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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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Mitrovic M, Pantic N, Sabljic N, Bukumiric Z, Virijevic M, Pravdic Z, Cvetkovic M, Rajic J, Bodrozic J, Milosevic V, Todorovic-Balint M, Vidovic A, Suvajdzic-Vukovic N, Antic D. Arterial Thrombosis in Patients with Acute Myeloid Leukemia: Incidence and Risk Factors. Cancers (Basel) 2023; 15:cancers15113060. [PMID: 37297022 DOI: 10.3390/cancers15113060] [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: 05/14/2023] [Revised: 05/30/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Patients with hematological malignancies have an increased risk of arterial thrombotic events (ATEs) after diagnosis, compared to matched controls without cancer. However, data about incidence and risk factors for ATE development in patients with acute myeloid leukemia (AML) are missing. AIM The objectives of this study were to determine the incidence of ATE in non-promyelocytic-AML patients and to define the potential risk factors for ATE development. METHODS We conducted a retrospective cohort study of adult patients with newly diagnosed AML. The primary outcome was the occurrence of confirmed ATE, defined as myocardial infarction, stroke or critical limb ischemia. RESULTS Out of 626 eligible AML patients, 18 (2.9%) patients developed ATE in the median time of 3 (range: 0.23-6) months. Half of these patients died due to ATE complications. Five parameters were predictors of ATE: BMI > 30 (p = 0.000, odds ratio [OR] 20.488, 95% CI: 6.581-63.780), prior history of TE (p = 0.041, OR 4.233, 95% CI: 1.329-13.486), presence of comorbidities (p = 0.027, OR 5.318, 95% CI: 1.212-23.342), presence of cardiovascular comorbidities (p < 0.0001, OR 8.0168, 95% CI: 2.948-21.800) and cytogenetic risk score (p = 0.002, OR 2.113, 95% CI: 1.092-5.007). CONCLUSIONS Our study showed that patients with AML are at increased risk of ATE. The risk was increased in patients with cardiovascular comorbidities, previous thrombosis, adverse cytogenetic risk as well as BMI > 30.
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Affiliation(s)
- Mirjana Mitrovic
- Clinic of Hematology, Unviersity Clinical Center of Serbia, 2 Koste Todorovica St., 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Nikola Pantic
- Clinic of Hematology, Unviersity Clinical Center of Serbia, 2 Koste Todorovica St., 11000 Belgrade, Serbia
| | - Nikica Sabljic
- Clinic of Hematology, Unviersity Clinical Center of Serbia, 2 Koste Todorovica St., 11000 Belgrade, Serbia
| | - Zoran Bukumiric
- Faculty of Medicine, Institute for Medical Statistics and Informatics, University of Belgrade, 11000 Belgrade, Serbia
| | - Marijana Virijevic
- Clinic of Hematology, Unviersity Clinical Center of Serbia, 2 Koste Todorovica St., 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Zlatko Pravdic
- Clinic of Hematology, Unviersity Clinical Center of Serbia, 2 Koste Todorovica St., 11000 Belgrade, Serbia
| | - Mirjana Cvetkovic
- Clinic of Hematology, Unviersity Clinical Center of Serbia, 2 Koste Todorovica St., 11000 Belgrade, Serbia
| | - Jovan Rajic
- Clinic of Hematology, Unviersity Clinical Center of Serbia, 2 Koste Todorovica St., 11000 Belgrade, Serbia
| | - Jelena Bodrozic
- Clinic of Hematology, Unviersity Clinical Center of Serbia, 2 Koste Todorovica St., 11000 Belgrade, Serbia
| | - Violeta Milosevic
- Clinic of Hematology, Unviersity Clinical Center of Serbia, 2 Koste Todorovica St., 11000 Belgrade, Serbia
| | - Milena Todorovic-Balint
- Clinic of Hematology, Unviersity Clinical Center of Serbia, 2 Koste Todorovica St., 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Ana Vidovic
- Clinic of Hematology, Unviersity Clinical Center of Serbia, 2 Koste Todorovica St., 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Nada Suvajdzic-Vukovic
- Clinic of Hematology, Unviersity Clinical Center of Serbia, 2 Koste Todorovica St., 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Darko Antic
- Clinic of Hematology, Unviersity Clinical Center of Serbia, 2 Koste Todorovica St., 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
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