Effects of Anticoagulant Preventive Injection in Patients With Blood Cancer (METRO B)

Centre Hospitalier Universitaire de Saint Etienne

Status and phase: Completed; Phase 2

Conditions: Multiple Myeloma; Lymphoma

Treatments: Other: Blood sample; Drug: Tinzaparin

Study type: Interventional

Funder types: Other; Industry

Identifiers

NCT02260414

2014-000946-31 (EudraCT Number)

1408049

Details and patient eligibility

About

In cancer, the incidence of venous thromboembolism (VTE) is particularly high in patients with myeloma, especially when it is de novo and treated with thalidomide, lenalidomide or erythropoietin. Curiously, the prevention of VTE with LMWH (low-molecular-weight heparin) in myeloma seems no more effective than that achieved with aspirin, while the effectiveness of the latter in the primary prevention of VTE has never been demonstrated regardless of the type of population considered. Meanwhile, a biological study showed that prophylactic doses of LMWH in patients with different types of cancer did not always optimal reduction of thrombin peak during the 24 hours following the injection of LMWH. These clinical and biological studies lead to the conclusion that patients with myeloma may be resistant to the usual doses of preventive LMWH, which may explain the failure of prevention.

Initially we intend to investigate whether this resistance to prophylactic doses of LMWH is present in patient's biology and if this resistance is specific to myeloma in hematological cancers. For this, we propose to study the evolution of thrombin generation by Thrombinography during 24 hours after subcutaneous injection of 4500 anti-Xa IU Tinzaparin in 6 patients with de novo myeloma whit high thrombo embolic risk ie treated with thalidomide, lenalidomide or erythropoietin. LMWH is Tinzaparin chosen because it does not accumulate in patients with impaired renal function, and has a greater anti-biological activity thrombotic than other LMWH.

To assess whether the observed pattern of thrombin generation is particularly multiple myeloma, we will take the same study in 6 patients with aggressive lymphoma and 6 medical patients hospitalized for acute heart and respiratory failure.

Enrollment: 19 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

1. Body weight between 40 and 100 kg
2. Patient:

2a- With multiple myeloma indication with de novo standard treatment thalidomide or lenalidomide or erythropoietin (group 1) 2b- Or hospitalized for aggressive lymphoma treated with chemotherapy (group 2) 2c- Or older than 40 years and hospitalized at least three days for an acute medical pathology type of acute respiratory or cardiac (group 3) decompensation

Exclusion criteria

• Patient requiring anticoagulant therapy at curative doses
• Patients with a lower platelet count 80 G / L
• Subject with a history of heparin-induced thrombocytopenia
• Subject with a history of hemorrhagic disease
• History of severe trauma within 6 weeks prior to enrollment
• Organic lesion at risk of bleeding
• Poor renal with creatinine clearance <30 ml / min
• Hypersensitivity to Tinzaparin
• Events or bleeding tendencies associated with coagulation disorders
• Subject on oral anticoagulant
• For group 3: Presence of hematological malignancy or active cancer

Trial design

Primary purpose: Basic Science

Allocation: Non-Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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19 participants in 3 patient groups

Patients with multiple myeloma

Experimental group

Description:

Patient with multiple myeloma indication with de novo standard treatment thalidomide or lenalidomide or erythropoietin treated with one injection of 4500 IU tinzaparin and blood samples taken at hours : 0, 3, 8, 18 and 24 after subcutaneous injection of tinzaparin

Treatment:

Other: Blood sample

Drug: Tinzaparin

Patients with agressive lymphoma

Active Comparator group

Description:

Patient hospitalized for aggressive lymphoma treated with chemotherapy treated with one injection of 4500 IU tinzaparin and blood samples taken at hours : 0, 3, 8, 18 and 24 after subcutaneous injection of tinzaparin

Treatment:

Other: Blood sample

Drug: Tinzaparin

Patients with acute medical condition

Active Comparator group

Description:

Patient older than 40 years and hospitalized at least three days for an acute medical pathology type of acute respiratory or cardiac treated with one injection of 4500 IU tinzaparin and blood samples taken at hours : 0, 3, 8, 18 and 24 after subcutaneous injection of tinzaparin

Treatment:

Other: Blood sample

Drug: Tinzaparin