patients. J. Clin. Med., 8.","DOI":"10.3390\/jcm8101695"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1007\/s12185-018-2416-4","article-title":"Pomalidomide with or without dexamethasone for relapsed\/refractory multiple myeloma in Japan: A retrospective analysis by the Kansai Myeloma Forum","volume":"107","author":"Kuroda","year":"2018","journal-title":"Int. J. Hematol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1111\/ejh.13039","article-title":"Efficacy, safety, and cost of pomalidomide in relapsed and refractory multiple myeloma","volume":"100","author":"Gueneau","year":"2018","journal-title":"Eur. J. Haematol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1007\/s11239-017-1534-9","article-title":"Use of direct oral anticoagulants in patients on immunomodulatory agents","volume":"44","author":"Man","year":"2017","journal-title":"J. Thromb. Thrombolysis"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1056\/NEJMoa1411321","article-title":"Carfilzomib, lenalidomide, and dexamethasone for relapsed multiple myeloma","volume":"372","author":"Stewart","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Conticello, C., Romano, A., Del Fabro, V., Martino, E.A., Calafiore, V., Sapienza, G., Leotta, V., Parisi, M.S., Markovic, U., and Garibaldi, B. (2019). Feasibility, Tolerability and Efficacy of Carfilzomib in Combination with Lenalidomide and Dexamethasone in Relapsed Refractory Myeloma Patients: A Retrospective Real-Life Survey of the Sicilian Myeloma Network. J. Clin. Med., 8.","DOI":"10.3390\/jcm8060877"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"980","DOI":"10.1001\/jamaoncol.2016.3350","article-title":"Cardiovascular and Thrombotic Complications of Novel Multiple Myeloma Therapies: A Review","volume":"3","author":"Li","year":"2017","journal-title":"JAMA Oncol."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Fotiou, D., Gavriatopoulou, M., and Terpos, E. (2020). Multiple Myeloma and Thrombosis: Prophylaxis and Risk Prediction Tools. Cancers, 12.","DOI":"10.3390\/cancers12010191"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1007\/s11239-019-01891-0","article-title":"What are the difficulties in conducting randomised controlled trials of thromboprophylaxis in myeloma patients and how can we address these? Lessons from apixaban versus LMWH or aspirin as thromboprophylaxis in newly diagnosed multiple myeloma (TiMM) feasibility clinical trial","volume":"48","author":"Sayar","year":"2019","journal-title":"J. Thromb. Thrombolysis"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1182\/blood.2020005125","article-title":"Thrombosis in Patients with Myeloma Treated in the Myeloma IX and Myeloma XI Phase III Randomized Controlled Trials","volume":"136","author":"Bradbury","year":"2020","journal-title":"Blood"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1176","DOI":"10.1002\/ajh.25603","article-title":"Predicting venous thromboembolism in multiple myeloma: Development and validation of the IMPEDE VTE score","volume":"94","author":"Sanfilippo","year":"2019","journal-title":"Am. J. Hematol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"840","DOI":"10.6004\/jnccn.2018.7273","article-title":"Derivation and Validation of a Risk Assessment Model for Immunomodulatory Drug-Associated Thrombosis Among Patients with Multiple Myeloma","volume":"17","author":"Li","year":"2019","journal-title":"J. Natl. Compr. Cancer Netw."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1002\/ajh.25459","article-title":"Apixaban for the prevention of thromboembolism in immunomodulatory-treated myeloma patients: Myelaxat, a phase 2 pilot study","volume":"94","author":"Pegourie","year":"2019","journal-title":"Am. J. Hematol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1016\/S0741-5214(95)70195-8","article-title":"Reporting standards in venous disease: An update. International Consensus Committee on Chronic Venous Disease","volume":"21","author":"Porter","year":"1995","journal-title":"J. Vasc. Surg."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1002\/cncr.26302","article-title":"Prophylactic recombinant erythropoietin therapy and thalidomide are predictors of venous thromboembolism in patients with multiple myeloma: Limited effectiveness of thromboprophylaxis","volume":"118","author":"Anaissie","year":"2012","journal-title":"Cancer"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1038\/s41408-020-0273-x","article-title":"Developments in continuous therapy and maintenance treatment approaches for patients with newly diagnosed multiple myeloma","volume":"10","author":"Dimopoulos","year":"2020","journal-title":"Blood Cancer J."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/9\/2876\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:07:12Z","timestamp":1760177232000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/9\/2876"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9,5]]},"references-count":56,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2020,9]]}},"alternative-id":["jcm9092876"],"URL":"https:\/\/doi.org\/10.3390\/jcm9092876","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,9,5]]}}}