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Spannbauer A, Bergler-Klein J. Cardio-Oncology: A New Discipline in Medicine and Its Relevance to Hematology. Hamostaseologie 2024; 44:255-267. [PMID: 38723641 DOI: 10.1055/a-2284-5855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2024] Open
Abstract
Cardio-oncology, a burgeoning subspecialty, addresses the complex interplay between cardiology and oncology, particularly in light of increased cardiovascular (CV) disease mortality in cancer patients. This review provides a comprehensive overview of cardio-oncology with a focus on the therapies used in hematological malignancies. We explore the bidirectional relationship between heart failure and cancer, emphasizing the need for collaborative care. The review discusses risk stratification, highlighting the importance of baseline CV risk assessment and personalized surveillance regimens. Primary and secondary prevention strategies, including pharmacological interventions, are outlined. The review also delves into the cardiotoxicity associated with hematological cancer therapies, focusing on anthracyclines, Bruton kinase inhibitors, BCR-ABL tyrosine kinase inhibitors, CAR-T cell therapy, immune checkpoint inhibitors, multiple myeloma treatments, and hematopoietic stem cell transplantation. We then highlight the high risk of venous and arterial thromboembolisms in cancer patients and the challenges of anticoagulation management in cardio-oncology. Finally, the review touches on the importance of long-term follow-up and appropriate screening in cancer survivors at high risk of CV morbidity and mortality, based on their CV risk profile and the type and dose of cardiotoxic therapies they received such as anthracyclines or high radiation doses.
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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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Vandenbroucke JP, Sørensen HT, Rehkopf DH, Gradus JL, Mackenbach JP, Glymour MM, Galea S, Henderson VW. Report on the Joint Workshop on the Relations between Health Inequalities, Ageing and Multimorbidity, Iceland, May 3-4, 2023. Clin Epidemiol 2024; 16:9-22. [PMID: 38259327 PMCID: PMC10801289 DOI: 10.2147/clep.s443152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 12/13/2023] [Indexed: 01/24/2024] Open
Abstract
This paper is a summary of key presentations from a workshop in Iceland on May 3-4, 2023 arranged by Aarhus University and with participation of the below-mentioned scientists. Below you will find the key messages from the presentations made by: Professor Jan Vandenbroucke, Department of Clinical Epidemiology, Aarhus University, Emeritus Professor, Leiden University; Honorary Professor, London School of Hygiene & Tropical Medicine, UKProfessor, Chair Henrik Toft Sørensen, Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, DenmarkProfessor David H. Rehkopf, Director, the Stanford Center for Population Health Sciences, Stanford University, CA., USProfessor Jaimie Gradus, Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, USProfessor Johan Mackenbach, Emeritus Professor, Department of Public Health, Erasmus University Rotterdam, HollandProfessor, Chair M Maria Glymour, Department of Epidemiology, Boston University School of Public Health, Boston University, Boston, Massachusetts, USProfessor, Dean Sandro Galea, School of Public Health, Boston University, Boston, Massachusetts, USProfessor Victor W. Henderson, Departments of Epidemiology & Population Health and of Neurology & Neurological Sciences, Stanford University, Stanford, CA, US; Department of Clinical Epidemiology, Aarhus University, Aarhus, DK.
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Affiliation(s)
- Jan P Vandenbroucke
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
- Leiden University, Leiden, Netherlands
- London School of Hygiene & Tropical Medicine, London, UK
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
- Aarhus University Hospital, Aarhus, Denmark
| | - David H Rehkopf
- Stanford Center for Population Health Sciences, Stanford University, CA, USA
| | - Jaimie L Gradus
- Department of Epidemiology, School of Public Health, Boston University, Boston, MA, USA
| | - Johan P Mackenbach
- Department of Public Health, Erasmus University Rotterdam, Rotterdam, Holland
| | - M Maria Glymour
- Department of Epidemiology, Boston University School of Public Health, Boston University, Boston, MA, USA
| | - Sandro Galea
- School of Public Health, Boston University, Boston, MA, USA
| | - Victor W Henderson
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
- Departments of Epidemiology & Population Health and of Neurology & Neurological Sciences, Stanford University, Stanford, CA, USA
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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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Reyes EJ, Ruiz-Talero P, Arenas MA, Hernández-Flórez C, Muñoz OM. Factors associated with in-hospital and outpatient survival of patients with different types of stage IV cancer and venous thromboembolism. J Int Med Res 2023; 51:3000605231219170. [PMID: 38147642 PMCID: PMC10752176 DOI: 10.1177/03000605231219170] [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: 08/09/2023] [Accepted: 11/17/2023] [Indexed: 12/28/2023] Open
Abstract
OBJECTIVE To identify factors associated with in-hospital and outpatient survival of patients with different types of stage IV cancer who present with venous thromboembolic disease (VTE). METHODS In this prospective cohort, in-hospital and outpatient survival rates up to 180 days were analyzed using Kaplan-Meier curves. Cox regression was used to identify factors associated with different survival functions. RESULTS One hundred patients were analyzed (median age, 67.5 years; 75% with Charlson index of <10; 69% with Eastern Cooperative Oncology Group (ECOG) score of 3-4). In-hospital mortality was 18%, and the median time from admission to death was 11 days (interquartile range, 1-61 days). Factors significantly associated with in-hospital mortality were the ECOG score and thrombocytopenia. The 180-day mortality rate was 52%, with deaths mainly occurring in the first 90 days since VTE diagnosis. Additional factors significantly associated with outpatient mortality included male sex and neoplasms with a high risk of thrombosis (lung, pancreas, stomach, uterus, bladder, and kidney neoplasms). CONCLUSION Patients with stage IV cancer and acute VTE have short survival. Poor prognostic factors are thrombocytopenia, the ECOG score, and certain types of cancer. These results may help physicians individualize decisions regarding initiation and continuation of anticoagulant therapy.
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Affiliation(s)
| | - Paula Ruiz-Talero
- Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
- Department of Internal Medicine, Hospital Universitario San Ignacio, Bogotá, Colombia
| | | | - Catalina Hernández-Flórez
- Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
- Department of Internal Medicine, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Oscar M Muñoz
- Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
- Department of Internal Medicine, Hospital Universitario San Ignacio, Bogotá, Colombia
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