Comparative Analysis and Validation of the IMPEDED VTE, IMPEDE VTE, and SAVED Risk Models in Predicting Venous Thromboembolism in Multiple Myeloma Patients: A Retrospective Study in Türkiye

Background: Several thrombotic risk assessment models have been proposed for identifying patients with a high risk of thrombosis (the IMPEDE venous thromboembolism (VTE), SAVED, and PRISM scores) in multiple myeloma (MM). Recently, adding a biomarker (D-dimer) for the IMPEDE VTE score has shown that it can boost the detection power of IMPEDED VTE. However, data from studies comparing these models in MM are scarce. Even real-world data arguing the utility of thrombotic risk assessment models in MM from low- or middle-income countries like Türkiye are lacking. Methods: We aimed to show the possibility of detecting VTE using the IMPEDED VTE score in our cohort by retrospectively screening MM patients. Therefore, we aimed to compare the IMPEDE VTE, SAVED and IMPEDED VTE scoring models. Results: We conducted a retrospective analysis of 455 MM patients from three centers in Bursa, Türkiye, evaluating the incidence of VTE within six months of the treatment. The IMPEDED VTE score showed superior predictive accuracy (c-statistic of 0.701), compared to the IMPEDE VTE (0.618) and SAVED (0.633) scores, demonstrating the added value of D-dimer as a biomarker. The cumulative incidence of VTE in the cohort was 10.7%, comparable to rates observed in real-world studies. Conclusions: Despite the interventions and thrombotic risk assessment models, thrombosis remains a high-risk entity. Personalized risk assessment tools, such as IMPEDED VTE, could be used to manage thrombotic risk in MM patients, particularly in resource-limited settings. Albeit the thromboprophylaxis (51.6%), our findings support the utility of biomarker-enhanced models for better VTE-risk stratification, particularly in resource-limited settings.