Incidence of venous thromboembolism in patients with non-Hodgkin lymphoma

Abstract

Introduction Patients with non-Hodgkin lymphoma (NHL) have an increased risk of venous thromboembolism (VTE). Current risk-prediction models classify NHL as a single entity. We aimed to quantify the difference in VTE risk in follicular lymphoma (FL) versus diffuse large B cell lymphoma (DLBCL). Methods Using a prospective cohort study, we identified 2,730 patients (2,037 DLBCL; 693 FL) within the Veteran’s Administration Central Cancer Registry. A competing risk model assessed the association between VTE risk and histology in the first year after NHL diagnosis. We assessed the effect of additional risk factors for VTE in NHL. Results In univariate analysis, DLBCL was associated with increased risk of VTE compared to FL in the first year after diagnosis; this association was no longer significant in adjusted analysis (adjusted hazard ratio (aHR) 1.52; 95% CI 0.97–2.40). Major risk factors for VTE included history of VTE before NHL diagnosis (aHR 4.73, p=<0.0001) and time period during chemotherapy administration (aHR 7.60, p=<0.0001). Additional risk factors included: stage III/IV disease (p=0.02), BMI ≥ 30 (p=0.02), B-symptoms (p=0.02), and doxorubicin (p=0.04). The cumulative incidence of VTE was highest in the period following diagnosis and decreased over time for both histologies. Conclusion DLBCL is associated with increased risk of VTE compared to FL. This risk is markedly attenuated when adjusting for additional risk factors. The strongest predictors for development of VTE included: time period during chemotherapy administration (especially doxorubicin) and history of VTE. This knowledge can assist clinicians in identifying NHL patients at high risk for VTE.

Risk factors for venous thromboembolism in patients with lymphoma requiring hospitalization

“…Patients as those with low-grade histology who did not require a hospital stay were not retrieved. As expected, this may explain the higher incidence rate of VTE with respect to other reports 1,2,8,10 . Therefore, our study tackles the issue of VTE frequency in a population at increased risk, in whom special care is required and specific information are needed.…”

“…The VTE risk is the highest upfront during the first month after lymphoma diagnosis and decreases over time 2 . This upfront risk may be related to tumor burden and start of chemotherapy as contributing factors.…”

“…Khorana et al developed a risk model for predicting chemotherapy-associated VTE based on baseline clinical and laboratory variables; however, only a minority of patients (12.6%) in the study cohort had lymphomas 1 . Several studies indicate a higher VTE risk in patients with aggressive non-Hodgkin lymphomas (NHL) 2,4–8 , advanced stage disease (III/IV) 2 , localization in the central nervous system (CNS) 9 , and use of anthracyclines 2 . The incidence of VTE during chemotherapy in NHL patients was investigated analyzing the databases of 12 Italian clinical trials, identifying DLBCL histology and Khorana score as risk factors 8 .…”

Risk of venous thromboembolism in patients with non‐Hodgkin lymphoma surviving blood or marrow transplantation

“…Patients with non‐Hodgkin lymphoma (NHL), particularly those with aggressive lymphoma, those with a higher stage of disease (stage III or IV), and those with central nervous system involvement at diagnosis, are at high risk for venous thromboembolism (VTE) . Several studies in patients with NHL have shown that VTE events occur soon after the NHL diagnosis and during chemotherapy administration . However, in the majority of these studies, patients were followed for only 1 to 3 years, and this has left a gap in our understanding of the long‐term risk of VTE.…”

“…[1][2][3] Several studies in patients with NHL have shown that VTE events occur soon after the NHL diagnosis and during chemotherapy administration. 1,[4][5][6] However, in the majority of these studies, patients were followed for only 1 to 3 years, and this has left a gap in our understanding of the long-term risk of VTE. Furthermore, blood or marrow transplantation (BMT) is increasingly being used successfully for relapsed or refractory NHL.…”