Contributions
Abstract: S840
Type: Oral Presentation
Presentation during EHA23: On Saturday, June 16, 2018 from 12:15 - 12:30
Location: Room A9
Background
The impact of venous thromboembolism (VTE) on morbidity and mortality is significant in hematological cancer patients, including acute leukemia (AL). Identifying risk factors for the development of VTE among patients with AL will enable clinicians to stratify patients according to their VTE risk and consider individualized approaches for anticoagulant prophylaxis.
Aims
We aimed to identify potential predictors of VTE in AL patients in previoslu published studies.
Methods
We conducted a systematic review of randomized trials and observational studies assessing VTE in the setting of AL including acute myeloid leukemia (AML), acute promyelocytic leukemia (APL) or acute lymphoid leukemia (ALL). Studies were included if they contained information on total VTE events, catheter related thrombosis (CRT) and cerebral vein thrombosis (CVT). Relative Risks (RR) for all VTE events, CRT and CVT were calculated among AL subgroups.
Results
A total of 30 studies were included (29 cohort and 1 case control) with 15,491 AL participants. Of the total participants, the number of evaluable patients was 10,788 for AML, 3,242 for ALL, and 1,031 for APL. The median time for VTE occurrence from AL diagnosis was reported in 22 studies, ranging between 5 and 92 days. The median time of VTE occurrence from AL diagnosis was <1 month in 14 studies (64% of evaluable studies); 1-2 months in 7 studies (32%); and only 1 study reported a median time of 3 months (~4%). The risk of VTE was higher in ALL patients compared to AML patients (excluding APL) [RR: 1.8; 95%CI: 1.58-2.10; p<0.00001]. When comparing APL patients to other AML subtypes, the risk was 1.5-fold significantly higher in APL [RR: 1.56; 95%CI: 1.24-1.97; p=0.0001]. The risk of thrombosis was higher with the presence of catheter [RR: 1.2; 95%CI: 1.04-1.36; p=0.0074]. A subgroup analysis of CRT comparing AL subgroups showed that the risk of CRT is similar between AML vs. ALL [RR: 0.9; 95%CI: 0.72-1.13; p=0.405]. The risk was also similar between peripherally inserted central line vs. central venous catheter [RR: 1.08; 95%CI: 0.81-1.45; p=0.557]. When comparing APL with ALL patients, the risk of CRT was higher among APL [RR: 1.54; 95%CI: 1.10-2.18; p=0.0122]. Finally, the risk of CVT was 4-fold higher with ALL patients receiving l-asparaginase compared to AML patients [RR: 4.1; 95%CI: 1.75-9.73; p=0.0012].
Conclusion
Factors that seem to influence VTE risk in AL patients include leukemia phenotype, the presence of catheters, and probably the use of l-asparignase. The risk of thrombosis seems to be higher in the initial period following the diagnosis. Due to the lack of available data in published studies, other potential predictors could not be identified. A thrombosis risk prediction model study is warranted to develop risk stratification criteria for AL patients.
Session topic: 35. Thrombosis and vascular biology & translational Research
Keyword(s): acute leukemia, Prediction, Systematic review, Venous thromboembolism
Abstract: S840
Type: Oral Presentation
Presentation during EHA23: On Saturday, June 16, 2018 from 12:15 - 12:30
Location: Room A9
Background
The impact of venous thromboembolism (VTE) on morbidity and mortality is significant in hematological cancer patients, including acute leukemia (AL). Identifying risk factors for the development of VTE among patients with AL will enable clinicians to stratify patients according to their VTE risk and consider individualized approaches for anticoagulant prophylaxis.
Aims
We aimed to identify potential predictors of VTE in AL patients in previoslu published studies.
Methods
We conducted a systematic review of randomized trials and observational studies assessing VTE in the setting of AL including acute myeloid leukemia (AML), acute promyelocytic leukemia (APL) or acute lymphoid leukemia (ALL). Studies were included if they contained information on total VTE events, catheter related thrombosis (CRT) and cerebral vein thrombosis (CVT). Relative Risks (RR) for all VTE events, CRT and CVT were calculated among AL subgroups.
Results
A total of 30 studies were included (29 cohort and 1 case control) with 15,491 AL participants. Of the total participants, the number of evaluable patients was 10,788 for AML, 3,242 for ALL, and 1,031 for APL. The median time for VTE occurrence from AL diagnosis was reported in 22 studies, ranging between 5 and 92 days. The median time of VTE occurrence from AL diagnosis was <1 month in 14 studies (64% of evaluable studies); 1-2 months in 7 studies (32%); and only 1 study reported a median time of 3 months (~4%). The risk of VTE was higher in ALL patients compared to AML patients (excluding APL) [RR: 1.8; 95%CI: 1.58-2.10; p<0.00001]. When comparing APL patients to other AML subtypes, the risk was 1.5-fold significantly higher in APL [RR: 1.56; 95%CI: 1.24-1.97; p=0.0001]. The risk of thrombosis was higher with the presence of catheter [RR: 1.2; 95%CI: 1.04-1.36; p=0.0074]. A subgroup analysis of CRT comparing AL subgroups showed that the risk of CRT is similar between AML vs. ALL [RR: 0.9; 95%CI: 0.72-1.13; p=0.405]. The risk was also similar between peripherally inserted central line vs. central venous catheter [RR: 1.08; 95%CI: 0.81-1.45; p=0.557]. When comparing APL with ALL patients, the risk of CRT was higher among APL [RR: 1.54; 95%CI: 1.10-2.18; p=0.0122]. Finally, the risk of CVT was 4-fold higher with ALL patients receiving l-asparaginase compared to AML patients [RR: 4.1; 95%CI: 1.75-9.73; p=0.0012].
Conclusion
Factors that seem to influence VTE risk in AL patients include leukemia phenotype, the presence of catheters, and probably the use of l-asparignase. The risk of thrombosis seems to be higher in the initial period following the diagnosis. Due to the lack of available data in published studies, other potential predictors could not be identified. A thrombosis risk prediction model study is warranted to develop risk stratification criteria for AL patients.
Session topic: 35. Thrombosis and vascular biology & translational Research
Keyword(s): acute leukemia, Prediction, Systematic review, Venous thromboembolism