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Ma S, La J, Swinnerton KN, Guffey D, Bandyo R, Pozas GDL, Hanzelka K, Xiao X, Hernandez CR, Amos CI, Chitalia V, Ravid K, Merriman KW, Flowers CR, Fillmore NR, Li A. Thrombosis risk prediction in lymphoma patients: A multi-institutional, retrospective model development and validation study. Am J Hematol 2024; 99:1230-1239. [PMID: 38654461 PMCID: PMC11166507 DOI: 10.1002/ajh.27335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/05/2024] [Accepted: 03/23/2024] [Indexed: 04/26/2024]
Abstract
Venous thromboembolism (VTE) poses a significant risk to cancer patients receiving systemic therapy. The generalizability of pan-cancer models to lymphomas is limited. Currently, there are no reliable risk prediction models for thrombosis in patients with lymphoma. Our objective was to create a risk assessment model (RAM) specifically for lymphomas. We performed a retrospective cohort study to develop Fine and Gray sub-distribution hazard model for VTE and pulmonary embolism (PE)/ lower extremity deep vein thrombosis (LE-DVT) respectively in adult lymphoma patients from the Veterans Affairs national healthcare system (VA). External validations were performed at the Harris Health System (HHS) and the MD Anderson Cancer Center (MDACC). Time-dependent c-statistic and calibration curves were used to assess discrimination and fit. There were 10,313 (VA), 854 (HHS), and 1858 (MDACC) patients in the derivation and validation cohorts with diverse baseline. At 6 months, the VTE incidence was 5.8% (VA), 8.2% (HHS), and 8.8% (MDACC), respectively. The corresponding estimates for PE/LE-DVT were 3.9% (VA), 4.5% (HHS), and 3.7% (MDACC), respectively. The variables in the final RAM included lymphoma histology, body mass index, therapy type, recent hospitalization, history of VTE, history of paralysis/immobilization, and time to treatment initiation. The RAM had c-statistics of 0.68 in the derivation and 0.69 and 0.72 in the two external validation cohorts. The two models achieved a clear differentiation in risk stratification in each cohort. Our findings suggest that easy-to-implement, clinical-based model could be used to predict personalized VTE risk for lymphoma patients.
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Affiliation(s)
- Shengling Ma
- Section of Hematology-Oncology, Baylor College of Medicine, Houston, TX
| | - Jennifer La
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Kaitlin N Swinnerton
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA
| | - Danielle Guffey
- Institute for Clinical & Translational Research, Baylor College of Medicine, Houston, TX
| | | | - Giordana De Las Pozas
- Department of Cancer Registry, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Katy Hanzelka
- Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Xiangjun Xiao
- Institute for Clinical & Translational Research, Baylor College of Medicine, Houston, TX
| | | | - Christopher I Amos
- Institute for Clinical & Translational Research, Baylor College of Medicine, Houston, TX
- Section of Epidemiology and Population Science, Baylor College of Medicine, Houston, TX
| | - Vipul Chitalia
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA
- Department of Medicine and Whitaker Cardiovascular Institute, Boston University Chobanian and Advedisian School of Medicine, Boston, MA
- Institute of Medical Engineering and Sciences, Massachusetts Institute of Technology, Cambridge, MA
| | - Katya Ravid
- Department of Medicine and Whitaker Cardiovascular Institute, Boston University Chobanian and Advedisian School of Medicine, Boston, MA
| | - Kelly W Merriman
- Department of Cancer Registry, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Christopher R Flowers
- Department of Lymphoma-Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Nathanael R Fillmore
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Ang Li
- Section of Hematology-Oncology, Baylor College of Medicine, Houston, TX
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2
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Fukatsu M, Ikezoe T. Cancer-associated thrombosis in hematologic malignancies. Int J Hematol 2024; 119:516-525. [PMID: 38270784 DOI: 10.1007/s12185-023-03690-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/01/2023] [Accepted: 12/18/2023] [Indexed: 01/26/2024]
Abstract
Patients with hematologic malignancies are often complicated not only by severe bleeding due to thrombocytopenia and disseminated intravascular coagulation but also by thromboembolic events, just like in patients with solid cancers, and these events can negatively impact patient outcomes. Nevertheless, the prevention and treatment of cancer-associated thrombosis (CAT) in hematologic malignancies has not been adequately investigated due to the limited size, heterogeneity, and unique pathophysiology of the patient population. This article summarizes the current understanding, risk factors, prediction models, and optimal prevention and treatment strategies of CAT in hematologic malignancies on a disease-by-disease basis, including acute leukemia, lymphoma, myeloma, and myeloproliferative neoplasms. Specific considerations of novel molecular targeted therapeutics introduced in recent years, such as immunomodulatory drugs and tyrosine kinase inhibitors, are also discussed based on the latest clinical trials.
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Affiliation(s)
- Masahiko Fukatsu
- Department of Hematology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
| | - Takayuki Ikezoe
- Department of Hematology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
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Sánchez Prieto I, Gutiérrez Jomarrón I, Martínez Vázquez C, Rodríguez Barquero P, Gili Herreros P, García-Suárez J. Comprehensive evaluation of genetic and acquired thrombophilia markers for an individualized prediction of clinical thrombosis in patients with lymphoma and multiple myeloma. J Thromb Thrombolysis 2024:10.1007/s11239-024-02977-0. [PMID: 38676874 DOI: 10.1007/s11239-024-02977-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/02/2024] [Indexed: 04/29/2024]
Abstract
Patients diagnosed with lymphoma or multiple myeloma are at elevated risk of venous thromboembolism (VTE). Optimum risk stratification and effective thromboprophylaxis can only be achieved through the development of a multiple-specific risk score that successfully captures all aspects of the heterogeneous prothrombotic environment existing in these patients. Our aim was to identify risk factors for thrombosis and suggest an improved tool combining clinical data, thrombo-inflammatory biomarkers and genetic (Thrombo inCode® test) variables for predicting thrombotic risk in patients with lymphoma and multiple myeloma. A prospective longitudinal study was conducted on newly-diagnosed lymphoma and multiple myeloma patients who presented at our institution between February 2020 and January 2021. The study included 47 patients with lymphoma and 16 patients with multiple myeloma. We performed a follow-up of 1 year or until September 2021. The incidence of venous thrombosis and associated risk factors were analysed, including the genetic Thrombo inCode® test. Khorana and ThroLy scores for lymphoma patients and IMPEDE VTE score for myeloma patients were calculated. At a median follow-up of 9.1 months, VTE incidence was 9.5% (6/63), with 4 and 2 patients with lymphoma and myeloma who developed the events, respectively. Univariate analysis showed that the incidence of thrombosis was significantly higher in patients with ECOG ≥ 2 and prior immobility. Median factor VIII levels were significantly higher in patients with thrombosis (with increased values in all of them). Moreover, there was a trend in genetic variant rs5985 (factor XIII) as a protective factor, and a trend to higher thrombotic risk in patients with factor V Leiden, rs2232698 variant (serpinA10), low total protein S activity, elevated D-dimer, aggressive lymphoma and treatment with dexamethasone. The results of our study demonstrate promise for the potential use of widely accessible markers to increase precision in risk prediction for VTE in patients with lymphoma and multiple myeloma, particularly ECOG ≥ 2, immobility and higher factor VIII levels, as well as lymphoma aggressiveness, treatment with dexamethasone and the haemostatic biomarkers D-dimer and total protein S activity. Additionally, genetic variants factor V Leiden, serpinA10 rs2232698 and factor XIII-A Val34Leu warrant further investigation for use in the research setting.
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Affiliation(s)
- Irene Sánchez Prieto
- Hematology Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain.
| | - Isabel Gutiérrez Jomarrón
- Hematology Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Celia Martínez Vázquez
- Hematology Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Pedro Rodríguez Barquero
- Hematology Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Paula Gili Herreros
- Hematology Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Julio García-Suárez
- Hematology Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
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Hantrakun N, Phinyo P, Tantiworawit A, Rattarittamrong E, Chai-Adisaksopha C, Rattanathammethee T, Hantrakool S, Piriyakhuntorn P, Punnachet T, Niprapan P, Norasetthada L. Incidence of venous thromboembolism and predictive ability of age-adjusted international prognostic index for prediction of venous thromboembolism in Asian patients with diffuse large B-cell lymphoma. J Thromb Thrombolysis 2024; 57:473-482. [PMID: 38091158 DOI: 10.1007/s11239-023-02908-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 03/26/2024]
Abstract
Diffuse large B-cell lymphoma (DLBCL) is one of the malignancies at high risk for the development of venous thromboembolism (VTE). We aimed to evaluate the incidence of VTE and the predictive ability of the age-adjusted international prognostic index (aaIPI) for the prediction of VTE among DLBCL patients. This was a retrospective cohort study including adult patients with newly diagnosed DLBCL. Differences in VTE occurrence within one year after diagnosis of DLBCL were estimated across aaIPI groups using the Kaplan-Meier model, Cox's model, and Gray's model with deaths regarded as competing events. Five hundred and ninety-one newly diagnosed DLBCL patients with a median age of 58 (range 16-93) years were included in this study. At a median follow-up time of 365 (range 2-365) days, VTE events were objectively diagnosed in 32 patients, giving a one-year cumulative incidence of VTE of 5.4% (95% confidence interval [CI], 3.7-7.6). Patients with aaIPI ≥ 2 had a significantly higher risk of VTE than patients with aaIPI < 2 (hazard ratio, 3.5; 95% CI, 1.6-7.8; p = 0.001 based on Cox's model and sub-distribution hazard ratio, 3.0; 95% CI, 1.3-6.7; p = 0.007 using Gray's model). The C-statistic of aaIPI was 0.65 (95% CI, 0.58-0.72). We demonstrated that the incidence of VTE in Asian DLBCL patients was not uncommon. The aaIPI was effective in determining the risk of VTE in DLBCL patients, even when including death as a competing event. aaIPI may be helpful in identifying patients at higher risk of VTE in DLBCL patients.
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Affiliation(s)
- Nonthakorn Hantrakun
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Phichayut Phinyo
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Center for Clinical Epidemiology and Clinical Statistic, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Adisak Tantiworawit
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Ekarat Rattarittamrong
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Chatree Chai-Adisaksopha
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Thanawat Rattanathammethee
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sasinee Hantrakool
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pokpong Piriyakhuntorn
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Teerachat Punnachet
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Piangrawee Niprapan
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Lalita Norasetthada
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
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Qin X, Gao X, Yang Y, Ou S, Luo J, Wei H, Jiang Q. Developing a risk assessment tool for cancer-related venous thrombosis in China: a modified Delphi-analytic hierarchy process study. BMC Cancer 2024; 24:120. [PMID: 38263026 PMCID: PMC10807161 DOI: 10.1186/s12885-024-11877-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/13/2024] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVE To develop a Risk Assessment Tool for Cancer-related Venous Thrombosis in China. METHODS A modified two-round Delphi method was employed to establish consensus within a field to reach an agreement via a questionnaire or by interviewing a multidisciplinary panel of experts by collecting their feedback to inform the next round, exchanging their knowledge, experience, and opinions anonymously, and resolving uncertainties. Furthermore, The AHP (Analytic Hierarchy Process) was used to determine the final quality indicators' relative importance. RESULTS The expert's positive coefficient was 85.19% in the first round and 82.61% in the second round, with authoritative coefficients of 0.89 and 0.92 in the respective surveys. The P-value of Kendall's W test was all less than 0.001 for each round, and the W-value for concordance at the end of the two rounds was 0.115. The final Risk Assessment Tool for Cancer-related Venous Thrombosis consisted of three domains, ten subdomains, and 39 indicators, with patient factors weighing 0.1976, disease factors weighing 0.4905, and therapeutic factors weighing 0.3119. CONCLUSION The tool is significantly valid and reliable with a strong authority and coordination degree, and it can be used to assess the risk of cancer-related VTE and initiate appropriate thrombophylactic interventions in China.
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Affiliation(s)
- Xiaoli Qin
- Department of Pharmacy, The Third People's Hospital of Chengdu, 610031, Chengdu, Sichuan, P.R. China
- School of Pharmacy, Chengdu Medical College, 610500, Chengdu, Sichuan, P.R. China
| | - Xiurong Gao
- School of Pharmacy, Chengdu Medical College, 610500, Chengdu, Sichuan, P.R. China
| | - Yujie Yang
- Department of Pharmacy, The Third People's Hospital of Chengdu, 610031, Chengdu, Sichuan, P.R. China
| | - Shunlong Ou
- Department of Pharmacy, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, 610041, Chengdu, Sichuan, P.R. China
| | - Jing Luo
- Department of Pharmacy, The Second People's Hospital of Yibin, 644000, Yibin, Sichuan, P.R. China
| | - Hua Wei
- Department of Pharmacy, Chengdu Second People's Hospital, 610011, Chengdu, Sichuan, P.R. China
| | - Qian Jiang
- Department of Pharmacy, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, 610041, Chengdu, Sichuan, P.R. China.
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6
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Drăgan A, Drăgan AŞ. Novel Insights in Venous Thromboembolism Risk Assessment Methods in Ambulatory Cancer Patients: From the Guidelines to Clinical Practice. Cancers (Basel) 2024; 16:458. [PMID: 38275899 PMCID: PMC10813930 DOI: 10.3390/cancers16020458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/07/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024] Open
Abstract
Many cancer patients will experience venous thromboembolism (VTE) at some stage, with the highest rate in the initial period following diagnosis. Novel cancer therapies may further enhance the risk. VTE in a cancer setting is associated with poor prognostic, a decreased quality of life, and high healthcare costs. If thromboprophylaxis in hospitalized cancer patients and perioperative settings is widely accepted in clinical practice and supported by the guidelines, it is not the same situation in ambulatory cancer patient settings. The guidelines do not recommend primary thromboprophylaxis, except in high-risk cases. However, nowadays, risk stratification is still challenging, although many tools have been developed. The Khrorana score remains the most used method, but it has many limits. This narrative review aims to present the current relevant knowledge of VTE risk assessment in ambulatory cancer patients, starting from the guideline recommendations and continuing with the specific risk assessment methods and machine learning models approaches. Biomarkers, genetic, and clinical features were tested alone or in groups. Old and new models used in VTE risk assessment are exposed, underlining their clinical utility. Imaging and biomolecular approaches to VTE screening of outpatients with cancer are also presented, which could help clinical decisions.
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Affiliation(s)
- Anca Drăgan
- Department of Cardiovascular Anaesthesiology and Intensive Care, Emergency Institute for Cardiovascular Diseases “Prof. Dr. C C Iliescu”, 258 Fundeni Road, 022328 Bucharest, Romania
| | - Adrian Ştefan Drăgan
- Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd, 050474 Bucharest, Romania;
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Ma’koseh M, Abufara A, Albaghdadi D, Ghalayni R, Abdel-Razeq S, Alzughali E, Abdel Rahman F, Alhalaseh Y, Halahleh K, Abdel-Razeq H. The Application of Existing Risk Assessment Models (RAMS) to Predict the Occurrence of Venous Thromboembolic Events among Patients with Classic Hodgkin Lymphoma. J Clin Med 2024; 13:436. [PMID: 38256570 PMCID: PMC10816014 DOI: 10.3390/jcm13020436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 12/06/2023] [Accepted: 12/25/2023] [Indexed: 01/24/2024] Open
Abstract
Background: A majority of patients included in risk assessment models (RAMs) developed to predict venous thromboembolic events (VTE) in lymphoma were non-Hodgkin lymphoma. Our study aims to evaluate the incidence and predictors of VTE, utilizing different RAMs, in patients with classic Hodgkin lymphoma (cHL) treated with adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD). Methods: Adult patients with cHL, treated and followed at our center, were included. Correlations between different variables, Khorana score, and thrombosis in lymphoma (ThroLy) RAMs with VTE were examined using Fisher's exact test and logistic regression analysis. Results: A total of 321 patients were included, with a median age of 29 (range: 18-83) years. Of them, 169 (52.6%) had advanced-stage disease. Combined modality treatment was given to 169 (52.6%) patients. A total of 52 (16.2%) patients had relapsed or refractory disease. VTE were reported in 15 (4.7%) patients and were mostly during the administration of first-line (n = 8, 53.3%), or salvage chemotherapy (n = 6, 40.0%). There was no correlation between a Khorana score > 2 (p = 0.689) or ThroLy score > 3 (p = 0.335) and VTE. Older age (p = 0.014) and relapsed or refractory disease (p = 0.003) significantly correlated with VTE. Conclusions: VTE are uncommon in cHL. The commonly used RAMs failed to predict VTE. However, older age and relapsed or refractory disease significantly increased this risk.
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Affiliation(s)
- Mohammad Ma’koseh
- Department of Internal Medicine, King Hussein Cancer Center, Amman 11941, Jordan; (M.M.); (A.A.); (D.A.); (R.G.); (E.A.); (Y.A.); (K.H.)
- School of Medicine, The University of Jordan, Amman 11942, Jordan;
| | - Alaa Abufara
- Department of Internal Medicine, King Hussein Cancer Center, Amman 11941, Jordan; (M.M.); (A.A.); (D.A.); (R.G.); (E.A.); (Y.A.); (K.H.)
| | - Dana Albaghdadi
- Department of Internal Medicine, King Hussein Cancer Center, Amman 11941, Jordan; (M.M.); (A.A.); (D.A.); (R.G.); (E.A.); (Y.A.); (K.H.)
| | - Ruba Ghalayni
- Department of Internal Medicine, King Hussein Cancer Center, Amman 11941, Jordan; (M.M.); (A.A.); (D.A.); (R.G.); (E.A.); (Y.A.); (K.H.)
| | | | - Eman Alzughali
- Department of Internal Medicine, King Hussein Cancer Center, Amman 11941, Jordan; (M.M.); (A.A.); (D.A.); (R.G.); (E.A.); (Y.A.); (K.H.)
| | - Fadwa Abdel Rahman
- Department of Radiation Oncology, King Hussein Cancer Center, Amman 11941, Jordan;
| | - Yazan Alhalaseh
- Department of Internal Medicine, King Hussein Cancer Center, Amman 11941, Jordan; (M.M.); (A.A.); (D.A.); (R.G.); (E.A.); (Y.A.); (K.H.)
| | - Khalid Halahleh
- Department of Internal Medicine, King Hussein Cancer Center, Amman 11941, Jordan; (M.M.); (A.A.); (D.A.); (R.G.); (E.A.); (Y.A.); (K.H.)
| | - Hikmat Abdel-Razeq
- Department of Internal Medicine, King Hussein Cancer Center, Amman 11941, Jordan; (M.M.); (A.A.); (D.A.); (R.G.); (E.A.); (Y.A.); (K.H.)
- School of Medicine, The University of Jordan, Amman 11942, Jordan;
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8
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López Sacerio A, Tejeda Ramón MC, Morales Helguera A, Pérez Castillo Y, Cruz Rodríguez J, Guerra Rodríguez JF, Falanga A. Validation of venous thromboembolism predictive model in hematologic malignancies. Ann Hematol 2023; 102:3613-3620. [PMID: 37782372 DOI: 10.1007/s00277-023-05463-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 09/17/2023] [Indexed: 10/03/2023]
Abstract
Although several scores stratify venous thromboembolism (VTE) risk in solid tumors, hematologic malignancies (HM) are underrepresented. To develop an internal and external validation of a logistic regression model to predict VTE risk in hospitalized HM patients. Validation of the existing VTE predictive model was performed through a prospective case-control study in 496 hospitalized HM patients between December 2010 and 2020 at the Arnaldo Milián University Hospital, Cuba. The predictive model designed with data from 285 patients includes 5 predictive factors: hypercholesterolemia, tumoral activity, use of thrombogenic drugs, diabetes mellitus, and immobilization. The model was internally validated using bootstrap analysis. External validation was realized in a prospective cohort of 211 HM patients. The predictive model had a 76.4% negative predictive value (NPV) and an 81.7% positive predictive value (PPV) in the bootstrapping validation. The area under curve (AUC) in the bootstrapping set was 0.838. Accuracy was 80.1% and 82.9% in the internal and external validation, respectively. In the external validation, the model produced 89.7% of NPV, 67.7% of PPV, 74.6% of sensitivity, and 86.2% of specificity. The AUC in the external validation was 0.900. VTE predictive model is a reproducible and simple tool with good accuracy and discrimination.
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Affiliation(s)
| | | | | | - Yunierkis Pérez Castillo
- Bio-Chemoinformatics Group and School of Physical and Mathematical Sciences, University of Las Américas, Quito, Ecuador
| | | | | | - Anna Falanga
- Department of Transfusion Medicine and Hematology, Hospital Papa Giovanni XXIII, Bergamo, Italy
- University of Milan Bicocca, Monza, Italy
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9
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Krayem B, Brenner B, Horowitz NA. Thrombosis in Pregnant Women with Hematological Malignancies: A Case-Based Review. Semin Thromb Hemost 2022; 49:348-354. [PMID: 36535649 DOI: 10.1055/s-0042-1759683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AbstractCancer and pregnancy induce a procoagulant environment which may lead to maternal and fetal complications, such as venous thromboembolism, fetal growth restriction, and fetal loss. The incidence of hematological malignancies diagnosed during pregnancy is rising, and thrombotic events in such malignancies are not rare. Management of thrombosis during pregnancy poses a therapeutic challenge, that is further exacerbated by the impact of cancer. The available data on managing pregnant women with hematological malignancies are limited to those with myeloproliferative neoplasms, mainly essential thrombocythemia, and, to a lesser extent, polycythemia vera. Low-dose aspirin is recommended throughout pregnancy, and considering treatment with low-molecular-weight heparin and interferon formulations is advised for high-risk patients. Currently, guidelines for handling thrombotic events in pregnant women with lymphoma or leukemia are lacking, and their management is based on data extrapolated from retrospective studies, and guidelines for prevention and treatment of cancer-associated thrombosis. The present case-based review will focus on the complex issue of thrombotic risk in pregnant women with hematological malignancies, specifically myeloproliferative neoplasms, lymphomas, and leukemias.
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Affiliation(s)
- Baher Krayem
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
| | - Benjamin Brenner
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Netanel A. Horowitz
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
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10
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Sanfilippo KM, Wang TF, Carrier M, Falanga A, Gage BF, Khorana AA, Maraveyas A, Soff GA, Wells PS, Zwicker JI. Standardization of risk prediction model reporting in cancer-associated thrombosis: Communication from the ISTH SSC subcommittee on hemostasis and malignancy. J Thromb Haemost 2022; 20:1920-1927. [PMID: 35635332 DOI: 10.1111/jth.15759] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 11/27/2022]
Abstract
Since the development of the Khorana score to predict risk of cancer-associated venous thromboembolism (VTE), many modified and de novo risk prediction models (RPMs) have been proposed. Comparison of the prognostic performance across models requires comprehensive reporting and standardized methods for model development, validation and evaluation. To improve the standardization of RPM reporting, the Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis (TRIPOD) tool was published in 2015. To better understand the quality of reporting and development of RPMs for cancer-associated VTE, we performed a literature search of published RPMs and assessed each model using the TRIPOD checklist. Our results yielded 29 RPMs for which 30 items were evaluated. There was a non-significant (p = 0.15) improvement in reporting of the 30 items in the post-TRIPOD era (81%) versus the pre-TRIPOD era (75%). Of seven items (title, sample size, missing data handling, baseline demographics, methods and results for model performance, and supplemental resources) with the lowest reporting in the pre-TRIPOD era (<70%), there was an average improvement of 22% in the post-TRIPOD era. Only two of the 22 studies published in the post-TRIPOD era acknowledged compliance with TRIPOD. Informed by the results of this assessment, the Scientific and Standardization Committee (SSC) Subcommittee on Hemostasis & Malignancy of the International Society on Thrombosis and Hemostasis (ISTH) advocates for standardization of four key elements of RPMs for cancer-associated VTE: (1) inclusion of the TRIPOD checklist, (2) clear definition of the derivation population, with justification of sample size, (3) clear definition of predictors, and (4) external validation prior to implementation.
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Affiliation(s)
- Kristen M Sanfilippo
- Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA
- John Cochran Saint Louis Veterans Administration Medical Center, Saint Louis, Missouri, USA
| | - Tzu-Fei Wang
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Marc Carrier
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Anna Falanga
- Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
- Department of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Brian F Gage
- Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Alok A Khorana
- Taussig Cancer Institute, Cleveland Clinic and Case Comprehensive Cancer Center, Cleveland, Ohio, USA
| | - Anthony Maraveyas
- Faculty of Health Sciences, Joint Centre for Cancer Studies, The Hull York Medical School, Castle Hill Hospital, Hull, UK
| | - Gerald A Soff
- Department of Medicine, University of Miami Health System/Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Phillip S Wells
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Jeffrey I Zwicker
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
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11
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Falanga A, Brenner B, Khorana AA, Francis C. Thrombotic complications in patients with cancer: Advances in pathogenesis, prevention, and treatment—A report from ICTHIC 2021. Res Pract Thromb Haemost 2022; 6:e12744. [PMID: 35794962 PMCID: PMC9248072 DOI: 10.1002/rth2.12744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/28/2022] [Accepted: 05/03/2022] [Indexed: 11/05/2022] Open
Abstract
Venous thromboembolism (VTE) is a common complication in cancer patients, resulting in deep vein thrombosis (DVT) or pulmonary embolism (PE), and is responsible for high morbidity and mortality. This article discusses evidence and future perspectives on pathogenesis and prevention and treatment of thrombotic complications in patients with cancer. In April 2021, international basic researchers and clinicians met for the virtual edition of the 10th International Conference on Thrombosis & Hemostasis Issues in Cancer. Pathogenic mechanisms, markers and scores for risk assessment, diagnosis and therapy issues, current prophylaxis recommendations, and special settings, such as palliative care, pediatrics, and COVID‐19 patients were discussed. Emerging areas of interest in cancer associated VTE are the role of immunotherapy, platelet activation markers, genetic alterations and real‐world systems‐based approaches to prevention and treatment.
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Affiliation(s)
- Anna Falanga
- Division of Immunohematology and Transfusion Medicine Hospital Papa Giovanni XXIII Bergamo Italy
- Department of Medicine and Surgery University of Milan Bicocca Milan Italy
| | - Benjamin Brenner
- Department of Hematology and Bone Marrow Transplantation Rambam Health Care Campus Haifa Israel
| | - Alok A. Khorana
- Taussig Cancer Institute Cleveland Clinic Lerner College of Medicine Cleveland Clinic Cleveland Ohio USA
| | - Charles W. Francis
- James P Wilmot Cancer Center and University of Rochester Rochester NY USA
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12
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Pénichoux J, Rio J, Kammoun L, Vermeulin T, Pepin LF, Camus V, Dubois S, Bouclet F, Alani M, Contentin N, Leprêtre S, Stamatoullas A, Lanic H, Lemasle E, Ménard AL, Lenain P, Gilles-Baray M, Georgescu D, Clatot F, Tilly H, Jardin F. Retrospective analysis of the safety of peripherally inserted catheters versus implanted port catheters during first-line treatment for patients with diffuse large B-cell lymphoma. Eur J Haematol 2022; 109:41-49. [PMID: 35285085 PMCID: PMC9313835 DOI: 10.1111/ejh.13767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/07/2022] [Accepted: 03/09/2022] [Indexed: 11/29/2022]
Abstract
Objectives Both peripherally inserted central catheters (PICCs) and implanted port catheters (PORTs) are commonly used for the delivery of immunochemotherapy. We compared the safety of the two types of devices in a homogeneous and monocentric population of diffuse large B‐cell lymphoma (DLBCL) patients who were treated with first‐line immunochemotherapy by evaluating the numbers of catheter‐related venous thromboses (VTs) and infections that occurred in the six months after implantation according to the type of device. Methods Using a propensity score, the adjusted relative risk (ARR) between the type of catheter and the occurrence of catheter‐related complications (infection and/or VT) of interest was retrospectively determined. Results 479 patients were enrolled (266 PORTs/213 PICCs), and 26 VTs (5.4%) and 30 infections (6.3%) were identified in the period following PICC/PORT implantation. The adjusted relative risk (ARR) of catheter‐related complications (infection and/or VT) according to the type of device was 2.6 (95% CI =1.3–5.9, p = .0075). This risk increase associated with the PICC device was significant for both infections (ARR = 3.2; 95% CI = 1.3–10.9) and thrombosis (ARR = 4; 95% CI = 1.5–11.6). Conclusion Our study supports the preferential use of PORTs for the first line of treatment for DLBCL patients.
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Affiliation(s)
- Juliette Pénichoux
- Department of Clinical Haematology, Centre Henri Becquerel, Rouen, France
| | - Julien Rio
- Department of Medical Informatics, Centre Henri Becquerel, Rouen, France
| | - Leila Kammoun
- Unit of Clinical Haematology, Centre Hospitalier Eure-Seine, Evreux, France
| | - Thomas Vermeulin
- Department of Medical Informatics, Centre Henri Becquerel, Rouen, France
| | | | - Vincent Camus
- Department of Clinical Haematology, Centre Henri Becquerel, Rouen, France
| | - Sydney Dubois
- Department of Clinical Haematology, Centre Henri Becquerel, Rouen, France
| | - Florian Bouclet
- Department of Clinical Haematology, Centre Henri Becquerel, Rouen, France
| | - Mustafa Alani
- Department of Clinical Haematology, Centre Henri Becquerel, Rouen, France
| | - Nathalie Contentin
- Department of Clinical Haematology, Centre Henri Becquerel, Rouen, France
| | - Stéphane Leprêtre
- Department of Clinical Haematology, Centre Henri Becquerel, Rouen, France
| | | | - Hélène Lanic
- Department of Clinical Haematology, Centre Henri Becquerel, Rouen, France
| | - Emilie Lemasle
- Department of Clinical Haematology, Centre Henri Becquerel, Rouen, France
| | - Anne-Lise Ménard
- Department of Clinical Haematology, Centre Henri Becquerel, Rouen, France
| | - Pascal Lenain
- Department of Clinical Haematology, Centre Henri Becquerel, Rouen, France
| | - Marie Gilles-Baray
- Department of Surgery and Anaesthesia/Intensive Care Unit, Centre Henri Becquerel, Rouen, France
| | - Dragos Georgescu
- Department of Surgery and Anaesthesia/Intensive Care Unit, Centre Henri Becquerel, Rouen, France
| | - Florian Clatot
- Department of Medical Oncology, Centre Henri Becquerel, Rouen, France
| | - Hervé Tilly
- Department of Clinical Haematology, Centre Henri Becquerel, Rouen, France
| | - Fabrice Jardin
- Department of Clinical Haematology, Centre Henri Becquerel, Rouen, France
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13
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Best practice & research: Clinical hematology review on thrombosis and bleeding in hematological malignancy. Best Pract Res Clin Haematol 2022; 35:101353. [DOI: 10.1016/j.beha.2022.101353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/06/2022] [Accepted: 06/13/2022] [Indexed: 01/19/2023]
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14
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Sanfilippo KM. Venous thromboembolism and risk stratification in hematological malignancies. Thromb Res 2022; 213 Suppl 1:S16-S21. [DOI: 10.1016/j.thromres.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/14/2021] [Accepted: 01/05/2022] [Indexed: 11/26/2022]
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15
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Otasevic V, Mihaljevic B, Milic N, Stanisavljevic D, Vukovic V, Tomic K, Fareed J, Antic D. Immune activation and inflammatory biomarkers as predictors of venous thromboembolism in lymphoma patients. Thromb J 2022; 20:20. [PMID: 35439998 PMCID: PMC9016935 DOI: 10.1186/s12959-022-00381-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 04/12/2022] [Indexed: 12/21/2022] Open
Abstract
Background Lymphomas are characterized by elevated synthesis of inflammatory soluble mediators that could trigger the development of venous thromboembolism (VTE). However, data on the relationship between specific immune dysregulation and VTE occurrence in patients with lymphoma are scarce. Therefore, this study aimed to assess the association between inflammatory markers and the risk of VTE development in patients with lymphoma. Methods The erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lactate dehydrogenase (LDH), total protein (TP), and albumin were assessed in 706 patients with newly diagnosed or relapsed lymphoma. Data were collected for all VTE events, while the diagnosis of VTE was established objectively based on radiographic studies. ROC (receiver operating characteristic) curve analysis was performed to define the optimal cutoff values for predicting VTE. Results The majority of patients was diagnosed with aggressive non-Hodgkin lymphoma (58.8%) and had advanced stage disease (59.9%). Sixty-nine patients (9.8%) developed VTE. The NLR, PLR, ESR, CRP, and LDH were significantly higher in the patients with lymphoma with VTE, whereas the TP and albumin were significantly lower in those patients. Using the univariate regression analysis, the NLR, PLR, TP, albumin, LDH, and CRP were prognostic factors for VTE development. In the multivariate regression model, the NLR and CRP were independent prognostic factors for VTE development. ROC curve analysis demonstrated acceptable specificity and sensitivity of the parameters: NLR, PLR, and CRP for predicting VTE. Conclusion Inflammatory dysregulation plays an important role in VTE development in patients with lymphoma. Widely accessible, simple inflammatory parameters can classify patients with lymphoma at risk of VTE development. Supplementary Information The online version contains supplementary material available at 10.1186/s12959-022-00381-3.
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Affiliation(s)
- Vladimir Otasevic
- Lymphoma Center, Clinic for Hematology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Biljana Mihaljevic
- Lymphoma Center, Clinic for Hematology, University Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Natasa Milic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dejana Stanisavljevic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vojin Vukovic
- Lymphoma Center, Clinic for Hematology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Kristina Tomic
- Lymphoma Center, Clinic for Hematology, University Clinical Center of Serbia, Belgrade, Serbia
| | | | - Darko Antic
- Lymphoma Center, Clinic for Hematology, University Clinical Center of Serbia, Belgrade, Serbia. .,Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
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16
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Gangaraju R, Davis ES, Bhatia S, Kenzik KM. Venous-thromboembolism and associated health care utilization in elderly patients with diffuse large B cell lymphoma. Cancer 2022; 128:2348-2357. [PMID: 35363373 DOI: 10.1002/cncr.34210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 02/17/2022] [Accepted: 03/09/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Patients with lymphoma have an increased risk of venous thromboembolism (VTE). The authors examined the risk of VTE and subsequent health care utilization in elderly patients with diffuse large B cell lymphoma (DLBCL). METHODS A total of 5537 DLBCL patients ≥66 years old enrolled in Medicare from the Surveillance, Epidemiology, and End Results registry and a noncancer control group of Medicare beneficiaries (n = 5537) were identified. Cumulative incidence function to examine the risk of VTE 12 months after DLBCL diagnosis was used. Fine and Gray method was used to examine the risk factors associated with VTE risk in multivariable models. Total number of hospitalizations, outpatient visits, and Medicare spending were compared in DLBCL patients with and without VTE. RESULTS VTE was diagnosed in 8.3% DLBCL patients and 1.5% controls, yielding an 8.6-fold higher risk of VTE in DLBCL in adjusted analysis (95% confidence interval [CI], 6.62-11.20; P < .001). Multivariable regression analysis showed that precancer VTE history was associated with an increased risk of developing VTE after a DLBCL diagnosis (hazard ratio [HR], 5.39; 95% CI, 4.39-6.63), and Asian individuals were associated with a lower risk (HR, 0.54; 95% CI, 0.29-1.00). Patients newly diagnosed with VTE after lymphoma had a 1.7-fold higher rate of hospitalization and a 1.2-fold higher rate of outpatient visits compared to those without, resulting in excess Medicare spending of $22,208 in the first year after DLBCL diagnosis. CONCLUSIONS Elderly patients with DLBCL have an elevated risk of VTE resulting in excess health care utilization. VTE history before DLBCL was associated with increased risk of post-DLBCL VTE, and Asian individuals were associated with a lower risk of VTE.
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Affiliation(s)
- Radhika Gangaraju
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama
| | - Elizabeth S Davis
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kelly M Kenzik
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama
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17
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Impacto del perfil mutacional sobre el riesgo trombótico en pacientes con cáncer. Rev Clin Esp 2022. [DOI: 10.1016/j.rce.2021.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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18
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Prevention of venous thromboembolism in hematologic neoplasms: an expert consensus from SEHH-SETH. Clin Transl Oncol 2021; 24:770-783. [PMID: 34850351 DOI: 10.1007/s12094-021-02735-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 11/10/2021] [Indexed: 10/19/2022]
Abstract
Venous thromboembolism (VTE) is a serious complication in hematologic neoplasms, so finding adequate prevention strategies is an urgent requirement. However, prospective studies with large enough cohorts are scarce, limiting the development of evidence-based thromboprophylaxis guidelines. The present position paper is addressed to all hematologists treating patients affected by hematologic neoplasms with the aim to provide clinicians with a useful tool for the prevention of VTE.
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19
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Bastos-Oreiro M, Ortiz J, Pradillo V, Salas E, Marínez-Laperche C, Muñoz A, Buño I, Diéz-Martin JL, Soria JM, Pascual Izquierdo C. Incorporating genetic and clinical data into the prediction of thromboembolism risk in patients with lymphoma. Cancer Med 2021; 10:7585-7592. [PMID: 34598309 PMCID: PMC8559493 DOI: 10.1002/cam4.4280] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 08/14/2021] [Accepted: 08/26/2021] [Indexed: 12/21/2022] Open
Abstract
Background The incorporation of genetic variables into risk scores for predicting venous thromboembolic events (VTE) could improve their capacity to identify those patients for whom thromboprophylaxis would be most beneficial. Proof‐of‐concept of this is provided by the TiC‐ONCO score for predicting the risk of VTE in patients with solid tumours. Our aim was to develop a similarly improved tool—the TiC‐LYMPHO score—for predicting VTE in patients with lymphoma. Methods In a retrospective observational study of 208 patients with lymphoma, 31 (14.9%) were found to have experienced an episode of VTE either at the time of diagnosis or over the next 6 months. Clinical variables associated with VTE, determined via logistic regression analysis, plus the same genetic variables included in the TiC‐ONCO score, were used to build the TiC‐LYMPHO score algorithm. The sensitivity, specificity, predictive values and AUC of the TiC‐LYMPHO, the Khorana and ThroLy scores were compared in the same population. Results The TiC‐LYMPHO score showed a significantly higher AUC, sensitivity and NPV (0.783, 95.35% and 97.98% respectively) than the other scores. The ThroLy score showed a significantly higher specificity (96.43% vs. 54.49%; p < 0.0001) and PPV (37.50% vs. 26.36%; p = 0.0147) than the TiC‐LYMPHO score, whereas its AUC, sensitivity and NPV were significantly lower (0.579, 19.35% and 86.48%, respectively). Conclusion These results show that by incorporating genetic and clinical data into VTE risk assessment, the TiC‐LYMPHO score can categorize patients with lymphoma better in terms of their risk of VTE and allow individualized thromboprophylaxis to be prescribed.
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Affiliation(s)
- Mariana Bastos-Oreiro
- Hematology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain.,Gregorio Marañón Health Research Institute, Madrid, Spain.,Genomics Unit, Hospital General Universitario. Gregorio Marañón, Madrid, Spain.,Cell Biology Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Javier Ortiz
- Hematology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Virginia Pradillo
- Hematology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Eduardo Salas
- Gendiag, S.L. Scientific Department, Barcelona, Spain
| | - Carolina Marínez-Laperche
- Hematology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain.,Gregorio Marañón Health Research Institute, Madrid, Spain
| | - Andrés Muñoz
- Oncology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ismael Buño
- Hematology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain.,Gregorio Marañón Health Research Institute, Madrid, Spain
| | - José Luis Diéz-Martin
- Hematology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain.,Gregorio Marañón Health Research Institute, Madrid, Spain
| | - Jose Manuel Soria
- Hospital Universitario de la Santa Creu I Santa Pau, Barcelona, Spain
| | - Cristina Pascual Izquierdo
- Hematology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain.,Gregorio Marañón Health Research Institute, Madrid, Spain
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20
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Abdel-Razeq H, Ma'koseh M, Mansour A, Bater R, Amarin R, Abufara A, Halahleh K, Manassra M, Alrwashdeh M, Almomani M, Zmaily M. The Application of the ThroLy Risk Assessment Model to Predict Venous Thromboembolism in Patients with Diffuse Large B-Cell Lymphoma. Clin Appl Thromb Hemost 2021; 27:10760296211045908. [PMID: 34590497 PMCID: PMC8642105 DOI: 10.1177/10760296211045908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Patients with aggressive lymphomas are at higher risk for venous
thromboembolism (VTE). ThroLy is a risk assessment model (RAM) derived to
predict the occurrence of VTE in various types of lymphomas. In this study,
we assess the clinical application of ThroLy RAM in a unified group of
patients with diffuse large B-cell lymphoma (DLBCL). Methods Hospital databases were searched for patients with DLBCL and
radiologically-confirmed VTE. Items in the ThroLy RAM, including prior VTE,
reduced mobility, obesity, extranodal disease, mediastinal involvement,
neutropenia and hemoglobin < 10.0 g/dL, were retrospectively
reviewed. Results A total of 524 patients, median age 49 (range: 18-90) years were included.
Patients had high disease burden; 57.3% with stage III/IV and 34.0% with
bulky disease. All were treated on unified guidelines; 63 (12.0%) had
primary refractory disease. Venous thromboembolic events were reported in 71
(13.5%) patients. Among 121 patients with high (> 3) ThroLy score, 22.3%
developed VTE compared to 8.4% and 12.4% in those with low and intermediate
risk scores, respectively (P = .014). Simplifying the
ThroLy model into two risk groups; high-risk (score ≥ 3) and low risk (score
< 3) can still segregate patients; VTE developed in 44 (17.2%) high-risk
patients (n = 256) compared to 27 (10.1%) in the low-risk
group (n = 268), P = .038. Neutropenia, a
component of the ThroLy, was encountered in only 14 (2.7%) patients. Conclusions ThroLy RAM can identify patients with DLBCL at high risk for VTE. Model can
be modified by dividing patients into two, rather than three risk groups,
and further simplified by omitting neutropenia.
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Affiliation(s)
- Hikmat Abdel-Razeq
- 37559King Hussein Cancer Center, Amman, Jordan.,54658The University of Jordan, Amman, Jordan
| | | | - Asem Mansour
- 37559King Hussein Cancer Center, Department of Radiology, Amman, Jordan
| | - Rayan Bater
- 37559King Hussein Cancer Center, Amman, Jordan
| | - Rula Amarin
- 37559King Hussein Cancer Center, Amman, Jordan
| | | | | | | | | | | | - Mais Zmaily
- 37559King Hussein Cancer Center, Department of Radiology, Amman, Jordan
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21
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Páramo JA, Marcos-Jubilar M, Lecumberri R. Impact of the mutation profile on thrombotic risk in cancer patients. Rev Clin Esp 2021; 222:93-99. [PMID: 34548256 DOI: 10.1016/j.rceng.2021.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/16/2021] [Indexed: 10/20/2022]
Abstract
Patients with cancer present with an elevated risk of thrombosis, which entails high morbidity and mortality. Various predictive scales that incorporate clinical and biological data have been developed to identify those at high risk of thrombosis, but, in general, they do not allow for the optimal selection of subjects who are candidates for thromboprophylaxis. Recent studies have demonstrated that the mutation profile has a high impact on the risk of thrombosis; this will facilitate developing new predictive models of thrombosis in patients with cancer.
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Affiliation(s)
- J A Páramo
- Servicio de Hematología, Clínica Universidad de Navarra, Pamplona, Spain.
| | - M Marcos-Jubilar
- Servicio de Hematología, Clínica Universidad de Navarra, Pamplona, Spain
| | - R Lecumberri
- Servicio de Hematología, Clínica Universidad de Navarra, Pamplona, Spain
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22
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Li X, Hou SL, Li X, Li L, Lian K, Cui JY, Wang GG, Yang T. Risk Factors of Thromboembolism in Lymphoma Patients Undergoing Chemotherapy and its Clinical Significance. Clin Appl Thromb Hemost 2021; 27:10760296211037923. [PMID: 34498533 PMCID: PMC8580488 DOI: 10.1177/10760296211037923] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
This study investigated the risk factors of thromboembolism (TE) in lymphoma patients undergoing chemotherapy and its clinical significance. A total of 304 lymphoma patients who received chemotherapy from January 2012 to July 2019 were retrospectively analyzed, including 111 patients with and 193 patients without TE. The clinical characteristics and related laboratory test results were compared between the 2 groups using univariate analysis, while the risk factors for TE in lymphoma patients undergoing chemotherapy were analyzed using multivariate logistic regression analysis. Univariate analysis revealed an increase in the risk of TE among lymphoma patients with chemotherapy in the following categories: female patients, patients with body mass index <18.5 or > 24, patients aged ≥60 years, those with platelet abnormality before chemotherapy, single hospital-stay patients, and Ann Arbor stage III/IV patients. Multivariate logistic regression analysis revealed that for platelet count abnormality before chemotherapy, Ann Arbor stage III/IV and female patients represented independent risk factors for TE among lymphoma patients after chemotherapy (P < .05). For lymphoma patients treated with chemotherapy, the risk of TE occurring in women, patients with platelet abnormalities before chemotherapy, and patients at Ann Arbor stage III/IV was significantly higher compared with other patients. For these patients, we recommend prophylactic anticoagulant therapy.
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Affiliation(s)
- Xiao Li
- Department of Thoracic Oncology, Linfen Central Hospital, Linfen, China
| | - Shu-Ling Hou
- Bethune Hospital Affiliated to Shanxi Medical University, 576225Shanxi Bethune Hospital, Taiyuan, China
| | - Xi Li
- Bethune Hospital Affiliated to Shanxi Medical University, 576225Shanxi Bethune Hospital, Taiyuan, China
| | - Li Li
- Bethune Hospital Affiliated to Shanxi Medical University, 576225Shanxi Bethune Hospital, Taiyuan, China
| | - Ke Lian
- Bethune Hospital Affiliated to Shanxi Medical University, 576225Shanxi Bethune Hospital, Taiyuan, China
| | - Ju-Ya Cui
- Bethune Hospital Affiliated to Shanxi Medical University, 576225Shanxi Bethune Hospital, Taiyuan, China
| | - Gang-Gang Wang
- Bethune Hospital Affiliated to Shanxi Medical University, 576225Shanxi Bethune Hospital, Taiyuan, China
| | - Tao Yang
- Bethune Hospital Affiliated to Shanxi Medical University, 576225Shanxi Bethune Hospital, Taiyuan, China
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How I treat and prevent venous thrombotic complications in patients with lymphoma. Blood 2021; 139:1489-1500. [PMID: 34479364 DOI: 10.1182/blood.2019003689] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 03/08/2021] [Indexed: 11/20/2022] Open
Abstract
Venous thromboembolism (VTE) is a common complication occurring in 5-10% of patients with lymphoma. As the complexity of lymphoma management has increased with novel therapies, so too has the treatment of VTE. Therapeutic options for the treatment of cancer-associated VTE have expanded from only warfarin and low-molecular-weight heparins (LMWHs) to include the direct oral anticoagulants (DOACs) apixaban, edoxaban and rivaroxaban. There have been no head-to-head trials comparing different DOACs in this setting and randomized trials comparing a DOAC with LMWH dalteparin differ in trial design and results. Drug-drug interactions, drug-specific side effects and patient selection are important considerations when prescribing anticoagulant therapy. In all patients, the relative risks of thrombosis and bleeding, the availability of the anticoagulant, and the life expectancy of the patient are vital elements in selecting the most appropriate anticoagulant (which can vary over time) for the individual patient. We describe the intricacies and challenges of treating thrombotic complications in patients with lymphoma with an emphasis on evidence and guideline-based care.
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Mosaad M, Elnaem MH, Cheema E, Ibrahim I, Ab Rahman J, Kori AN, Hin HS. Cancer-Associated Thrombosis: A Clinical Scoping Review of the Risk Assessment Models Across Solid Tumours and Haematological Malignancies. Int J Gen Med 2021; 14:3881-3897. [PMID: 34335052 PMCID: PMC8318782 DOI: 10.2147/ijgm.s320492] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/05/2021] [Indexed: 12/18/2022] Open
Abstract
Cancer-associated thrombosis (CAT) is a leading cause of death in cancer patients receiving outpatient chemotherapy. The latest guidelines emphasize stratifying the patients in terms of CAT risks periodically. Multiple risk assessment models (RAMs) were developed to classify patients and guide thromboprophylaxis to high-risk patients. This study aimed to discuss and highlight different RAMs across various malignancy types with their related advantages and disadvantages. A scoping review was conducted using predefined search terms in three scientific databases, including Google Scholar, Science Direct, and PubMed. The search for studies was restricted to original research articles that reported risk assessment models published in the last thirteen years (between 2008 and 2021) to cover the most recently published evidence following the development of the principal risk assessment score in 2008. Data charting of the relevant trials, scores, advantages, and disadvantages were done iteratively considering the malignancy type. Of the initially identified 1115 studies, 39 studies with over 67,680 patients were included in the review. In solid organ malignancy, nine risk assessment scores were generated. The first and most known Khorana risk score still offers the best available risk assessment model when used for high-risk populations with a threshold of 2 and above. However, KRS has a limitation of failure to stratify low-risk patients. The COMPASS-CAT score showed the best performance in the lung carcinoma patients who have a higher prevalence of thrombosis than other malignancy subtypes. In testicular germ cell tumours, Bezan et al RAM is a validated good discriminatory RAM for this malignancy subtype. CAT in haematological malignancy seems to be under-investigated and has multiple disease-related, and treatment-related confounding factors. AL-Ani et al score performed efficiently in acute leukemia. In multiple myeloma, both SAVED and IMPEDED VTE scores showed good performance. Despite the availability of different disease-specific scores in lymphoma-related thrombosis, the standard of care needs to be redefined.
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Affiliation(s)
- Manar Mosaad
- Department of Internal Medicine, Faculty of Medicine, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Mohamed Hassan Elnaem
- Department of Pharmacy Practice, Faculty of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Ejaz Cheema
- School of Pharmacy, University of Birmingham, Birmingham, B15 2TT, UK
| | - Ismail Ibrahim
- Department of Internal Medicine, Faculty of Medicine, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Jamalludin Ab Rahman
- Department of Community Medicine, Faculty of Medicine, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Ahlam Naila Kori
- Haematology Unit, Tengku Ampuan Afzan Hospital, Kuantan, Pahang, Malaysia
| | - How Soon Hin
- Department of Internal Medicine, Faculty of Medicine, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
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Horowitz NA, Brenner B. Thrombosis in hematological malignancies: mechanisms and implications. Thromb Res 2021; 191 Suppl 1:S58-S62. [PMID: 32736780 DOI: 10.1016/s0049-3848(20)30398-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 01/12/2020] [Accepted: 01/13/2020] [Indexed: 12/21/2022]
Abstract
A B S T R A C T Thrombotic events are a major cause of morbidity and mortality in cancer. While the association of venous thromboembolic events with cancer is well documented, in recent years arterial events (i.e. acute myocardial infarction and ischemic strokes) have also emerged as relatively common complications among cancer patients. In hematological malignancies incorporating a heterogeneous group of diseases, the prediction of thrombosis occurrence and/or recurrence is challenging, due to unique disease characteristics. Furthermore, the treatment of thrombosis in these patients is often complicated because of disease- or therapy-related thrombocytopenia. In addition, patients with hematological cancers are poorly represented in randomized control clinical trials; hence, evidence-based guidelines are limited. This review will discuss the incidence of venous and arterial thrombotic events in common myeloid and lymphoproliferative diseases. Several new mechanisms contributing to cancer- associated thrombosis will be elaborated. The complicated issue of risk assessment and management of venous thrombosis in patients with hematological malignancies will be delineated.
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Affiliation(s)
- Netanel A Horowitz
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel; Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
| | - Benjamin Brenner
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel; Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Gerotziafas GT, Mahé I, Lefkou E, AboElnazar E, Abdel-Razeq H, Taher A, Antic D, Elalamy I, Syrigos K, Van Dreden P. Overview of risk assessment models for venous thromboembolism in ambulatory patients with cancer. Thromb Res 2021; 191 Suppl 1:S50-S57. [PMID: 32736779 DOI: 10.1016/s0049-3848(20)30397-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 01/15/2020] [Accepted: 01/23/2020] [Indexed: 02/07/2023]
Abstract
A B S T R A C T Important progress has been made in the development of risk assessment models (RAM) for the identification of outpatients on anticancer treatment at risk of venous thromboembolism (VTE). Since the breakthrough publication of the original Khorana risk score (KRS) more than 10 years ago, a new generation of KRS-based scores have been developed, including the Vienna Cancer and Thrombosis Study, PROTECHT, CONKO, ONCOTEV, TicOnco and the CATS/MICA score. Among these the CATS/MICA score showed that a simplified score composed of only two calibrated predictors, the type of cancer and the D-dimer levels, offers a user-friendly tool for the evaluation of cancer-associated thrombosis (CAT) risk. The COMPASS-CAT score is the first that introduced a more synthetic approach of risk evaluation by combining cancer-related predictors with patient comorbidity in a score which is designed for the types of cancer frequently seen in the community (i.e. breast, lung colon or ovarian cancers) and has been externally validated in independent studies. The Throly score is registered as part of the same group as it has a similar structure to the COMPASS-CAT score and is applicable in patients with lymphoma. The incorporation of specific biomarkers of hypercoagulability to the RAM for CAT offers the possibility to perform a precision medicine approach in the prevention of CAT. The improvement of RAM for CAT with artificial intelligence methodologies and deep learning techniques is the challenge in the near future.
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Affiliation(s)
- Grigoris T Gerotziafas
- Research Group "Cancer, Haemostasis and Angiogenesis", INSERM U938, Centre de Recherche Saint-Antoine, Institut Universitaire de Cancérologie, Faculty of Medicine, Sorbonne University, Paris, France; Service d'Hématologie Biologique Hôpital Tenon, Hôpitaux Universitaires de l'Est Parisien, Assistance Publique Hôpitaux de Paris, Paris, France; Department of Hematology and Cell Therapy, Saint Antoine Hospital, Hôpitaux Universitaires de l'Est Parisien, Assistance Publique Hôpitaux de Paris, Sorbonne University, Paris, France.
| | - Isabelle Mahé
- Internal Medicine Department, Hôpital Louis Mourier, APHP, Colombes, Inserm UMR_S1140, Université Paris-Diderot Paris7, Paris, France
| | - Eleftheria Lefkou
- Research Group "Cancer, Haemostasis and Angiogenesis", INSERM U938, Centre de Recherche Saint-Antoine, Institut Universitaire de Cancérologie, Faculty of Medicine, Sorbonne University, Paris, France
| | | | - Hiqmat Abdel-Razeq
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Ali Taher
- Department of Internal Medicine, Division of Hematology/Oncology, American University of Beirut, Lebanon
| | - Darko Antic
- Clinic for Hematology, Clinical Center Serbia, University of Belgrade, Belgrade, Serbia
| | - Ismail Elalamy
- Research Group "Cancer, Haemostasis and Angiogenesis", INSERM U938, Centre de Recherche Saint-Antoine, Institut Universitaire de Cancérologie, Faculty of Medicine, Sorbonne University, Paris, France; Service d'Hématologie Biologique Hôpital Tenon, Hôpitaux Universitaires de l'Est Parisien, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Kostas Syrigos
- Oncology Unit, 3(rd) Dept of Medicine, National and Kapodistrian University of Athens, School of Medicine, "Sotiria" General Hospital, Athens, Greece
| | - Patrick Van Dreden
- Research Group "Cancer, Haemostasis and Angiogenesis", INSERM U938, Centre de Recherche Saint-Antoine, Institut Universitaire de Cancérologie, Faculty of Medicine, Sorbonne University, Paris, France; Clinical Research Department, Diagnostica Stago, Gennevilliers, France
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27
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Candeloro M, Guman NAM, Kraaijpoel N, Di Nisio M. Risk Assessment Models for Thrombosis and Anticoagulant-Related Bleeding in Ambulatory Cancer Patients. Semin Thromb Hemost 2021; 47:972-981. [PMID: 34111897 DOI: 10.1055/s-0040-1722608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cancer patients have a high risk of developing venous thromboembolism and arterial thrombosis, along with an increased risk of anticoagulant-related bleeding with primary and secondary prophylaxis of cancer-associated thrombosis. Decisions on initiation, dosing, and duration of anticoagulant therapy for prevention and treatment of cancer-associated thrombosis are challenging, as clinicians have to balance patients' individual risk of (recurrent) thrombosis against the risk of bleeding complications. For this purpose, several dedicated risk assessment models for venous thromboembolism in cancer patients have been suggested. However, most of these scores perform poorly and have received limited to no validation. For bleeding and arterial thrombosis, no risk scores have been developed specifically for cancer patients, and treatment decisions remain based on clinical gestalt and rough and unstructured estimation of the risks. The aims of this review are to summarize the characteristics and performance of risk assessment scores for (recurrent) venous thromboembolism and discuss available data on risk assessment for bleeding and arterial thrombosis in the cancer population. This summary can help clinicians in daily practice to make a balanced decision when considering the use of risk assessment models for cancer-associated venous thromboembolism. Future research attempts should aim at improving risk assessment for arterial thrombosis and anticoagulant-related bleeding in cancer patients.
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Affiliation(s)
- Matteo Candeloro
- Department of Medicine and Ageing Sciences, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Noori A M Guman
- Department of Vascular Medicine, Tergooi Hospital, Hilversum, The Netherlands.,Department of Vascular Medicine, Amsterdam UMC/University of Amsterdam, Amsterdam, The Netherlands
| | - Noémie Kraaijpoel
- Department of Vascular Medicine, Amsterdam UMC/University of Amsterdam, Amsterdam, The Netherlands
| | - Marcello Di Nisio
- Department of Medicine and Ageing Sciences, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy.,Department of Vascular Medicine, Amsterdam UMC/University of Amsterdam, Amsterdam, The Netherlands
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Abdel-Razeq H, Ma’koseh M, Abdel-Razeq R, Amarin R, Abufara A, Mansour R, Manasrah M, Al-Rwashdeh M, Bater R. The Application of the Lymphoma International Prognostic Index to Predict Venous Thromboembolic Events in Diffuse Large B-Cell Lymphoma Patients. Front Oncol 2021; 11:677776. [PMID: 34123847 PMCID: PMC8195619 DOI: 10.3389/fonc.2021.677776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/04/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Venous thromboembolic events (VTE) are commonly encountered in patients with lymphoma. Several risk assessments models (RAM) had attempted to identify higher risk patients with varying success. The International Prognostic Index (IPI) is a clinicopathological tool developed to help predict both response to treatment and prognosis of patients with diffuse large B-cell lymphoma (DLBCL). OBJECTIVE In this study, we utilize the IPI index to identify group of patients with DLBCL at higher risk for VTE. PATIENTS/METHODS Patients with pathologically-confirmed diagnosis of DLBCL and with image-confirmed VTE, treated and followed at our institution were included. Rates of VTE was calculated for each risk category. RESULTS A total of 373 patients, median age 49 (range: 18-90) years were included. VTE were reported in 56 (15.0%) patients; 51 (91.1%) had active disease while 29 (51.8%) were ambulatory at time of VTE diagnosis. VTE rates were particularly high among patients with poor performance status (26.2%, P=0.028) and high LDH (19.0%, P=0.023). Applying the age-adjusted IPI separated patients into two risk categories; VTE were diagnosed in 9.7% in patients with "low and low-intermediate" scores compared to 19.8% in patients with "high and high-intermediate" scores, P=0.020. CONCLUSIONS The original IPI and its modified versions, routinely used at diagnosis as a prognostic and predictive tool for patients with DLBCL, can also be utilized to define high risk patients for VTE; the risk of whom might be high enough to recommend thromboprophylaxis even in the ambulatory settings. More work is needed to refine and improve currently available RAMs.
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Affiliation(s)
- Hikmat Abdel-Razeq
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
- School of Medicine, University of Jordan, Amman, Jordan
| | - Mohammad Ma’koseh
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | | | - Rula Amarin
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Alaa Abufara
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Razan Mansour
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Mohammad Manasrah
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | | | - Rayan Bater
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
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HIGH-2-LOW risk model to predict venous thromboembolism in allogeneic transplant patients after platelet engraftment. Blood Adv 2021; 5:167-175. [PMID: 33570631 DOI: 10.1182/bloodadvances.2020003353] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/25/2020] [Indexed: 11/20/2022] Open
Abstract
Venous thromboembolism (VTE) after allogeneic hematopoietic cell transplantation (HCT) is a significant treatment-associated complication, although optimal timing of thromboprophylaxis remains uncertain when weighing concurrent risks of bleeding. We aimed to derive and internally validate a risk assessment model (RAM) using patients who underwent first allogeneic HCT from 2006 through 2015 (n = 1703). Index date was defined as the 30th day after transplant, at which point we estimated >75% of patients would have achieved platelet engraftment >50 × 109/L. Stepwise logistic regression modeling was used for model development, and internal validation was achieved by fitting a logistic regression model with 1000 bootstrapped resamples to estimate the optimism-corrected c-statistic. The final RAM, "HIGH-2-LOW," included 7 predictors obtained at 30 days after transplant: History of catheter-related deep venous thrombosis (DVT), Inpatient at day 30, Graft-versus-host disease grade 3 to 4, History of pulmonary embolism or lower-extremity DVT, Lymphoma diagnosis, Obesity with body mass index ≥35 kg/m2, and White blood cell count ≥11 × 109/L. Approximately 16% of patients were stratified as high risk, with incident VTE rate of 10.3% at 100 days compared with 1.5% for those at low risk. VTE odds ratios at 100 days were 5.87 (95% confidence interval [CI], 2.98-11.57) and 2.71 (95% CI, 1.38-5.35) in the high- and intermediate-risk vs low-risk groups, respectively. HIGH-2-LOW model serves as a novel and potentially clinically meaningful tool to identify high-risk allogeneic HCT patients who may benefit from early thromboprophylaxis after platelet engraftment.
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30
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Yang J, Zhang Y, Yang P, Zhang X, Li M, Zou L. A novel nomogram based on prognostic factors for predicting venous thrombosis risk in lymphoma patients. Leuk Lymphoma 2021; 62:2383-2391. [PMID: 33966585 DOI: 10.1080/10428194.2021.1913149] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Lymphoma-associated venous thromboembolism (VTE) can be a serious complication in lymphoma patients. We designed a nomogram as a guide to estimate the VTE risk in lymphoma patients. We retrospectively analyzed 555 Chinese lymphoma patients who were newly diagnosed at West China Hospital. The nomogram was generated based on multivariate regression coefficients. The multivariate analysis indicated that advanced clinical stage (p < .001*), Hodgkin lymphoma (p = .045*), and prechemotherapy Hb level <115 g/L (p = .01*) were independent risk factors for VTE in lymphoma patients. A calibration plot and the area under the receiver operating characteristic curve were used to validate the novel nomogram. The nomogram displayed a good C-index (0.73), and the calibration plot showed excellent agreement between the predicted and actual probabilities. The AUROC of the nomogram was 0.731, demonstrating a strong discriminatory ability. Notably, the predictive value of the nomogram was better than the Khorana risk score.
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Affiliation(s)
- Jingshi Yang
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yuqin Zhang
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Peipei Yang
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Xiaolu Zhang
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Mei Li
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Liqun Zou
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
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31
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Venous thromboembolic events in T-cell lymphoma patients: Incidence, risk factors and clinical features. Leuk Res 2021; 103:106537. [PMID: 33631621 DOI: 10.1016/j.leukres.2021.106537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Patients with hematologic malignancies are prone to developing thromboembolism. The incidence, risk factors and clinical features for developing venous thromboembolism (VTE) are not well-elucidated in patients with T-cell lymphoma. MATERIALS AND METHODS The present study retrospectively analyzed 668 patients with VTE, including pulmonary embolism (PE) and deep vein thrombosis (DVT), who were admitted to Tianjin Medical University Cancer Institute and Hospital and Sun Yat-sen University Cancer Center from January 2006 to December 2018. All patients were diagnosed with T-cell lymphoma, and all episodes of symptomatic VTE were confirmed by imaging and ultrasound. The follow-up results were obtained through telephone communication and outpatient visits. RESULTS A total of 668 patients were analyzed. Thirty-three (4.94%) patients had at least one episode of VTE, and all of which were deep vein thrombosis alone. All VTEs occurred in patients who received chemotherapy, while no VTE occurred in patients who did not receive chemotherapy. By univariate analysis, central venous catheter (CVC) (odds ratio [OR] 6.63, confidence interval [CI] 2.24-19.57, P = 0.001), Eastern Cooperative Oncology Group (ECOG) performance status 2, 3, or 4 (OR: 62.15, CI: 15.42-250.48, P = 0.000), and stage III or IV (OR: 4.06, CI: 1.00-16.40, P = 0.049) were identified as risk factors for developing VTE. By multivariate analysis, CVC (OR: 3.23, CI: 1.49-7.23, P = 0.003) and stage III or IV (OR: 2.30, CI: 1.06-4.97, P = 0.035) were still significant risk factors for developing VTE. CONCLUSION The incidence of VTE in the present study population was comparable to that of lymphoma patients, other than T-cell lymphoma, and VTE was associated with CVC and advanced stage.
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Dharmavaram G, Cao S, Sundaram S, Ayyappan S, Boughan K, Gallogly M, Malek E, Metheny L, Tomlinson B, Otegbeye F, Lazarus HM, Cooper B, Fu P, Lima M, Caimi PF. Aggressive lymphoma subtype is a risk factor for venous thrombosis. Development of lymphoma - specific venous thrombosis prediction models. Am J Hematol 2020; 95:918-926. [PMID: 32311162 DOI: 10.1002/ajh.25837] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 03/19/2020] [Accepted: 04/13/2020] [Indexed: 01/27/2023]
Abstract
Venous thromboembolic events (VTE) are a frequent complication of lymphoma. We conducted a retrospective analysis to compare VTE risk in diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL). Subjects were randomly assigned to training and validation sets to identify risk factors of VTE and evaluate risk model performance, including the Khorana score. A group of 790 patients were diagnosed from 2002 to 2014 (DLBCL = 542, FL = 248). Median follow- up was 49 months. We observed 106 VTE, with higher incidence in DLBCL (5-year cumulative incidence = 16.3% vs 3.8% in FL patients). Five-year OS for patients with VTE was 51.4% vs 73.1% in patients without VTE (P < .001). Baseline VTE risk factors identified in the training cohort included lymphoma subtype, previous VTE, ECOG performance status ≥2, decreased albumin, increased calcium, elevated WBC, absolute lymphocyte count or monocyte count, and presence of bulky disease. Addition of new variables to the Khorana score improved its performance measured by Akaike information criterion and Concordance index. A new risk model including lymphoma subtype, albumin, WBC count, and bulky disease was validated in time-based ROC analyses. These findings were confirmed in the validation cohort. Lymphoma subtypes have different VTE risk. The effect of lymphoma subtype was independent from disease burden and the use of systemic therapy. The Khorana risk-score was validated in time to event analyses, and a more robust lymphoma-specific VTE risk score is proposed. These findings suggest lymphoma patients with highest VTE risk can be identified with baseline parameters.
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Affiliation(s)
- Gouri Dharmavaram
- School of MedicineCase Western Reserve University Cleveland Ohio USA
| | - Shufen Cao
- Department of Population and Quantitative Health SciencesCase Western Reserve University Cleveland Ohio USA
| | - Suchitra Sundaram
- Department of MedicineRoswell Park Cancer Institute Buffalo New York USA
| | - Sabarish Ayyappan
- Division of Hematology, Oncology and Bone & Marrow TransplantationUniversity of Iowa Iowa City Iowa USA
| | - Kirsten Boughan
- Hematologic Malignancies and Stem Cell Transplant Program, Division of Hematology and OncologyUniversity Hospitals Seidman Cancer Center, Cleveland, Ohio and Case Comprehensive Cancer Center Cleveland Ohio USA
| | - Molly Gallogly
- Hematologic Malignancies and Stem Cell Transplant Program, Division of Hematology and OncologyUniversity Hospitals Seidman Cancer Center, Cleveland, Ohio and Case Comprehensive Cancer Center Cleveland Ohio USA
| | - Ehsan Malek
- Hematologic Malignancies and Stem Cell Transplant Program, Division of Hematology and OncologyUniversity Hospitals Seidman Cancer Center, Cleveland, Ohio and Case Comprehensive Cancer Center Cleveland Ohio USA
| | - Leland Metheny
- Hematologic Malignancies and Stem Cell Transplant Program, Division of Hematology and OncologyUniversity Hospitals Seidman Cancer Center, Cleveland, Ohio and Case Comprehensive Cancer Center Cleveland Ohio USA
| | - Benjamin Tomlinson
- Hematologic Malignancies and Stem Cell Transplant Program, Division of Hematology and OncologyUniversity Hospitals Seidman Cancer Center, Cleveland, Ohio and Case Comprehensive Cancer Center Cleveland Ohio USA
| | - Folashade Otegbeye
- Hematologic Malignancies and Stem Cell Transplant Program, Division of Hematology and OncologyUniversity Hospitals Seidman Cancer Center, Cleveland, Ohio and Case Comprehensive Cancer Center Cleveland Ohio USA
| | - Hillard M. Lazarus
- Hematologic Malignancies and Stem Cell Transplant Program, Division of Hematology and OncologyUniversity Hospitals Seidman Cancer Center, Cleveland, Ohio and Case Comprehensive Cancer Center Cleveland Ohio USA
| | - Brenda Cooper
- Hematologic Malignancies and Stem Cell Transplant Program, Division of Hematology and OncologyUniversity Hospitals Seidman Cancer Center, Cleveland, Ohio and Case Comprehensive Cancer Center Cleveland Ohio USA
| | - Pingfu Fu
- Department of Population and Quantitative Health SciencesCase Western Reserve University Cleveland Ohio USA
| | - Marcos Lima
- Hematologic Malignancies and Stem Cell Transplant Program, Division of Hematology and OncologyUniversity Hospitals Seidman Cancer Center, Cleveland, Ohio and Case Comprehensive Cancer Center Cleveland Ohio USA
| | - Paolo F. Caimi
- Hematologic Malignancies and Stem Cell Transplant Program, Division of Hematology and OncologyUniversity Hospitals Seidman Cancer Center, Cleveland, Ohio and Case Comprehensive Cancer Center Cleveland Ohio USA
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Borchmann S, Müller H, Hude I, Fuchs M, Borchmann P, Engert A. Thrombosis as a treatment complication in Hodgkin lymphoma patients: a comprehensive analysis of three prospective randomized German Hodgkin Study Group (GHSG) trials. Ann Oncol 2020; 30:1329-1334. [PMID: 31132094 DOI: 10.1093/annonc/mdz168] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The prognosis of Hodgkin lymphoma (HL) is excellent rendering research into treatment complications highly important. An important complication of cancer and its treatment is thrombosis. Thrombotic events are regularly observed in HL patients but precise information on incidence and risk factors is lacking and the value of prophylactic anticoagulation unclear. PATIENTS AND METHODS Thus, we comprehensively studied thrombotic events in 5773 patients from the German Hodgkin Study Group (GHSG) HD13-15 trials in early-favorable, intermediate and advanced HL. We estimated the incidence of and identified risk factors for thrombotic events. Additionally, we provide detailed data on the time course and characteristics of thrombotic events. RESULTS A total of 193 thrombotic events occurred for an incidence of 3.3%. Out of these, 175 (90.7%) were venous thromboses, 3 (1.5%) newly emerging post-thrombotic syndromes and 15 (7.8%) arterial thromboses. There were 11 (0.7%) events in early-favorable, 27 (1.3%) in early-unfavorable and 155 (7.3%) in advanced patients, the latter incidence being significantly higher (P < 0.001). The most common locations were deep vein thrombosis of the arm (46.3%) and leg (24.6%). Most venous thrombotic events occurred during chemotherapy (78.9%). We observed 59 (30.6%) catheter-associated events and a descriptively increased risk of venous thrombotic events in patients with oral contraception use during treatment (6.8% versus 3.9%). In advanced HL, the incidence of venous thrombotic events was increased upon treatment with BEACOPP-14 (9.4%, P = 0.0079) compared with 5.1% with 6×BEACOPPesc and 5.7% with 8×BEACOPPesc. Among commonly applied risk factors, including the Khorana score, only age and smoking were prognostic. CONCLUSIONS The incidence of thrombotic events in advanced stage HL is comparable to other high-risk cancer patients, especially if treated with dose-dense regimens. Additional risk factors are higher age and smoking. Selected HL patients could benefit from prophylactic anticoagulation, however, further interventional studies are needed before general recommendations can be made.
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Affiliation(s)
- S Borchmann
- Faculty of Medicine, Department I of Internal Medicine, GHSG; Faculty of Medicine, Center for Molecular Medicine, University Hospital of Cologne, University of Cologne, Cologne, Germany; Faculty of Medicine, Else Kröner Forschungskolleg Clonal Evolution in Cancer, University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - H Müller
- Faculty of Medicine, Department I of Internal Medicine, GHSG
| | - I Hude
- Faculty of Medicine, Department I of Internal Medicine, GHSG; Division of Hematology, Department of Internal Medicine, University Hospital Center Zagreb, Zagreb, Croatia
| | - M Fuchs
- Faculty of Medicine, Department I of Internal Medicine, GHSG
| | - P Borchmann
- Faculty of Medicine, Department I of Internal Medicine, GHSG
| | - A Engert
- Faculty of Medicine, Department I of Internal Medicine, GHSG.
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Hohaus S, Bartolomei F, Cuccaro A, Maiolo E, Alma E, D’Alò F, Bellesi S, Rossi E, De Stefano V. Venous Thromboembolism in Lymphoma: Risk Stratification and Antithrombotic Prophylaxis. Cancers (Basel) 2020; 12:cancers12051291. [PMID: 32443753 PMCID: PMC7281118 DOI: 10.3390/cancers12051291] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 02/06/2023] Open
Abstract
Lymphoma is listed among the neoplasias with a high risk of venous thromboembolism (VTE). Risk factors for VTE appear to differ from risk factors in solid tumors. We review the literature of the last 20 years for reports identifying these risk factors in cohorts consisting exclusively of lymphoma patients. We selected 25 publications. The most frequent studies were analyses of retrospective single-center cohorts. We also included two reports of pooled analyses of clinical trials, two meta-analyses, two analyses of patient registries, and three analyses of population-based databases. The VTE risk is the highest upfront during the first two months after lymphoma diagnosis and decreases over time. This upfront risk may be related to tumor burden and the start of chemotherapy as contributing factors. Factors consistently reported as VTE risk factors are aggressive histology, a performance status ECOG ≥ 2 leading to increased immobility, more extensive disease, and localization to particular sites, such as central nervous system (CNS) and mediastinal mass. Association between laboratory values that are part of risk assessment models in solid tumors and VTE risk in lymphomas are very inconsistent. Recently, VTE risk scores for lymphoma were developed that need further validation, before they can be used for risk stratification and primary prophylaxis. Knowledge of VTE risk factors in lymphomas may help in the evaluation of the individual risk-benefit ratio of prophylaxis and help to design prospective studies on primary prophylaxis in lymphoma.
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Affiliation(s)
- Stefan Hohaus
- Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.D.); (E.R.); (V.D.S.)
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, L.go A. Gemelli, 8, 00168 Rome, Italy; (F.B.); (A.C.); (E.M.); (E.A.); (S.B.)
- Correspondence: ; Tel.: +39-06-30154180; Fax: +39-06-35503777
| | - Francesca Bartolomei
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, L.go A. Gemelli, 8, 00168 Rome, Italy; (F.B.); (A.C.); (E.M.); (E.A.); (S.B.)
| | - Annarosa Cuccaro
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, L.go A. Gemelli, 8, 00168 Rome, Italy; (F.B.); (A.C.); (E.M.); (E.A.); (S.B.)
| | - Elena Maiolo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, L.go A. Gemelli, 8, 00168 Rome, Italy; (F.B.); (A.C.); (E.M.); (E.A.); (S.B.)
| | - Eleonora Alma
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, L.go A. Gemelli, 8, 00168 Rome, Italy; (F.B.); (A.C.); (E.M.); (E.A.); (S.B.)
| | - Francesco D’Alò
- Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.D.); (E.R.); (V.D.S.)
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, L.go A. Gemelli, 8, 00168 Rome, Italy; (F.B.); (A.C.); (E.M.); (E.A.); (S.B.)
| | - Silvia Bellesi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, L.go A. Gemelli, 8, 00168 Rome, Italy; (F.B.); (A.C.); (E.M.); (E.A.); (S.B.)
| | - Elena Rossi
- Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.D.); (E.R.); (V.D.S.)
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, L.go A. Gemelli, 8, 00168 Rome, Italy; (F.B.); (A.C.); (E.M.); (E.A.); (S.B.)
| | - Valerio De Stefano
- Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.D.); (E.R.); (V.D.S.)
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, L.go A. Gemelli, 8, 00168 Rome, Italy; (F.B.); (A.C.); (E.M.); (E.A.); (S.B.)
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Wang TF, Delluc A. Thromboprophylaxis in patients with multiple myeloma. Br J Haematol 2020; 190:493-494. [PMID: 32395827 DOI: 10.1111/bjh.16731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 04/18/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Tzu-Fei Wang
- Division of Hematology, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Aurélien Delluc
- Department of Medicine, Ottawa Hospital Research Institute at the University of Ottawa, Ottawa, Ontario, Canada
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Shakaryants GA, Budanova DA, Lobastov KV, Khabarova NV, Kirichenko YY, Belenkov YN. [Treatment and secondary prevention of venous thromboembolism in cancer patients]. ACTA ACUST UNITED AC 2020; 60:71-79. [PMID: 32375618 DOI: 10.18087/cardio.2020.3.n904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 12/09/2019] [Indexed: 11/18/2022]
Abstract
Oncological patients are a high-risk group for venous thromboembolic complications. These complications significantly impair the outcome of antitumor treatment and take a leading place in the structure of mortality. Treatment of venous thromboembolic complications in oncological patients is a serious challenge. When selecting an anticoagulant, the physician should consider its efficacy and safety and possible drug interactions. Based on results of multiple studies presented in this article, physicians will be able to choose an optimum therapeutic tactics and secondary prevention of thromboembolic complications for this group of patients.
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Affiliation(s)
- G A Shakaryants
- Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University). Russian Federation, Moscow
| | - D A Budanova
- Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University). Russian Federation, Moscow
| | - K V Lobastov
- Federal State Budget Educational Institution of Higher Education N.I.Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation, Russian Federation, Moscow
| | - N V Khabarova
- Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University). Russian Federation, Moscow
| | - Yu Yu Kirichenko
- Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University). Russian Federation, Moscow
| | - Yu N Belenkov
- Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University). Russian Federation, Moscow
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The Incidence of Venous Thromboembolism and Impact on Survival in Hodgkin Lymphoma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 20:542-547. [PMID: 32245743 DOI: 10.1016/j.clml.2020.02.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/22/2020] [Accepted: 02/29/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Thrombosis increase the acute and long-term morbidity and mortality in malignancy patients. We analyzed venous thromboembolism (VTE) in patients with Hodgkin lymphoma, the impact of VTE on survival, predisposing factors for VTE, and predicting value of Khorana and ThroLy score models. PATIENTS AND METHODS We included 150 adult patients with Hodgkin lymphoma between January 2010 and 2018 at our university hospital. RESULTS VTE was observed in 31 patients (20.7%). The types of VTE were 18 upper and 3 lower extremity deep vein thrombosis and 10 pulmonary embolism (1 with lower extremity deep vein thrombosis). Twenty-nine patients developed VTE during the treatment with a median time of episode as 5 months. In logistic regression analysis, a body mass index of >32 kg/m2, high fibrinogen levels, initial thrombocytosis and leukocytosis, splenic and extranodal involvement, presence of a central venous line, advanced stage, line of treatment status of thromboprophylaxis, VTE timing, and better Eastern Cooperative Oncology Group performance scores were observed to be related with VTE. Kaplan Meier survival analysis showed a negative impact of VTE on survival. Khorana and ThroLy risk assessment models were found predictive for VTE (P = .000 and P = .003, respectively), although only ThroLy score was associated with the survival. CONCLUSION Thromboprophylaxis and precautions for VTE in patients with Hodgkin lymphoma according to validated risk assessment models can improve prognosis and quality of life owing to the impact of VTE on survival in the study.
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Mulder FI, Bosch FTM, van Es N. Primary Thromboprophylaxis in Ambulatory Cancer Patients: Where Do We Stand? Cancers (Basel) 2020; 12:E367. [PMID: 32033438 PMCID: PMC7072463 DOI: 10.3390/cancers12020367] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 01/31/2020] [Accepted: 02/02/2020] [Indexed: 02/07/2023] Open
Abstract
Venous thromboembolism (VTE), comprising deep-vein thrombosis and pulmonary embolism, is a frequent complication in ambulatory cancer patients. Despite the high risk, routine thromboprophylaxis is not recommended because of the high number needed to treat and the risk of bleeding. Two recent trials demonstrated that the number needed to treat can be reduced by selecting cancer patients at high risk for VTE with prediction scores, leading the latest guidelines to suggest such an approach in clinical practice. Yet, the interpretation of these trial results and the translation of the guideline recommendations to clinical practice may be less straightforward. In this clinically-oriented review, some of the controversies are addressed by focusing on the burden of VTE in cancer patients, discussing the performance of available risk assessment scores, and summarizing the findings of recent trials. This overview can help oncologists, hematologists, and vascular medicine specialists decide about thromboprophylaxis in ambulatory cancer patients.
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Affiliation(s)
- Frits I. Mulder
- Department of Vascular Medicine, Amsterdam Cardiovascular Science, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (F.T.M.B.); (N.v.E.)
- Department of Internal Medicine, Tergooi Hospitals, 1213 XZ Hilversum, The Netherlands
| | - Floris T. M. Bosch
- Department of Vascular Medicine, Amsterdam Cardiovascular Science, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (F.T.M.B.); (N.v.E.)
- Department of Internal Medicine, Tergooi Hospitals, 1213 XZ Hilversum, The Netherlands
| | - Nick van Es
- Department of Vascular Medicine, Amsterdam Cardiovascular Science, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (F.T.M.B.); (N.v.E.)
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Muñoz Martín AJ, Gallardo Díaz E, García Escobar I, Macías Montero R, Martínez-Marín V, Pachón Olmos V, Pérez Segura P, Quintanar Verdúguez T, Salgado Fernández M. SEOM clinical guideline of venous thromboembolism (VTE) and cancer (2019). Clin Transl Oncol 2020; 22:171-186. [PMID: 31981080 DOI: 10.1007/s12094-019-02263-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 12/05/2019] [Indexed: 12/12/2022]
Abstract
In 2011, the Spanish Society of Medical Oncology (SEOM) first published a clinical guideline of venous thromboembolism (VTE) and cancer. This guideline was updated in 2014, and since then, multiple studies and clinical trials have changed the landscape of the treatment and prophylaxis of VTE in cancer patients. To incorporate the most recent evidence, including data from direct oral anticoagulants (DOACs) randomized clinical trials, SEOM presents a new update of the guideline.
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Affiliation(s)
- A J Muñoz Martín
- Medical Oncology Department, Instituto de Investigación Sanitaria Gregorio Marañón, C/ Dr. Esquerdo, 46, 28007, Madrid, Spain.
| | - E Gallardo Díaz
- Medical Oncology Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - I García Escobar
- Medical Oncology Department, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - R Macías Montero
- Medical Oncology Department, Complejo H. Universitario, Badajoz, Spain
| | - V Martínez-Marín
- Medical Oncology Department, Hospital Universitario la Paz, Madrid, Spain
| | - V Pachón Olmos
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERONC, Madrid, Spain
| | - P Pérez Segura
- Medical Oncology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | | | - M Salgado Fernández
- Medical Oncology Department, Complejo Hospitalario Universitario de Ourense, Ourense, Spain
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Sorigue M, Cañamero E, Siguenza P, Nomdedeu M, López-Núñez JJ. Recent developments and persisting challenges in the prevention and treatment of venous thromboembolism in patients with hematological malignancies. Leuk Lymphoma 2020; 61:1277-1291. [DOI: 10.1080/10428194.2020.1713321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Marc Sorigue
- Laboratory of Hematology, ICO-Hospital Germans Trias i Pujol, IJC, UAB, Badalona, Spain
| | - Eloi Cañamero
- Laboratory of Hematology, ICO-Hospital Germans Trias i Pujol, IJC, UAB, Badalona, Spain
| | - Patricia Siguenza
- Department of Internal Medicine, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Meritxell Nomdedeu
- Laboratory of Hematology, ICO-Hospital Germans Trias i Pujol, IJC, UAB, Badalona, Spain
| | - Juan J. López-Núñez
- Department of Internal Medicine, Hospital Germans Trias i Pujol, Badalona, Spain
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Otašević V, Antić D, Mihaljević B. Venous thromboembolic complications in lymphoma patients. MEDICINSKI PODMLADAK 2020. [DOI: 10.5937/mp71-29196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Lymphomas represent a heterogeneous group of malignant hematological diseases with high risk for development of venous thromboembolic complications (VTE). Consequently, VTE significantly impacts morbidity and mortality in these patients. Another concern is the financial burden of the healthcare system caused by diagnostic and therapeutic procedures of cancer-associated thrombosis (CAT). The complex biology of lymphoma, in conjunction with patient and treatment related risk factors for the development of VTE, results in a procoagulant hemostatic dysregulation. Considering the incidence of VTE in patients with lymphoma, there is an emerging demand for both reliable risks assessment model (RAM) for prediction of VTE, as well as for effective VTE prophylaxis and treatment. The clinical course of patients with malignant diseases is accompanied by a wide range of potential treatment complications, making the task of prevention and treatment of VTE even more challenging. In recent years, great progress has been achieved in understanding the pathophysiological mechanisms of thrombotic complications, while the significant number of randomized controlled trials (RCT) have provided standards of prophylaxis and treatment of VTE complications in patients with malignancy. In comparison to previous recommendations and guidelines for CAT, the use of direct oral anticoagulants (DOAC) has been gradually approaching low molecular weight heparins (LMWH) in terms of efficacy and safety profile in these indications. This systematic review is focused on the latest pathophysiological advances, risk factors assessment, prophylactic and therapeutic recommendations and guidelines concerning VTE in patients with lymphoma.
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Byun JM, Hong J, Yoon SS, Koh Y, Ock CY, Kim TM, Lee JH, Kim SH, Lee JO, Bang SM, Yhim HY, Bae SH, Mun YC, Oh D. Incidence and characteristics of venous thromboembolism in Asian patients with primary central nervous system lymphoma undergoing chemotherapy. Thromb Res 2019; 183:131-135. [PMID: 31677593 DOI: 10.1016/j.thromres.2019.10.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/27/2019] [Accepted: 10/08/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Venous thromboembolism (VTE) may lead to diminished quality of life and ultimately worse prognosis in cancer patients, but there is limited data on the incidence, risk factors and mortality impact of VTE in Asian primary central nervous system lymphoma (PCNSL) patients. OBJECTIVES To report the incidence, risk factors and mortality impact of VTE in Asian PCNSL patients. METHODS From 7 academic centers in Korea, 235 newly diagnosed PCNSL patients undergoing chemotherapy were retrospectively identified during period of January 2004 to September 2018. RESULTS All patients but 12 (6 T-cell, 6 other B-cell) had diffuse large B-cell lymphoma. During the median follow-up of 21 months, 33 patient (14.0%) developed VTE. Of the VTE events, 11 (33.3%) were deep vein thrombosis (DVT), 15 (45.5%) were pulmonary thromboembolism (PTE), and 7 (21.2%) were DVT with PTE. The median time to VTE was 2 months and the one-year actuarial incidence was 11.7%. On multivariate analysis, ECOG performance ≥2, age >60 years, female sex, and Hb <10 g/dL were independently associated with VTE. The patients with VTE were associated with shorter disease specific survival (P = 0.046) and overall survival (P = 0.022). CONCLUSION Overall, the incidence of VTE in Asian PCNSL seems to be lower compared to Western population. As VTE development is associated with overall survival and indicative of relapse, careful close monitoring is warranted.
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Affiliation(s)
- Ja Min Byun
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Junshik Hong
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
| | - Sung-Soo Yoon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Youngil Koh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chan-Young Ock
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Tae Min Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ji Hyun Lee
- Department of Internal Medicine, Dong-A University of College of Medicine, Busan, Republic of Korea
| | - Sung-Hyun Kim
- Department of Internal Medicine, Dong-A University of College of Medicine, Busan, Republic of Korea
| | - Jeong-Ok Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Soo-Mee Bang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ho-Young Yhim
- Department of Internal Medicine, Chonbuk National University Hospital, Jeonju, Republic of Korea
| | - Sung Hwa Bae
- Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Republic of Korea
| | - Yeung-Chul Mun
- Department of Internal Medicine, Ewha Women's University School of Medicine, Seoul, Republic of Korea
| | - Doyeun Oh
- Department of Internal Medicine, School of Medicine, CHA University, Seongnam, Republic of Korea
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Gangaraju R, Chen Y, Hageman L, Wu J, Francisco L, Kung M, Ness E, Parman M, Weisdorf DJ, Forman SJ, Arora M, Armenian SH, Bhatia S. Risk of venous thromboembolism in patients with non-Hodgkin lymphoma surviving blood or marrow transplantation. Cancer 2019; 125:4498-4508. [PMID: 31469420 DOI: 10.1002/cncr.32488] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/16/2019] [Accepted: 08/04/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Patients with non-Hodgkin lymphoma (NHL) have an increased risk of venous thromboembolism (VTE), particularly when they are receiving treatment. Blood or marrow transplantation (BMT) is recommended for relapsed/refractory NHL, and the risk of VTE after these patients undergo BMT is uncertain. METHODS Patients with NHL who survived 2 years or longer after BMT were surveyed for long-term health outcomes, including VTE. The median follow-up was 8.1 years (interquartile range, 5.6-12.9 years). The risk of VTE in 734 patients with NHL versus 897 siblings without a history of cancer and the risk factors associated with VTE were analyzed. RESULTS BMT survivors of NHL were at increased risk for VTE in comparison with siblings (odds ratio for allogeneic BMT survivors, 4.61; P < .0001; odds ratio for autologous BMT survivors, 1.75; P = .035). The cumulative incidence of VTE was 6.3% ± 0.9% at 5 years after BMT and 8.1% ± 1.1% at 10 years after BMT. In allogeneic BMT recipients, an increased body mass index (BMI; hazard ratio [HR] for BMI of 25-30 kg/m2 , 3.52; 95% confidence interval [CI], 1.43-8.64; P = .006; HR for BMI > 30 kg/m2 , 3.44; 95% CI, 1.15-10.23; P = .027) and a history of chronic graft-versus-host disease (HR, 3.33; 95% CI, 1.59-6.97; P = .001) were associated with an increased risk of VTE. Among autologous BMT recipients, a diagnosis of coronary artery disease (HR, 5.94; 95% CI, 1.7-20.71; P = .005) and prior treatment with carmustine (HR, 4.91; 95% CI, 1.66-14.51; P = .004) were associated with increased VTE risk. CONCLUSIONS Patients with NHL who survive BMT are at risk for developing late occurring VTE, and ongoing vigilance for this complication is required. Future studies assessing the role of thromboprophylaxis in high-risk patients with NHL are needed.
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Affiliation(s)
| | - Yanjun Chen
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Jessica Wu
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Michelle Kung
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Emily Ness
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Mariel Parman
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - Mukta Arora
- University of Minnesota, Minneapolis, Minnesota
| | | | - Smita Bhatia
- University of Alabama at Birmingham, Birmingham, Alabama
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Elmoamly S, Mattar M, Yacoub MF, Afif A. Can Biomarkers of Coagulation, Platelet Activation, and Inflammation Predict Venous Thromboembolism in Patients with Haematological Malignancies? Acta Haematol 2019; 141:245-253. [PMID: 30965330 DOI: 10.1159/000496914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 01/15/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND The incidence of venous thromboembolism (VTE) in haematological malignancies varies according to the type and grade of the disease and clinical variables, and there is a need to develop a tool to predict the occurrence of VTE in cancer patients at diagnosis to tailor prophylactic anticoagulation use during treatment. OBJECTIVE To study the incidence of VTE in haematological malignancies and clarify whether vascular and inflammatory biomarkers could be used as predictors of VTE in those patients. METHODS This was a prospective observational cohort study. Hypercoagulability and inflammatory biomarkers were assayed in a group of 171 patients with haematological malignancies at diagnosis. These markers included (1) coagulation and fibrinolysis activation markers (D-dimer, fibrinogen, antithrombin, plasminogen activator inhibitor 1), (2) endothelial and platelet activation markers (von Willebrand factor and soluble P-selectin), and (3) inflammatory markers (tumour necrosis factor αand interleukin 6). The end point was mortality or symptomatic VTE. RESULTS/CONCLUSION The incidence of symptomatic VTE was 7%. None of the tested biomarkers showed statistical significance as predictors for the occurrence of VTE in haematological malignancies. However, there were statistically significant associations between the occurrence of VTE and central venous access device insertion, the prothrombin time, and the erythrocyte sedimentation rate. An ESR above 106.5 mm/h is associated with increased VTE occurrence.
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Affiliation(s)
- Shereef Elmoamly
- Department of Internal Medicine and Clinical Haematology, Faculty of Medicine, Cairo University, Cairo, Egypt,
| | - Mervat Mattar
- Department of Internal Medicine and Clinical Haematology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Maha F Yacoub
- Department of Internal Medicine and Clinical Haematology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Alaa Afif
- Department of Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
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45
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Venous thromboembolism incidence in hematologic malignancies. Blood Rev 2018; 33:24-32. [PMID: 30262170 DOI: 10.1016/j.blre.2018.06.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 05/21/2018] [Accepted: 06/19/2018] [Indexed: 01/19/2023]
Abstract
Venous thromboembolism (VTE) remains a major cause of morbidity and mortality in patients with cancer. Although some very well validated scores delineate the risk of VTE by cancer subtype and other risk factors, hematologic malignancies are underrepresented in these models. This subgroup represents a unique entity that undergoes therapy that can be thrombogenic. The overall risk of VTE in patients with leukemia depends on the use of L-asparaginase treatment, older age, comorbidities and central venous catheters. Patients with acute promyelocytic leukemia are at particularly high risk of VTE but also have an increased risk of bleeding. Patients with aggressive lymphomas have a high incidence of VTE, roughly 10%. Patients with multiple myeloma at highest risk of VTE are those receiving immunomodulatory agents such as thalidomide or lenalidomide. Allogeneic stem cell transplantation carries a risk of thrombosis, particularly in patients developing graft versus host disease. This review summarizes the incidence of VTE in leukemia, lymphoma, myeloma and stem cell transplantation and provides practical guidance for preventing and managing VTE in patients with hematologic malignancies.
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46
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Risk factors for venous thromboembolism in patients with lymphoma requiring hospitalization. Blood Cancer J 2018; 8:54. [PMID: 29884791 PMCID: PMC5993802 DOI: 10.1038/s41408-018-0096-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 04/27/2018] [Accepted: 05/08/2018] [Indexed: 01/21/2023] Open
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Rupa-Matysek J, Brzeźniakiewicz-Janus K, Gil L, Krasiński Z, Komarnicki M. Evaluation of the ThroLy score for the prediction of venous thromboembolism in newly diagnosed patients treated for lymphoid malignancies in clinical practice. Cancer Med 2018; 7:2868-2875. [PMID: 29761831 PMCID: PMC6051175 DOI: 10.1002/cam4.1540] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 04/12/2018] [Accepted: 04/15/2018] [Indexed: 12/13/2022] Open
Abstract
The utility in clinical practice of a recently developed and validated predictive model for venous thromboembolism (VTE) events in lymphoma patients, known as the thrombosis lymphoma (ThroLy) score, is unknown. We evaluated the association of ThroLy with VTE in patients treated for diffuse large B-cell lymphoma (DLBCL) or Hodgkin lymphoma (HL) undergoing ambulatory first-line chemotherapy. Retrospective analyses were performed on 428 patients (median age 50), 241 were newly diagnosed DLBCL, and 187 had HL. During initial chemotherapy, 64 (15%) patients developed VTE. According to the ThroLy, 322 (75.2%) patients were considered low risk, 88 (20.6%) patients had intermediate risk and 18 (4.2%) patients high risk for VTE development. Patients with DLBCL were more often in the high-risk ThroLy group and had more VTE events than HL. VTE occurred in; 38.9% (n = 7) high-risk patients, 29.5% (n = 26) intermediate risk, and 9.6% (n = 31) low risk according to the ThroLy score. However, in multivariate analysis, high ThroLy (OR 5.13; 95% CI: 1.83-14.36, P = .002), intermediate ThroLy (OR 3.96; 95% CI: 2.19-7.17, P < .001), and aggressive lymphoma-DLBCL (OR 1.91; 95% CI: 1.05-3.47, P = .034) were all significantly associated with development of VTE, 48% of the VTE events occurred in the low-risk ThroLy score group (the ROC AUC (95% CI) 0.40-0.70 and C statistic-0.55). In our study, the ThroLy score was not a suitably accurate model for predicting VTE events in patients at higher risk of VTE. Further research should be conducted to identify new biomarkers that will predict these events and to establish a new VTE risk assessment model.
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Affiliation(s)
- Joanna Rupa-Matysek
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznań, Poland
| | | | - Lidia Gil
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznań, Poland
| | - Zbigniew Krasiński
- Department of General and Vascular Surgery, Poznan University of Medical Sciences, Poznań, Poland
| | - Mieczysław Komarnicki
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznań, Poland
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48
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Rupa-Matysek J, Gil L, Barańska M, Dytfeld D, Komarnicki M. Mean platelet volume as a predictive marker for venous thromboembolism in patients treated for Hodgkin lymphoma. Oncotarget 2018; 9:21190-21200. [PMID: 29765530 PMCID: PMC5940371 DOI: 10.18632/oncotarget.25002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 03/14/2018] [Indexed: 12/14/2022] Open
Abstract
Mean platelet volume (MPV) is reported to be associated with the risk of venous thromboembolism (VTE) and mortality in patients with cancer. We sought to determine the association of MPV with symptomatic VTE occurrence in patients treated for newly diagnosed Hodgkin lymphoma (HL) and their outcomes. We retrospectively studied 167 consecutive adult patients treated with HL. During first-line treatment 12 (7.2%) patients developed VTE and 14 (8%) died within the observation period. The pre-chemotherapy values of MPV were significantly lower in VTE patients than those without (p=0.0343). Patients with MPV≤25th percentile (6.8 fl) had an increased risk of VTE occurrence (p=0.0244). In multivariate analysis, MPV≤25th percentile (OR 2.21; 95%CI 1.07-4.57, p=0.033), advanced stage (OR 2.08; 95%CI 1.06-4.07, p=0.033) and bulky disease (OR 2.23; 95%CI 1.16-4.31, p=0.016) were significant factors for developing VTE. Only the impact of MPV≤25th percentile on VTE-free survival rates was found. VTE occurred in 43% (n=3) of the high-risk patients of the Thrombosis Lymphoma (ThroLy) score and in 17% (n=2) of the high-risk of the Khorana Risk Score (KRS). Neither the KRS nor the ThroLy score could identify patients at a high risk of VTE with a high degree of accuracy. We expanded the ThroLy score with the addition of the MPV≤25th percentile to more accurately identify HL patients with a higher risk of VTE. Our study indicates that the pre-chemotherapy MPV value, while of no use as an overall prognosis predictor, may still represent a useful prognostic marker for a significant VTE risk especially when incorporated into VTE-risk assessment models.
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Affiliation(s)
- Joanna Rupa-Matysek
- Department of Haematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznań, Poland
| | - Lidia Gil
- Department of Haematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznań, Poland
| | - Marta Barańska
- Department of Haematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznań, Poland
| | - Dominik Dytfeld
- Department of Haematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznań, Poland
| | - Mieczysław Komarnicki
- Department of Haematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznań, Poland
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Stark K, Schubert I, Joshi U, Kilani B, Hoseinpour P, Thakur M, Grünauer P, Pfeiler S, Schmidergall T, Stockhausen S, Bäumer M, Chandraratne S, von Brühl ML, Lorenz M, Coletti R, Reese S, Laitinen I, Wörmann SM, Algül H, Bruns CJ, Ware J, Mackman N, Engelmann B, Massberg S. Distinct Pathogenesis of Pancreatic Cancer Microvesicle-Associated Venous Thrombosis Identifies New Antithrombotic Targets In Vivo. Arterioscler Thromb Vasc Biol 2018; 38:772-786. [PMID: 29419408 DOI: 10.1161/atvbaha.117.310262] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 01/17/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Cancer patients are at high risk of developing deep venous thrombosis (DVT) and venous thromboembolism, a leading cause of mortality in this population. However, it is largely unclear how malignant tumors drive the prothrombotic cascade culminating in DVT. APPROACH AND RESULTS Here, we addressed the pathophysiology of malignant DVT compared with nonmalignant DVT and focused on the role of tumor microvesicles as potential targets to prevent cancer-associated DVT. We show that microvesicles released by pancreatic adenocarcinoma cells (pancreatic tumor-derived microvesicles [pcMV]) boost thrombus formation in a model of flow restriction of the mouse vena cava. This depends on the synergistic activation of coagulation by pcMV and host tissue factor. Unlike nonmalignant DVT, which is initiated and propagated by innate immune cells, thrombosis triggered by pcMV was largely independent of myeloid leukocytes or platelets. Instead, we identified externalization of the phospholipid phosphatidylethanolamine as a major mechanism controlling the prothrombotic activity of pcMV. Disrupting phosphatidylethanolamine-dependent activation of factor X suppressed pcMV-induced DVT without causing changes in hemostasis. CONCLUSIONS Together, we show here that the pathophysiology of pcMV-associated experimental DVT differs markedly from innate immune cell-promoted nonmalignant DVT and is therefore amenable to distinct antithrombotic strategies. Targeting phosphatidylethanolamine on tumor microvesicles could be a new strategy for prevention of cancer-associated DVT without causing bleeding complications.
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Affiliation(s)
- Konstantin Stark
- From the Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität, Munich, Germany (K.S., I.S., B.K., P.H., T.S., S.S., S.C., M.-L.v.B., M.L., R.C., S.M.); German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (K.S., S.M.); Institut für Laboratoriumsmedizin (U.J., M.T., P.G., S.P., M.B., B.E.) and Lehrstuhl für Anatomie, Histologie und Embryologie, Department of Veterinary Medicine (S.R.), Ludwig-Maximilians-Universität, Munich, Germany; Nuklearmedizinische Klinik und Poliklinik (I.L.) and II. Medizinische Klinik und Poliklinik (S.M.W., H.A.), Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Cologne, Germany (C.J.B.); Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock (J.W.); and Department of Medicine, University of North Carolina at Chapel Hill (N.M.).
| | - Irene Schubert
- From the Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität, Munich, Germany (K.S., I.S., B.K., P.H., T.S., S.S., S.C., M.-L.v.B., M.L., R.C., S.M.); German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (K.S., S.M.); Institut für Laboratoriumsmedizin (U.J., M.T., P.G., S.P., M.B., B.E.) and Lehrstuhl für Anatomie, Histologie und Embryologie, Department of Veterinary Medicine (S.R.), Ludwig-Maximilians-Universität, Munich, Germany; Nuklearmedizinische Klinik und Poliklinik (I.L.) and II. Medizinische Klinik und Poliklinik (S.M.W., H.A.), Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Cologne, Germany (C.J.B.); Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock (J.W.); and Department of Medicine, University of North Carolina at Chapel Hill (N.M.)
| | - Urjita Joshi
- From the Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität, Munich, Germany (K.S., I.S., B.K., P.H., T.S., S.S., S.C., M.-L.v.B., M.L., R.C., S.M.); German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (K.S., S.M.); Institut für Laboratoriumsmedizin (U.J., M.T., P.G., S.P., M.B., B.E.) and Lehrstuhl für Anatomie, Histologie und Embryologie, Department of Veterinary Medicine (S.R.), Ludwig-Maximilians-Universität, Munich, Germany; Nuklearmedizinische Klinik und Poliklinik (I.L.) and II. Medizinische Klinik und Poliklinik (S.M.W., H.A.), Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Cologne, Germany (C.J.B.); Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock (J.W.); and Department of Medicine, University of North Carolina at Chapel Hill (N.M.)
| | - Badr Kilani
- From the Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität, Munich, Germany (K.S., I.S., B.K., P.H., T.S., S.S., S.C., M.-L.v.B., M.L., R.C., S.M.); German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (K.S., S.M.); Institut für Laboratoriumsmedizin (U.J., M.T., P.G., S.P., M.B., B.E.) and Lehrstuhl für Anatomie, Histologie und Embryologie, Department of Veterinary Medicine (S.R.), Ludwig-Maximilians-Universität, Munich, Germany; Nuklearmedizinische Klinik und Poliklinik (I.L.) and II. Medizinische Klinik und Poliklinik (S.M.W., H.A.), Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Cologne, Germany (C.J.B.); Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock (J.W.); and Department of Medicine, University of North Carolina at Chapel Hill (N.M.)
| | - Parandis Hoseinpour
- From the Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität, Munich, Germany (K.S., I.S., B.K., P.H., T.S., S.S., S.C., M.-L.v.B., M.L., R.C., S.M.); German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (K.S., S.M.); Institut für Laboratoriumsmedizin (U.J., M.T., P.G., S.P., M.B., B.E.) and Lehrstuhl für Anatomie, Histologie und Embryologie, Department of Veterinary Medicine (S.R.), Ludwig-Maximilians-Universität, Munich, Germany; Nuklearmedizinische Klinik und Poliklinik (I.L.) and II. Medizinische Klinik und Poliklinik (S.M.W., H.A.), Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Cologne, Germany (C.J.B.); Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock (J.W.); and Department of Medicine, University of North Carolina at Chapel Hill (N.M.)
| | - Manovriti Thakur
- From the Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität, Munich, Germany (K.S., I.S., B.K., P.H., T.S., S.S., S.C., M.-L.v.B., M.L., R.C., S.M.); German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (K.S., S.M.); Institut für Laboratoriumsmedizin (U.J., M.T., P.G., S.P., M.B., B.E.) and Lehrstuhl für Anatomie, Histologie und Embryologie, Department of Veterinary Medicine (S.R.), Ludwig-Maximilians-Universität, Munich, Germany; Nuklearmedizinische Klinik und Poliklinik (I.L.) and II. Medizinische Klinik und Poliklinik (S.M.W., H.A.), Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Cologne, Germany (C.J.B.); Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock (J.W.); and Department of Medicine, University of North Carolina at Chapel Hill (N.M.)
| | - Petra Grünauer
- From the Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität, Munich, Germany (K.S., I.S., B.K., P.H., T.S., S.S., S.C., M.-L.v.B., M.L., R.C., S.M.); German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (K.S., S.M.); Institut für Laboratoriumsmedizin (U.J., M.T., P.G., S.P., M.B., B.E.) and Lehrstuhl für Anatomie, Histologie und Embryologie, Department of Veterinary Medicine (S.R.), Ludwig-Maximilians-Universität, Munich, Germany; Nuklearmedizinische Klinik und Poliklinik (I.L.) and II. Medizinische Klinik und Poliklinik (S.M.W., H.A.), Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Cologne, Germany (C.J.B.); Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock (J.W.); and Department of Medicine, University of North Carolina at Chapel Hill (N.M.)
| | - Susanne Pfeiler
- From the Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität, Munich, Germany (K.S., I.S., B.K., P.H., T.S., S.S., S.C., M.-L.v.B., M.L., R.C., S.M.); German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (K.S., S.M.); Institut für Laboratoriumsmedizin (U.J., M.T., P.G., S.P., M.B., B.E.) and Lehrstuhl für Anatomie, Histologie und Embryologie, Department of Veterinary Medicine (S.R.), Ludwig-Maximilians-Universität, Munich, Germany; Nuklearmedizinische Klinik und Poliklinik (I.L.) and II. Medizinische Klinik und Poliklinik (S.M.W., H.A.), Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Cologne, Germany (C.J.B.); Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock (J.W.); and Department of Medicine, University of North Carolina at Chapel Hill (N.M.)
| | - Tobias Schmidergall
- From the Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität, Munich, Germany (K.S., I.S., B.K., P.H., T.S., S.S., S.C., M.-L.v.B., M.L., R.C., S.M.); German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (K.S., S.M.); Institut für Laboratoriumsmedizin (U.J., M.T., P.G., S.P., M.B., B.E.) and Lehrstuhl für Anatomie, Histologie und Embryologie, Department of Veterinary Medicine (S.R.), Ludwig-Maximilians-Universität, Munich, Germany; Nuklearmedizinische Klinik und Poliklinik (I.L.) and II. Medizinische Klinik und Poliklinik (S.M.W., H.A.), Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Cologne, Germany (C.J.B.); Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock (J.W.); and Department of Medicine, University of North Carolina at Chapel Hill (N.M.)
| | - Sven Stockhausen
- From the Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität, Munich, Germany (K.S., I.S., B.K., P.H., T.S., S.S., S.C., M.-L.v.B., M.L., R.C., S.M.); German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (K.S., S.M.); Institut für Laboratoriumsmedizin (U.J., M.T., P.G., S.P., M.B., B.E.) and Lehrstuhl für Anatomie, Histologie und Embryologie, Department of Veterinary Medicine (S.R.), Ludwig-Maximilians-Universität, Munich, Germany; Nuklearmedizinische Klinik und Poliklinik (I.L.) and II. Medizinische Klinik und Poliklinik (S.M.W., H.A.), Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Cologne, Germany (C.J.B.); Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock (J.W.); and Department of Medicine, University of North Carolina at Chapel Hill (N.M.)
| | - Markus Bäumer
- From the Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität, Munich, Germany (K.S., I.S., B.K., P.H., T.S., S.S., S.C., M.-L.v.B., M.L., R.C., S.M.); German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (K.S., S.M.); Institut für Laboratoriumsmedizin (U.J., M.T., P.G., S.P., M.B., B.E.) and Lehrstuhl für Anatomie, Histologie und Embryologie, Department of Veterinary Medicine (S.R.), Ludwig-Maximilians-Universität, Munich, Germany; Nuklearmedizinische Klinik und Poliklinik (I.L.) and II. Medizinische Klinik und Poliklinik (S.M.W., H.A.), Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Cologne, Germany (C.J.B.); Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock (J.W.); and Department of Medicine, University of North Carolina at Chapel Hill (N.M.)
| | - Sue Chandraratne
- From the Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität, Munich, Germany (K.S., I.S., B.K., P.H., T.S., S.S., S.C., M.-L.v.B., M.L., R.C., S.M.); German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (K.S., S.M.); Institut für Laboratoriumsmedizin (U.J., M.T., P.G., S.P., M.B., B.E.) and Lehrstuhl für Anatomie, Histologie und Embryologie, Department of Veterinary Medicine (S.R.), Ludwig-Maximilians-Universität, Munich, Germany; Nuklearmedizinische Klinik und Poliklinik (I.L.) and II. Medizinische Klinik und Poliklinik (S.M.W., H.A.), Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Cologne, Germany (C.J.B.); Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock (J.W.); and Department of Medicine, University of North Carolina at Chapel Hill (N.M.)
| | - Marie-Luise von Brühl
- From the Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität, Munich, Germany (K.S., I.S., B.K., P.H., T.S., S.S., S.C., M.-L.v.B., M.L., R.C., S.M.); German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (K.S., S.M.); Institut für Laboratoriumsmedizin (U.J., M.T., P.G., S.P., M.B., B.E.) and Lehrstuhl für Anatomie, Histologie und Embryologie, Department of Veterinary Medicine (S.R.), Ludwig-Maximilians-Universität, Munich, Germany; Nuklearmedizinische Klinik und Poliklinik (I.L.) and II. Medizinische Klinik und Poliklinik (S.M.W., H.A.), Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Cologne, Germany (C.J.B.); Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock (J.W.); and Department of Medicine, University of North Carolina at Chapel Hill (N.M.)
| | - Michael Lorenz
- From the Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität, Munich, Germany (K.S., I.S., B.K., P.H., T.S., S.S., S.C., M.-L.v.B., M.L., R.C., S.M.); German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (K.S., S.M.); Institut für Laboratoriumsmedizin (U.J., M.T., P.G., S.P., M.B., B.E.) and Lehrstuhl für Anatomie, Histologie und Embryologie, Department of Veterinary Medicine (S.R.), Ludwig-Maximilians-Universität, Munich, Germany; Nuklearmedizinische Klinik und Poliklinik (I.L.) and II. Medizinische Klinik und Poliklinik (S.M.W., H.A.), Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Cologne, Germany (C.J.B.); Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock (J.W.); and Department of Medicine, University of North Carolina at Chapel Hill (N.M.)
| | - Raffaele Coletti
- From the Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität, Munich, Germany (K.S., I.S., B.K., P.H., T.S., S.S., S.C., M.-L.v.B., M.L., R.C., S.M.); German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (K.S., S.M.); Institut für Laboratoriumsmedizin (U.J., M.T., P.G., S.P., M.B., B.E.) and Lehrstuhl für Anatomie, Histologie und Embryologie, Department of Veterinary Medicine (S.R.), Ludwig-Maximilians-Universität, Munich, Germany; Nuklearmedizinische Klinik und Poliklinik (I.L.) and II. Medizinische Klinik und Poliklinik (S.M.W., H.A.), Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Cologne, Germany (C.J.B.); Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock (J.W.); and Department of Medicine, University of North Carolina at Chapel Hill (N.M.)
| | - Sven Reese
- From the Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität, Munich, Germany (K.S., I.S., B.K., P.H., T.S., S.S., S.C., M.-L.v.B., M.L., R.C., S.M.); German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (K.S., S.M.); Institut für Laboratoriumsmedizin (U.J., M.T., P.G., S.P., M.B., B.E.) and Lehrstuhl für Anatomie, Histologie und Embryologie, Department of Veterinary Medicine (S.R.), Ludwig-Maximilians-Universität, Munich, Germany; Nuklearmedizinische Klinik und Poliklinik (I.L.) and II. Medizinische Klinik und Poliklinik (S.M.W., H.A.), Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Cologne, Germany (C.J.B.); Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock (J.W.); and Department of Medicine, University of North Carolina at Chapel Hill (N.M.)
| | - Iina Laitinen
- From the Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität, Munich, Germany (K.S., I.S., B.K., P.H., T.S., S.S., S.C., M.-L.v.B., M.L., R.C., S.M.); German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (K.S., S.M.); Institut für Laboratoriumsmedizin (U.J., M.T., P.G., S.P., M.B., B.E.) and Lehrstuhl für Anatomie, Histologie und Embryologie, Department of Veterinary Medicine (S.R.), Ludwig-Maximilians-Universität, Munich, Germany; Nuklearmedizinische Klinik und Poliklinik (I.L.) and II. Medizinische Klinik und Poliklinik (S.M.W., H.A.), Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Cologne, Germany (C.J.B.); Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock (J.W.); and Department of Medicine, University of North Carolina at Chapel Hill (N.M.)
| | - Sonja Maria Wörmann
- From the Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität, Munich, Germany (K.S., I.S., B.K., P.H., T.S., S.S., S.C., M.-L.v.B., M.L., R.C., S.M.); German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (K.S., S.M.); Institut für Laboratoriumsmedizin (U.J., M.T., P.G., S.P., M.B., B.E.) and Lehrstuhl für Anatomie, Histologie und Embryologie, Department of Veterinary Medicine (S.R.), Ludwig-Maximilians-Universität, Munich, Germany; Nuklearmedizinische Klinik und Poliklinik (I.L.) and II. Medizinische Klinik und Poliklinik (S.M.W., H.A.), Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Cologne, Germany (C.J.B.); Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock (J.W.); and Department of Medicine, University of North Carolina at Chapel Hill (N.M.)
| | - Hana Algül
- From the Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität, Munich, Germany (K.S., I.S., B.K., P.H., T.S., S.S., S.C., M.-L.v.B., M.L., R.C., S.M.); German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (K.S., S.M.); Institut für Laboratoriumsmedizin (U.J., M.T., P.G., S.P., M.B., B.E.) and Lehrstuhl für Anatomie, Histologie und Embryologie, Department of Veterinary Medicine (S.R.), Ludwig-Maximilians-Universität, Munich, Germany; Nuklearmedizinische Klinik und Poliklinik (I.L.) and II. Medizinische Klinik und Poliklinik (S.M.W., H.A.), Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Cologne, Germany (C.J.B.); Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock (J.W.); and Department of Medicine, University of North Carolina at Chapel Hill (N.M.)
| | - Christiane J Bruns
- From the Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität, Munich, Germany (K.S., I.S., B.K., P.H., T.S., S.S., S.C., M.-L.v.B., M.L., R.C., S.M.); German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (K.S., S.M.); Institut für Laboratoriumsmedizin (U.J., M.T., P.G., S.P., M.B., B.E.) and Lehrstuhl für Anatomie, Histologie und Embryologie, Department of Veterinary Medicine (S.R.), Ludwig-Maximilians-Universität, Munich, Germany; Nuklearmedizinische Klinik und Poliklinik (I.L.) and II. Medizinische Klinik und Poliklinik (S.M.W., H.A.), Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Cologne, Germany (C.J.B.); Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock (J.W.); and Department of Medicine, University of North Carolina at Chapel Hill (N.M.)
| | - Jerry Ware
- From the Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität, Munich, Germany (K.S., I.S., B.K., P.H., T.S., S.S., S.C., M.-L.v.B., M.L., R.C., S.M.); German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (K.S., S.M.); Institut für Laboratoriumsmedizin (U.J., M.T., P.G., S.P., M.B., B.E.) and Lehrstuhl für Anatomie, Histologie und Embryologie, Department of Veterinary Medicine (S.R.), Ludwig-Maximilians-Universität, Munich, Germany; Nuklearmedizinische Klinik und Poliklinik (I.L.) and II. Medizinische Klinik und Poliklinik (S.M.W., H.A.), Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Cologne, Germany (C.J.B.); Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock (J.W.); and Department of Medicine, University of North Carolina at Chapel Hill (N.M.)
| | - Nigel Mackman
- From the Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität, Munich, Germany (K.S., I.S., B.K., P.H., T.S., S.S., S.C., M.-L.v.B., M.L., R.C., S.M.); German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (K.S., S.M.); Institut für Laboratoriumsmedizin (U.J., M.T., P.G., S.P., M.B., B.E.) and Lehrstuhl für Anatomie, Histologie und Embryologie, Department of Veterinary Medicine (S.R.), Ludwig-Maximilians-Universität, Munich, Germany; Nuklearmedizinische Klinik und Poliklinik (I.L.) and II. Medizinische Klinik und Poliklinik (S.M.W., H.A.), Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Cologne, Germany (C.J.B.); Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock (J.W.); and Department of Medicine, University of North Carolina at Chapel Hill (N.M.)
| | - Bernd Engelmann
- From the Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität, Munich, Germany (K.S., I.S., B.K., P.H., T.S., S.S., S.C., M.-L.v.B., M.L., R.C., S.M.); German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (K.S., S.M.); Institut für Laboratoriumsmedizin (U.J., M.T., P.G., S.P., M.B., B.E.) and Lehrstuhl für Anatomie, Histologie und Embryologie, Department of Veterinary Medicine (S.R.), Ludwig-Maximilians-Universität, Munich, Germany; Nuklearmedizinische Klinik und Poliklinik (I.L.) and II. Medizinische Klinik und Poliklinik (S.M.W., H.A.), Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Cologne, Germany (C.J.B.); Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock (J.W.); and Department of Medicine, University of North Carolina at Chapel Hill (N.M.)
| | - Steffen Massberg
- From the Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität, Munich, Germany (K.S., I.S., B.K., P.H., T.S., S.S., S.C., M.-L.v.B., M.L., R.C., S.M.); German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (K.S., S.M.); Institut für Laboratoriumsmedizin (U.J., M.T., P.G., S.P., M.B., B.E.) and Lehrstuhl für Anatomie, Histologie und Embryologie, Department of Veterinary Medicine (S.R.), Ludwig-Maximilians-Universität, Munich, Germany; Nuklearmedizinische Klinik und Poliklinik (I.L.) and II. Medizinische Klinik und Poliklinik (S.M.W., H.A.), Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Cologne, Germany (C.J.B.); Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock (J.W.); and Department of Medicine, University of North Carolina at Chapel Hill (N.M.)
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Rupa-Matysek J, Gil L, Kaźmierczak M, Barańska M, Komarnicki M. Prediction of venous thromboembolism in newly diagnosed patients treated for lymphoid malignancies: validation of the Khorana Risk Score. Med Oncol 2017; 35:5. [PMID: 29209847 PMCID: PMC5717131 DOI: 10.1007/s12032-017-1065-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 11/29/2017] [Indexed: 01/01/2023]
Abstract
The utility of the venous thromboembolism (VTE) risk assessment model known as the Khorana Risk Score (KRS) in patients with lymphoid malignancies receiving outpatient chemotherapy is not defined. We evaluated the association of the KRS with VTE in patients treated for diffuse large B cell lymphoma (DLBCL) or Hodgkin lymphoma (HL). Retrospective analyses were performed in 428 patients, 241 of whom were newly diagnosed with DLBCL and 187 of whom had HL. During the initial therapy, 64 (15%) patients developed VTE and 56 died during follow-up. More VTE events occurred in patients with DLBCL than in patients with HL. According to the KRS, 364 (85%) and 64 (15%) patients were considered to be at intermediate risk and high risk of VTE development, respectively. The high-risk KRS patients were more often diagnosed with HL than DLBCL (19 vs. 10%, P = 0.0143). The KRS did not discriminate between high- and intermediate-risk patients with respect to VTE occurrence (17 vs. 15%, P = 0.5868). In our patients, the KRS did not adequately predict VTE (positive predictive value 15%, negative predictive value 82% and C statistic 0.51). In the multivariate analysis, bulky disease (OR 2.34; 95% CI 1.62-3.36, P < 0.0001), poor prognostic disease (OR 1.32; 95% CI 1.01-1.74, P = 0.049) and DLBCL histological subtype (OR 1.61; 95% CI 1.17-2.19, P = 0.003) were all significantly associated with the VTE development. In this cohort of patients with lymphoid malignancies, the KRS did not adequately stratify or predict VTE events in patients at a higher risk of VTE. This finding suggests the need for the development of a disease-specific VTE assessment model.
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Affiliation(s)
- Joanna Rupa-Matysek
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Szamarzewskiego 84, 60-569, Poznan, Poland.
| | - Lidia Gil
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Szamarzewskiego 84, 60-569, Poznan, Poland
| | - Maciej Kaźmierczak
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Szamarzewskiego 84, 60-569, Poznan, Poland
| | - Marta Barańska
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Szamarzewskiego 84, 60-569, Poznan, Poland
| | - Mieczysław Komarnicki
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Szamarzewskiego 84, 60-569, Poznan, Poland
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