The Application of the Lymphoma International Prognostic Index to Predict Venous Thromboembolic Events in Diffuse Large B-Cell Lymphoma Patients

Abstract

BackgroundVenous thromboembolic events (VTE) are commonly encountered in patients with lymphoma. Several risk assessments models (RAM) had attempted to identify higher risk patients with varying success. The International Prognostic Index (IPI) is a clinicopathological tool developed to help predict both response to treatment and prognosis of patients with diffuse large B-cell lymphoma (DLBCL).ObjectiveIn this study, we utilize the IPI index to identify group of patients with DLBCL at higher risk for VTE.Patients/MethodsPatients with pathologically-confirmed diagnosis of DLBCL and with image-confirmed VTE, treated and followed at our institution were included. Rates of VTE was calculated for each risk category.ResultsA total of 373 patients, median age 49 (range: 18-90) years were included. VTE were reported in 56 (15.0%) patients; 51 (91.1%) had active disease while 29 (51.8%) were ambulatory at time of VTE diagnosis. VTE rates were particularly high among patients with poor performance status (26.2%, P=0.028) and high LDH (19.0%, P=0.023). Applying the age-adjusted IPI separated patients into two risk categories; VTE were diagnosed in 9.7% in patients with “low and low-intermediate” scores compared to 19.8% in patients with “high and high-intermediate” scores, P=0.020.ConclusionsThe original IPI and its modified versions, routinely used at diagnosis as a prognostic and predictive tool for patients with DLBCL, can also be utilized to define high risk patients for VTE; the risk of whom might be high enough to recommend thromboprophylaxis even in the ambulatory settings. More work is needed to refine and improve currently available RAMs.

Immune activation and inflammatory biomarkers as predictors of venous thromboembolism in lymphoma patients

“…To the best of our knowledge, there are no published studies on using the NLR and PLR to assess the risk of VTE in patients with lymphoma. Intermediate/high risk score of IPI in patients with DLBCL was significantly more frequent in the patients who developed VTE, comparing to those without VTE, which is in line with the recently published data [ 36 ].…”

Primary Thromboprophylaxis for the Prevention of Venous Thromboembolism in Cancer Patients with Central Venous Catheters: A Literature Review

“…These meta-analyses, have also reported that the use of LMWH or VKA as primary thromboprophylactic agents were associated with a significant reduction in symptomatic VTE. Due to the inconvenience of daily injections with LMWH, difficulty in managing VKA in cancer patients, and the potential risk of bleeding complications among this high-risk patient population, these findings were never incorporated in routine clinical practice [ 51 , 52 , 53 ].…”

Update on Thrombosis Risk in Patients with Cancer: Focus on Novel Anticancer Immunotherapies

“…33 In a very recent retrospective cohort study, comparing crude VTE rates in patients with advanced NSCLC ( n = 508), a higher risk was observed for ICI (23.5%) compared with chemotherapy (13.8%). 34 In contrast, a recent study reporting the cumulative risk of VTE in patients with advanced NSCLC undergoing systemic therapy ( n = 2,299) described a similarly high risk of VTE between patients treated with chemotherapy, ICI, and combined therapy of chemotherapy and ICI, with corresponding incidence rates of 13.5/100 PY, 18.0/100 PY, and 22.4/100 PY, respectively. 35 Further, in a recent health care database analysis including 1,823 patients with advanced cancers, a similarly high risk of VTE was observed with ICI therapy compared with patients treated with chemotherapy (6-month cumulative risk: 8.5 vs. 8.4%), with no significant differences in propensity score weighted analysis (weighted hazard ratio: 1.06; 95% CI: 0.88–1.26).…”