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Risk of venous thromboembolism in patients with non‐Hodgkin lymphoma surviving blood or marrow transplantation
Author(s) -
Gangaraju Radhika,
Chen Yanjun,
Hageman Lindsey,
Wu Jessica,
Francisco Liton,
Kung Michelle,
Ness Emily,
Parman Mariel,
Weisdorf Daniel J.,
Forman Stephen J.,
Arora Mukta,
Armenian Saro H.,
Bhatia Smita
Publication year - 2019
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.32488
Subject(s) - medicine , hazard ratio , odds ratio , interquartile range , cumulative incidence , body mass index , lymphoma , transplantation , confidence interval , cancer , incidence (geometry) , surgery , gastroenterology , physics , optics
Background Patients with non‐Hodgkin lymphoma (NHL) have an increased risk of venous thromboembolism (VTE), particularly when they are receiving treatment. Blood or marrow transplantation (BMT) is recommended for relapsed/refractory NHL, and the risk of VTE after these patients undergo BMT is uncertain. Methods Patients with NHL who survived 2 years or longer after BMT were surveyed for long‐term health outcomes, including VTE. The median follow‐up was 8.1 years (interquartile range, 5.6‐12.9 years). The risk of VTE in 734 patients with NHL versus 897 siblings without a history of cancer and the risk factors associated with VTE were analyzed. Results BMT survivors of NHL were at increased risk for VTE in comparison with siblings (odds ratio for allogeneic BMT survivors, 4.61; P < .0001; odds ratio for autologous BMT survivors, 1.75; P = .035). The cumulative incidence of VTE was 6.3% ± 0.9% at 5 years after BMT and 8.1% ± 1.1% at 10 years after BMT. In allogeneic BMT recipients, an increased body mass index (BMI; hazard ratio [HR] for BMI of 25‐30 kg/m 2 , 3.52; 95% confidence interval [CI], 1.43‐8.64; P = .006; HR for BMI > 30 kg/m 2 , 3.44; 95% CI, 1.15‐10.23; P = .027) and a history of chronic graft‐versus‐host disease (HR, 3.33; 95% CI, 1.59‐6.97; P = .001) were associated with an increased risk of VTE. Among autologous BMT recipients, a diagnosis of coronary artery disease (HR, 5.94; 95% CI, 1.7‐20.71; P = .005) and prior treatment with carmustine (HR, 4.91; 95% CI, 1.66‐14.51; P = .004) were associated with increased VTE risk. Conclusions Patients with NHL who survive BMT are at risk for developing late occurring VTE, and ongoing vigilance for this complication is required. Future studies assessing the role of thromboprophylaxis in high‐risk patients with NHL are needed.