Mortality and Vascular Events Among Elderly Patients With Chronic Myeloid Leukemia: A Retrospective Analysis of Linked SEER-Medicare Data

Lang, Kathleen; McGarry, Lisa; Huang, Huan; Dorer, David J.; Kaufman, Elise; Knopf, Kevin

doi:10.1016/j.clml.2016.01.006

Cited by 18 publications

(10 citation statements)

References 31 publications

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“…Two studies have assessed the risk of MI and ischemic stroke in patients with CML compared with non‐cancer patients . A study from the United States, based on linked Surveillance, Epidemiology, and End Results (SEER) cancer registry and Medicare Claims data for 1466 CML patients, reported an HR of 2.46 ( P < .001) for myocardial infarction and 1.54 ( P < .001) for ischemic and hemorrhagic stroke . Similar to our data, a more recent Swedish cohort study of CML patients during 2002‐2012 and age‐matched and sex‐matched individuals from the general population found incidence rate ratios of 1.9 (95% CI: 1.3 to 2.7) for myocardial infarction and 0.9 (95% CI: 0.5 to 1.5) for ischemic stroke .…”

Section: Discussionsupporting

confidence: 81%

“…Earlier studies have suggested that hematological cancers are associated with increased risk of myocardial infarction, but the existing literature has been contradictory for ischemic stroke . A Swedish population‐based cohort study of 18 627 multiple myeloma patients diagnosed from 1958 to 2006 and 70 991 age‐matched and sex‐matched individuals from the general population computed the 10‐year HRs for coronary artery disease (stable and unstable angina pectoris and myocardial infarction) and cerebrovascular complications (ischemic stroke, hemorrhagic stroke, and transient ischemic attack) .…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Several studies have suggested that some hematological cancers are associated with both arterial and venous thromboembolic events . These associations are presumably driven by factors such as specific treatment modalities, shared risk factors, infections, immobilization, cancer‐associated prothrombotic states, clinicians’ reluctance to treat patients with optimal doses of antithrombotic drugs inherent to their elevated bleeding risks, and tumor compression of vessel walls …”

Section: Introductionmentioning

confidence: 99%

“…However, prior research focused on selected types of hematological cancers, were limited by small sample sizes, assessed only venous or arterial thromboembolic events, and did not include data on bleeding risk. Bleeding risk may be substantially elevated in patients with hematological cancers due to pathophysiological changes in the hemostatic system and presence of other risk factors for bleeding, e.g., advancing age and abnormal renal function.…”

Section: Introductionmentioning

confidence: 99%

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Risk of thromboembolic and bleeding outcomes following hematological cancers: A Danish population‐based cohort study

Adelborg

Corraini

Darvalics

et al. 2019

Journal of Thrombosis and Haemostasis

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Background: Therapeutic advances have improved survival after hematological cancers. In turn, patients may be at increased risk of thromboembolic and bleeding events.Objectives: To examine the risks of myocardial infarction (MI), ischemic stroke, venous thromboembolism (VTE), and bleeding requiring hospital contact in patients with hematological cancers. Methods:We conducted a Danish population-based cohort study (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013). We identified all adult hematological cancer patients and sampled a general population comparison cohort in a 1:5 ratio matched by age, sex, previous thromboembolic events, bleeding, and solid cancer. Ten-year absolute risks of thromboembolism and bleeding were calculated and hazard ratios (HRs) were computed, controlling for matching factors.Results: Among 32 141 hematological cancer patients, the 10-year absolute risk of any thromboembolic or bleeding complication following hematological cancer was 19%: 3.3% for MI, 3.5% for ischemic stroke, 5.2% for VTE, and 8.5% for bleeding.Except among patients with myeloid leukemia, acute lymphoid leukemia, or myelodysplastic syndrome, the risk of thromboembolic events surpassed that of bleeding.The hematological cancer cohort overall was at increased risk for MI [HR = 1.36, 95% confidence interval (CI): 1.25-1.49], ischemic stroke (HR = 1.22, 95% CI: 1.12-1.33), VTE (HR = 3.37, 95% CI: 3.13-3.64), and bleeding (HR = 2.39, 95% CI: 2.26-2.53) compared with the general population. Conclusions:Approximately 2 of 10 hematological cancer patients experienced MI, ischemic stroke, VTE, or bleeding requiring hospital contact within 10 years. The hematological cancer cohort had higher hazards of MI, ischemic stroke, VTE, and bleeding requiring hospital contact than a general population comparison cohort. K E Y W O R D Scohort study, epidemiology, hematological cancer, myocardial infarction, stroke, venous thromboembolism 2.50 (0.Additional supporting information may be found online in the Supporting Information section at the end of the article. How to cite this article: Adelborg K, Corraini P, Darvalics B, et al. Risk of thromboembolic and bleeding outcomes following hematological cancers: A Danish population-based cohort study. J Thromb Haemost. 2019;17:1305-1318. https ://doi.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Risk of thromboembolic and bleeding outcomes following hematological cancers: A Danish population‐based cohort study

Adelborg

Corraini

Darvalics

et al. 2019

Journal of Thrombosis and Haemostasis

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Varying effects of tyrosine kinase inhibitors on platelet function—A need for individualized CML treatment to minimize the risk for hemostatic and thrombotic complications?

et al. 2019

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Since their introduction, tyrosine kinase inhibitors (TKIs, eg, imatinib, nilotinib, dasatinib, bosutinib, ponatinib) have revolutionized the treatment of chronic myeloid leukemia (CML). However, long‐term treatment with TKIs is associated with serious adverse events including both bleeding and thromboembolism. Experimental studies have shown that TKIs can cause platelet dysfunction. Herein, we present the first side‐by‐side investigation comparing the effects of currently used TKIs on platelet function and thrombin generation when used in clinically relevant concentrations. A flow cytometry multiparameter protocol was used to study a range of significant platelet activation events (fibrinogen receptor activation, alpha granule, and lysosomal exocytosis, procoagulant membrane exposure, and mitochondrial permeability changes). In addition, thrombin generation was measured in the presence of TKIs to assess the effects on global hemostasis. Results show that dasatinib generally inhibited platelet function, while bosutinib, nilotinib, and ponatinib showed less consistent effects. In addition to these general trends for each TKI, we observed a large degree of interindividual variability in the effects of the different TKIs. Interindividual variation was also observed when blood from CML patients was studied ex vivo with whole blood platelet aggregometry, free oscillation rheometry (FOR), and flow cytometry. Based on the donor responses in the side‐by‐side TKI study, a TKI sensitivity map was developed. We propose that such a sensitivity map could potentially become a valuable tool to help in decision‐making regarding the choice of suitable TKIs for a CML patient with a history of bleeding or atherothrombotic disease.

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Chronic Myelogenous Leukemia and Myeloproliferative Disorders in Older Adults

García‐Gutiérrez¹,

Alonso-Domínguez²

2017

Geriatric Oncology

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Mortality and Vascular Events Among Elderly Patients With Chronic Myeloid Leukemia: A Retrospective Analysis of Linked SEER-Medicare Data

Cited by 18 publications

References 31 publications

Risk of thromboembolic and bleeding outcomes following hematological cancers: A Danish population‐based cohort study

Risk of thromboembolic and bleeding outcomes following hematological cancers: A Danish population‐based cohort study

Varying effects of tyrosine kinase inhibitors on platelet function—A need for individualized CML treatment to minimize the risk for hemostatic and thrombotic complications?

Chronic Myelogenous Leukemia and Myeloproliferative Disorders in Older Adults

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