Aggressive lymphoma subtype is a risk factor for venous thrombosis. Development of lymphoma ‐ specific venous thrombosis prediction models

Dharmavaram, Gouri; Cao, Shufen; Sundaram, Suchitra; Ayyappan, Sabarish; Boughan, Kirsten M; Gallogly, Molly; Malek, Ehsan; Metheny, Leland; Tomlinson, Benjamin; Otegbeye, Folashade; Lazarus, Hillard M.; Cooper, Brenda; Fu, Pingfu; Lima, Marcos de; Caimi, Paolo

doi:10.1002/ajh.25837

Cited by 16 publications

(25 citation statements)

References 25 publications

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“…Patients with lymphoma are at high risk for VTE; more while having active disease and on chemotherapy. 21–23 In our study, at least half of lymphoma patients had the VTE while ambulatory around the time of VTE diagnosis. Obviously, none of such patients were on VTE prophylaxis.…”

Section: Discussionmentioning

confidence: 69%

The Application of the ThroLy Risk Assessment Model to Predict Venous Thromboembolism in Patients with Diffuse Large B-Cell Lymphoma

Abdel‐Razeq

Ma’koseh

Mansour

et al. 2021

Clin Appl Thromb Hemost

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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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Section: Discussionmentioning

confidence: 69%

The Application of the ThroLy Risk Assessment Model to Predict Venous Thromboembolism in Patients with Diffuse Large B-Cell Lymphoma

Abdel‐Razeq

Ma’koseh

Mansour

et al. 2021

Clin Appl Thromb Hemost

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“…(12) -7,7%. Veći broj naučnih radova navodi signifikantno veću učestalost VTE kod bolesnika sa agresivnim limfomima u odnosu na bolesnike sa indolentnim limfomima, uz variranje incidencije (12)(13)(14)(15)(16).…”

Section: Epidemiologijaunclassified

“…Iako se KS pokazao kad uslovno adekvatan alat za identifikaciju visokorizičnih pacijenata sa kancerom koji bi imali benefit od primene tromboprofilakse (19,48), performanse skora se nisu pokazale u potpunosti zadovoljavajućim kod specifične grupe pacijenata obolelih od limfoma (49). Takođe, pojedini podtipovi NHL, kao što su PMBCL, PNCSL i DBKL, karakteriše veća učestalost trombotičkih komplikacija u odnosu na indolentne limfome (5,6,16). Značajan problem KS je i niska senzitivnost koja se ogleda u činjenici da se većina VTE događaja kod pacijenata sa malignitetom zapravo događa izvan grupe visokog rizika (KS >3) (50).…”

Section: Epidemiologijaunclassified

Venous thromboembolic complications in lymphoma patients

Otašević¹,

Mihaljević²

2020

Medicinski podmladak

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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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“…In the study byAntic et al,(18) the rates of VTE development among lymphoma patients were 5.3% in the derivation cohort and 5.8% in the validation cohort. In a recently published article(19) focusing on DLBCL and follicular lymphoma, the reported rate of VTE development was 13.4%. These observed variations in the VTE rate in lymphoma patients are notable and may have several causes, including focusing on distinctive types of lymphoma, study methodology (e.g., retrospective vs. prospective), and publication time (more recent studies have been dedicated to CAT).…”

mentioning

confidence: 99%

“…(36)In our cohort, patients with aggressive lymphoma had a higher rate of VTE development (11.8%) than did patients with indolent lymphoma (5.8%) and HL (8.4%). Aggressive histology is predisposed to complicate the clinical course of lymphoma due to VTE (13,14,19,33,35,37). However, one large study by San lippo et al(38) concluded that the VTE risk for DLBCL is lowered after adjusting for additional risk factors.…”

mentioning

confidence: 99%

Immune Activation and Inflammatory Biomarkers as Predictors of Venous Thromboembolism in Lymphoma Patients

Otašević¹,

Mihaljević²,

Milić

et al. 2021

Preprint

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Background: Lymphomas are characterized by inflammatory soluble mediators that can trigger the development of venous thromboembolism (VTE). However, data on the relationship between specific immune dysregulation and VTE occurrence in lymphoma are scarce. The study aimed to assess the association between inflammatory markers and the risk of VTE development in lymphoma patients.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 set objectively based on radiographic studies. ROC (receiver operating characteristic) curve analysis was used to define the optimal cutoff values for predicting VTE.Results: The majority of patients were diagnosed with aggressive non-Hodgkin lymphoma (58.8%) and had advanced disease (59.9%). Sixty-nine patients (9.8%) developed VTE. The NLR, PLR, ESR, CRP, and LDH were significantly higher in lymphoma patients with VTE, whereas the TP and albumin were significantly lower. In 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 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 lymphoma patients at risk of VTE development.

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Aggressive lymphoma subtype is a risk factor for venous thrombosis. Development of lymphoma ‐ specific venous thrombosis prediction models

Cited by 16 publications

References 25 publications

The Application of the ThroLy Risk Assessment Model to Predict Venous Thromboembolism in Patients with Diffuse Large B-Cell Lymphoma

The Application of the ThroLy Risk Assessment Model to Predict Venous Thromboembolism in Patients with Diffuse Large B-Cell Lymphoma

Venous thromboembolic complications in lymphoma patients

Immune Activation and Inflammatory Biomarkers as Predictors of Venous Thromboembolism in Lymphoma Patients

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