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There is a paucity of data that pertain to thrombosis in patients with lymphoproliferative diseases. In few published studies the rate of thrombotic complications in lymphoproliferative disease is highly variable ranging from 1.5% up to 59.5% because of the different study types (prospective or retrospective, with hospitalized or ambulatory patients), types of disease (indolent vs. aggressive) and the disease stage,

There are few prediction tools for estimating the risk of thrombosis but they are based on studies performed on hospitalized medical patients without cancer or on hospitalized neutropenic cancer patients without special consideration to hematological malignancies

We reviewed all medical records of patients with with NHL, HL and CLL diagnosed according to the World Health Organisation classification and treated at our institution between January 2006 and December 2014.

A total of 1054 patients, with malignant lymphoma were eligible for analysis: 576 patients were men (54.6%) and 478 were women (45.4%), and mean age was 54.0 years. A total of 510 patients  (48.4%) had high-grade lymphoma, 211 had low-grade lymphoma (20.0%), 153 had Hodgkin lymphoma (14.5%), and 75 (7.1%) had other forms of lymphoma; HLL had 105 (10.0%) patients. In group of our lymphoma patients, 72 (6.8 %) had at least one TE. A total of 40 patients were men and 32 women. Thromboembolic events included deep vein thrombosis (38.9%), jugular vein thrombosis (12.5%), pulmonary embolism (11.1%), CNS thrombosis (6.9%), superficial vein thrombosis (2.8%), acute myocardial infarction (1.4%) and other (26.4%). In total of 49 pts (68%) thrombosis occurred during treatment or up to 3 months after completion of therapy, whereas in 23 pts (32%) thrombosis was diagnosed prior to therapy. Patients with aggressive NHL had significantly higher incidence of TE (8.6%) compared to all other types of lymphoma patients (RR=2.1; 95%CI for RR 1.2-3.6; p=0.009) (incidences of TE in low NHL, HL and other forms of limphoma were 4.3%, 3.3% and 6.7%). Pts with HLL had 8.6% incidence of TE. Patients with high grade lymphomas, overweight patients (BMI>25 kg/m2), patients with reduced mobility (ECOG>2), and patients with recent operative procedure (<4 weeks) had increased risk for thrombosis (p<0.05 for all). No difference regarding age, gender or disease stage was found. Based on previously mentioned risk factors a new TE risk model was developed for patients with lymphoma (excluding HLL). Patients who had at least two out of four risk factors fall into high risk group for TE (RR=13.0; 95%CI for RR 7.4-23.0; p<0.001). Predictive model for chemotherapy-associated TE developed by Khorana was also evaluated on this group of patients (RR=7.0; 95%CI for RR 3.3-14.7; p<0.001). In multivariate analysis our newly developed model for TE events in lymphoma patients were predictor of TE events and independent from Khorana model.

Prediction tools for estimating the risk of TE events in lymphoma patients have not been established but our newly developed model should be used in addition to chemotherapy-associated model in guiding best practice in the prevention of thromboembolism in patients living with lymphoma.