Increased thromboembolic incidence in anti-cardiolipin-positive patients with malignancy

Abstract

Summary This study was undertaken to determine the prevalence of anti-cardiolipin antibodies (ACLAs) in patients with malignancy and to investigate a possible association of ACLAs with thromboembolic events in such patients. The study included 216 patients with solid and non-solid malignancies and an age-matched control group of 88 healthy subjects. ACLA levels were measured and related to thromboembolic phenomena (diagnosed by imaging methods) that occurred within 12 months of the diagnosis of cancer. Forty-seven patients (approximately 22%) with cancer were ACLA positive as compared with only three subjects (approximately 3%) in the control group (P<0.0001). The ACLA-positive cancer patients had a significantly higher rate of thromboembolic events than ACLA-negative cancer patients: 13 of 47 (28%) vs 24 of 169 (14%), respectively (P<0.05). High titres of either IgG-ACLA or IgM-ACLA were found in 10 out of 13 ACLA-positive cancer patients with thrombotic complications, but in only 2 out of 34 cancer ACLA-positive patients without thromboembolic events (P<0.0001). In four cancer patients in whom ACLA levels were followed ACLA decreased after successful surgery/chemotherapy treatment and remained negative and thromboembolic free for 12 months of follow-up. Patients with malignancies show an increased prevalence of ACLA. Furthermore, ACLA-positive patients, mainly those with high titres, are much more prone to thromboembolic events.

Peripheral arterial ischemic events in cancer patients

“…20 Zuckerman et al reported that 21.8% of their patients with malignancies were positive for anticardiolipin antibodies (the most common type of antiphospholipid antibodies -APL), compared to 3.4% in the control group; similarly, 27.7% of the anticardiolipin positive patients experienced thromboembolic events, com pared to 14.2% of the anticardiolipinnegative patients (p < 0.05). 21 In recent years, a higher prevalence of APL has been found in patients with solid tumors compared to controls. 22 Research has suggested that these antibodies are produced in response to tumor antigens rather than secreted from the tumor cells themselves and that the antibodies are involved in the production of monoclonal immunoglobulin that might have lupus anticoagulant and anticardiolipin activities.…”

The Clinical Significance of Both IgM and IgG Anticardiolipin Antibodies in Non-Hodgkin’s Lymphoma

“…In this study, aCl IgM and aCL IgG antibodies were detected in 35.9% and 84.3% respectively in NHL patients, which is higher to the previous reports. Stasi et al [25] reported a prevalence of 35.7% aCL in NHL, whereas Genvresse et al [29] and Zukerman et al [17] reported a prevalence of 26.6% and 39% of aCL respectively.…”

“…Endler et al [15] found in a large cohort of patients with positive anticardiolipin antibodies that the risk of cancer-related mortality was increased 2.6-fold. These antibodies are associated with many disorders, including autoimmune disease and malignancy [16][17][18].…”

The pre-conditioning incidence of antiphospholipid antibodies is not significantly increased in patients with bone marrow transplant-related organ dysfunction

“…An increased incidence of aPA has been demonstrated in patients with malignancy. 37 Using our aPA ELISA, Ͻ5% of healthy individuals tested were positive for aPA. 17,32 The incidence of aPA-positive patients in this study (17/112 or 15.2%), including patients with MODS and control patients without MODS, compared to the number of aPA-positive healthy Table 2 aPA and organ dysfunction in MODS patients (n = 57) aPA positive (%) aPA negative (%) individuals is statistically significant (P Ͻ 0.002) and supports an earlier finding.…”