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VTEs was again observed in later thalidomide trials and led to a protocol amendment that thromboprophylaxis would be initiated for patients receiving thalidomide-based regimens. Patients receiving dexamethasone, which was commonly given in combination with thalidomide, were at particularly high risk for VTEs. A meta-analysis of> 3000 patients with MM showed that thalidomide increased the VTE risk by 2.6 times; when thalidomide was combined with dexamethasone, the VTE risk was increased by 8-fold. 12 Lenalidomide and pomalidomide, potent derivatives of thalidomide, have also demonstrated increased propensity for VTEs. The incidence of VTEs associated with these agents was lower in trials with mandatory thromboprophylaxis (Table).