Contributions
Abstract: EP1170
Type: E-Poster Presentation
Session title: Quality of life, palliative care, ethics and health economics
Background
Low molecular weight heparins (LMWH) are widely used in thrombosis prophylaxis in treated lymphoma patients with central peripheral venous device (PVD). The negative effect of heparin on osteogenesis is known, it is not clear how anticoagulants vit K inhibitors act while the role of LMWH is controversial. The negative effect of steroids on osteogenesis is also documented but there are no data on negative synergy related to the simultaneous intake of steroids and LMWH.
Aims
The aim of our study is to evaluate the bone events (bone fractures) observed retrospectively in a consecutive cohort of lymphoma patients treated with chemotherapy (with or without steroids) from January 2014 to January 2021 with at least 6 months of follow-up.
Methods
From January 2014 to January 2021 we observed 197 patients with a median follow-up of 38 months (range 6-85 months); 90 with aggressive NHL treated with CHOP or similar 34 f and 56 m with a median age of 59 years (range 23-77 years); 53 with indolent NHL treated with bendamustine based therapy; 23 f and 30 m with median age of 65 years (range 42-81 years) and 54 with HD treated with ABVD or similar; 26 f and 28 m with a median age of 34 years (range 16-75 years). All patients with PVD and all treated in prophylaxis with LMWH (enoxaparin or nadroparin) 4000 U / day.
Results
In the NHL group treated with steroids and LMWH the observed bone events (fractures) were 13/90 patients (14.5%), 6 M and 7 F with a mean age of 63 years (range 39-73 years) all patients had vertebral involvement, while in 2 patients, in addition to the vertebral, with the femur involvement were documented. In the NHL group treated with LMWH but non-steroids, the observed bone events were 3/53 patients (5.5%) all female with a mean age of 66 years, while in the HD group it was 2/54 patients ( 3.8%) all females with a mean age of 72 years, all with vertebral involvement only.
Conclusion
These data show a higher incidence of bone events in patients receiving steroid and LMWH therapy. This evidence suggests a negative synergism between the association of steroids and LMWH on bone metabolism and also probably confirms that vitamin D metabolism in patients with aggressive NHL may be implicated in the prognosis of these lymphomas.
This evidence suggests the need to integrate vit D with or without calcifying into the therapy of patients with aggressive NHL and to evaluate the possibility of proposing prophylaxis for thrombosis not with LMWH but with the new oral anticoagulants.
A prospective study is needed which also includes the study of calcium metabolism and bone mineralization both at diagnosis and over time in the various subtypes of NHL and which supportive treatments they have received.
Keyword(s):
Abstract: EP1170
Type: E-Poster Presentation
Session title: Quality of life, palliative care, ethics and health economics
Background
Low molecular weight heparins (LMWH) are widely used in thrombosis prophylaxis in treated lymphoma patients with central peripheral venous device (PVD). The negative effect of heparin on osteogenesis is known, it is not clear how anticoagulants vit K inhibitors act while the role of LMWH is controversial. The negative effect of steroids on osteogenesis is also documented but there are no data on negative synergy related to the simultaneous intake of steroids and LMWH.
Aims
The aim of our study is to evaluate the bone events (bone fractures) observed retrospectively in a consecutive cohort of lymphoma patients treated with chemotherapy (with or without steroids) from January 2014 to January 2021 with at least 6 months of follow-up.
Methods
From January 2014 to January 2021 we observed 197 patients with a median follow-up of 38 months (range 6-85 months); 90 with aggressive NHL treated with CHOP or similar 34 f and 56 m with a median age of 59 years (range 23-77 years); 53 with indolent NHL treated with bendamustine based therapy; 23 f and 30 m with median age of 65 years (range 42-81 years) and 54 with HD treated with ABVD or similar; 26 f and 28 m with a median age of 34 years (range 16-75 years). All patients with PVD and all treated in prophylaxis with LMWH (enoxaparin or nadroparin) 4000 U / day.
Results
In the NHL group treated with steroids and LMWH the observed bone events (fractures) were 13/90 patients (14.5%), 6 M and 7 F with a mean age of 63 years (range 39-73 years) all patients had vertebral involvement, while in 2 patients, in addition to the vertebral, with the femur involvement were documented. In the NHL group treated with LMWH but non-steroids, the observed bone events were 3/53 patients (5.5%) all female with a mean age of 66 years, while in the HD group it was 2/54 patients ( 3.8%) all females with a mean age of 72 years, all with vertebral involvement only.
Conclusion
These data show a higher incidence of bone events in patients receiving steroid and LMWH therapy. This evidence suggests a negative synergism between the association of steroids and LMWH on bone metabolism and also probably confirms that vitamin D metabolism in patients with aggressive NHL may be implicated in the prognosis of these lymphomas.
This evidence suggests the need to integrate vit D with or without calcifying into the therapy of patients with aggressive NHL and to evaluate the possibility of proposing prophylaxis for thrombosis not with LMWH but with the new oral anticoagulants.
A prospective study is needed which also includes the study of calcium metabolism and bone mineralization both at diagnosis and over time in the various subtypes of NHL and which supportive treatments they have received.
Keyword(s):