Number of Comorbidities Linked to Risk of Thromboembolism in Leukemia, Lymphoma

A higher number of comorbidities is a risk factor for thromboembolism in patients with acute leukemia, according to results from a retrospective study evaluating the incidence of venous and arterial thromboembolism in patients with acute leukemia or lymphoma. These findings were published in the Journal of Oncology Pharmacy Practice.  

Although well-established, evidence-based guidelines are available for the prevention and treatment of venous thromboembolic disease in patients with solid tumors and multiple myeloma, they are lacking in the setting of most hematologic malignancies despite recent evidence showing a high incidence of thromboembolic complications in these patients. One of the challenges of preventing and managing thromboembolism in this population is the high risk of bleeding due to associated thrombocytopenia. A central aim of this study was to evaluate the incidence of and risk factors for both venous and arterial thromboembolism in cohorts of patients with acute leukemia and lymphoma.

This retrospective study included patients admitted to a single institution with a diagnosis of any type of acute leukemia or lymphoma between November 2009 and March 2018. Excluded were those patients with a history of venous thromboembolism.

Of the 395 patients included in the study, 157 had acute leukemia and 238 had lymphoma. Data collected included information related to comorbidities, as well as thromboembolic and bleeding events. Blood-related parameters (ie, CBC) were also recorded for the periods covering diagnosis and during thromboembolic/bleeding events. Thromboembolic events had to be discovered on testing initiated as a result of associated clinical symptoms, and subsequently confirmed.

With a mean follow-up period of 13.05 months, the incidence of a thromboembolic event was 11.4% in the cohort of patients with acute leukemia, with 72.2% of cases occurring in patients with acute myeloid leukemia. Of these events, 88.8% were venous and 11.2% were arterial, and more than three-quarters took place within the first 6 months after diagnosis. Furthermore, the number of comorbidities was significantly higher in those experiencing thrombosis compared with those without thrombosis (1.0 vs 0.0; P =.002).

Regarding the cohort of patients with lymphoma, thromboembolism incidence was 9.2% during a mean follow-up period of 20.74 months. More venous than arterial events were observed (72.7% vs 27.3%). As seen in patients with acute leukemia, most (81.8%) of these events occurred within 6 months of diagnosis. Those with higher levels of lactate dehydrogenase (P =.009) and β₂-microglobulin (P =.007) were at significantly higher risk of experiencing a thromboembolic event vs not.

“Acute leukemia patients with any comorbidity and lymphoma patients with higher lactate dehydrogenase and β₂-microglobulin are at high risk of developing thromboembolic complications,” the study authors concluded.

ReferenceYıldız A, Albayrak M, Pala Ç, et al. The incidence and risk factors of thrombosis and the need for thromboprophylaxis in lymphoma and leukemia patients: a 9-year single-center experience [published online June 2, 2019]. J Oncol Pharm Pract. doi: 10.1177/1078155219851540