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

Abstract

Background Patients with non‐Hodgkin lymphoma (NHL) have an increased risk of venous thromboembolism (VTE), particularly when they are receiving treatment. Blood or marrow transplantation (BMT) is recommended for relapsed/refractory NHL, and the risk of VTE after these patients undergo BMT is uncertain. Methods Patients with NHL who survived 2 years or longer after BMT were surveyed for long‐term health outcomes, including VTE. The median follow‐up was 8.1 years (interquartile range, 5.6‐12.9 years). The risk of VTE in 734 patients with NHL versus 897 siblings without a history of cancer and the risk factors associated with VTE were analyzed. Results BMT survivors of NHL were at increased risk for VTE in comparison with siblings (odds ratio for allogeneic BMT survivors, 4.61; P < .0001; odds ratio for autologous BMT survivors, 1.75; P = .035). The cumulative incidence of VTE was 6.3% ± 0.9% at 5 years after BMT and 8.1% ± 1.1% at 10 years after BMT. In allogeneic BMT recipients, an increased body mass index (BMI; hazard ratio [HR] for BMI of 25‐30 kg/m2, 3.52; 95% confidence interval [CI], 1.43‐8.64; P = .006; HR for BMI > 30 kg/m2, 3.44; 95% CI, 1.15‐10.23; P = .027) and a history of chronic graft‐versus‐host disease (HR, 3.33; 95% CI, 1.59‐6.97; P = .001) were associated with an increased risk of VTE. Among autologous BMT recipients, a diagnosis of coronary artery disease (HR, 5.94; 95% CI, 1.7‐20.71; P = .005) and prior treatment with carmustine (HR, 4.91; 95% CI, 1.66‐14.51; P = .004) were associated with increased VTE risk. Conclusions Patients with NHL who survive BMT are at risk for developing late occurring VTE, and ongoing vigilance for this complication is required. Future studies assessing the role of thromboprophylaxis in high‐risk patients with NHL are needed.

Venous Thromboembolism in Lymphoma: Risk Stratification and Antithrombotic Prophylaxis

“…and V.D.S.). Of the 25 studies included, 12 studies were retrospective single-center studies [7,8,[10][11][12][13][14][15][16][17][18][19], two studies were retrospective multicenter trials [20,21], two pooled analysis of clinical trials [9,22], two meta-analyses [23,24], two analyses of patients [25,26] and three analyses of population-based registries [27][28][29], and two prospective single-center studies [6,30] ( Table 1). Four additional studies were identified by cross-referencing in the 21 published reports.…”

“…and V.D.S.). Of the 25 studies included, 12 studies were retrospective single-center studies [7,8,[10][11][12][13][14][15][16][17][18][19], two studies were retrospective multicenter trials [20,21], two pooled analysis of clinical trials [9,22], two meta-analyses [23,24], two analyses of patients [25,26] and three analyses of population-based registries [27][28][29], and two prospective single-center studies [6,30] (Table 1). Patients included into these studies were identified by institutional databases in 14 studies [7,8,[10][11][12][13][14][15][16][18][19][20][21]30], by the local hospital discharge registry in one study [17], by cancer registries in four studies (California Cancer Registry [27], VA Cancer registry [25], Swedish cancer registry [29], Danish lymphoma database [28]), by clinical trial registries in five ...…”

“…ICD codes were used to identify VTE in patient registries [17,25,27,28]. Other methods used included pharmacovigilance reports in a clinical trial [22] and a survey of participants of long-term survivors after bone marrow transplantation with a questionnaire [26]. The validity of coded discharge diagnoses for VTE identification was assessed in a study from Denmark [17].…”

“…In the analysis of 2730 male NHL patients of the VA Cancer Registry in the US, BMI > 30 kg/m 2 was present in 25% of patients and a moderate VTE risk factor in a competing risk model for VTE in the first year of NHL diagnosis (adjusted HR 1.6; 95% CI 1.08-2.37) [25]. A BMI > 25 kg/m 2 was identified as a VTE risk factor in long-term survivors following allogeneic transplantation for NHL [26]. However, BMI was not included in the analysis of VTE risk in the majority of published studies on lymphoma patients (Table 2).…”

“…In the study by Park et al on 686 patients, hypertension was significantly associated with VTE (p = 0.017), but was not maintained as a significant parameter in the competing risk analysis [30]. The diagnosis of coronary artery disease was identified as a risk factor for late VTE in long-term survivors with lymphoma following autologous transplantation [26].…”