Venous thromboembolism in the hematologic malignancies

Falanga, Anna; Marchetti, Marina; Russo, Laura

doi:10.1097/cco.0b013e3283592331

Cited by 92 publications

(88 citation statements)

References 65 publications

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“…That difference might be explained by the contributory role of active leukemia, steroids and asparaginase to a pro-thrombotic state and a higher risk for thrombo-embolic events. 22,23 Our definition of feasibility included the completion of chemotherapy within a predefined strict time schedule. Excessive delay in treatment was observed in only five patients, indicating that a disciplinary, dose-dense approach is feasible in adult patients with ALL.…”

Section: Discussionmentioning

confidence: 99%

Intensified chemotherapy inspired by a pediatric regimen combined with allogeneic transplantation in adult patients with acute lymphoblastic leukemia up to the age of 40

et al. 2011

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Event-free survival (EFS) at 5 years in pediatric acute lymphoblastic leukemia (ALL) is 480%. Outcome in adult ALL is still unsatisfactory, which is due to less cumulative dosing of chemotherapy and less strict adherence to timing of successive cycles. In the present phase II trial, we evaluated a pediatric regimen in adult patients with ALL under the age of 40. Treatment was according to the pediatric FRALLE approach for high-risk ALL patients and characterized by increased dosages of asparaginase, steroids, methotrexate and vincristin. However, allogeneic stem cell transplantation was offered to standard risk patients with a sibling donor and to all high-risk patients in contrast to the pediatric protocol. Feasibility was defined by achieving complete remission (CR) and completion of treatment within a strict timeframe in at least 60% of patients. In all, 54 patients were included with a median age of 26. CR was achieved in 49 patients (91%), of whom 33 completed treatment as scheduled (61%). Side effects primarily consisted of infections and occurred in 40% of patients. With a median follow-up of 32 months, EFS estimated 66% at 24 months and overall survival 72%. These data show that a dose-intensive pediatric regimen is feasible in adult ALL patients up to the age of 40.

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Section: Discussionmentioning

confidence: 99%

Intensified chemotherapy inspired by a pediatric regimen combined with allogeneic transplantation in adult patients with acute lymphoblastic leukemia up to the age of 40

et al. 2011

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“…10,11 Consolidation therapy with the thalidomide or lenalidomide after HSCT has been shown to improve complete respose rates and prolong event-free survival and is thus rapidly becoming standard of care. 54,55 In patients receiving thalidomide consolidation after autologous stem cell transplantation for MM, Barlogie et al 54 reported that rate of VTE was 24% and 6% in the induction and consolidation periods, respectively, despite thromboprophylaxis with LMWH.…”

Section: Multiple Myelomamentioning

confidence: 99%

“…[3][4][5] Although most commonly associated with solid malignancies, VTE is increasingly recognized as a complication in patients with hematologic malignancies and various studies have reported rates of VTE as high as 6% in patients with lymphoma, 6,7 5-20% in patients with acute leukemia 8,9 and 5-10% in multiple myeloma (MM) that can increase to as high as 23-75% in patients treated with chemotherapy, thalidomide or lenalidomide, and dexamethasone. 10,11 A large number of patients with hematologic malignancies undergo hematopoietic stem cell transplantation (HSCT); however, there is limited information regarding the incidence, risk factors, and the optimal approach to prevention and treatment of VTE in these patients. A 3.7% 1-year incidence of VTE, and 8-20% incidence of catheter-related thrombosis (CRT) have been reported in autologous stem cell transplant recipients.…”

Section: Introductionmentioning

confidence: 99%

Venous thromboembolism in hematopoietic stem cell transplant recipients

Chaturvedi

Neff

Nagler

et al. 2015

Bone Marrow Transplant

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Venous thromboembolism (VTE) is an increasingly recognized problem in the post-hematopoietic stem cell transplantation (HSCT) setting, with a lack of high-quality evidence-based data to recommend best practices. Few patients with hematologic malignancies and even fewer post-HSCT patients were included in randomized trials of VTE prophylaxis and treatment. Prior VTE, GVHD, infections and indwelling venous catheters are risk factors for thrombosis. The increasing use of post-transplant maintenance therapy with lenalidomide in patients with multiple myeloma adds to this risk after autologous HSCT. These patients are also at high risk of bleeding complications because of prolonged thrombocytopenia and managing the competing risks of bleeding and thrombosis can be challenging. This review aims to provide a practical, clinician-focused approach to the prevention and treatment of VTE in the post-HSCT setting.

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“…The moderate expression of TF in both bone marrow megakaryocytes and endothelial cells (Figure 2) suggests that it is these cells, which are the origin of at least part of the circulating TF-bearing microparticles. As thrombosis does not affect the outcome of most patients with MM, 8,9 we propose that it is the TF produced by the neoplastic cells themselves that drives malignant behavior, and that TF derived from nonneoplastic cell sources as a result of host response to cancer (acute phase reaction, inflammation and necrosis) or to known prothrombotic treatment regimens, 20 does not affect oncogenesis though it may still be important for the development of thrombosis.…”

Section: Resultsmentioning

confidence: 99%