Risk of venous thromboembolism in patients with non-Hodgkin lymphoma surviving blood or marrow transplantation

Radhika Gangaraju, Yanjun Chen, Lindsey Hageman, Jessica Wu, Liton Francisco, Michelle Kung, Emily Ness, Mariel Parman, Daniel J. Weisdorf, Stephen J. Forman, Mukta Arora, Saro H. Armenian, Smita Bhatia

Research output: Contribution to journalArticle

Abstract

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/m2, 3.52; 95% confidence interval [CI], 1.43-8.64; P =.006; HR for BMI > 30 kg/m2, 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.

Original languageEnglish (US)
JournalCancer
DOIs
StateAccepted/In press - Jan 1 2019

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Venous Thromboembolism
Non-Hodgkin's Lymphoma
Transplantation
Bone Marrow
Survivors
Siblings
Carmustine
Graft vs Host Disease
Coronary Artery Disease
Odds Ratio
Health
Therapeutics

Keywords

  • allogeneic blood or marrow transplantation
  • autologous blood or marrow transplantation
  • blood or marrow transplantation survivors
  • graft-versus-host disease
  • non-Hodgkin lymphoma
  • venous thromboembolism

Cite this

Gangaraju, R., Chen, Y., Hageman, L., Wu, J., Francisco, L., Kung, M., ... Bhatia, S. (Accepted/In press). Risk of venous thromboembolism in patients with non-Hodgkin lymphoma surviving blood or marrow transplantation. Cancer. https://doi.org/10.1002/cncr.32488

Risk of venous thromboembolism in patients with non-Hodgkin lymphoma surviving blood or marrow transplantation. / 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.

In: Cancer, 01.01.2019.

Research output: Contribution to journalArticle

Gangaraju, R, Chen, Y, Hageman, L, Wu, J, Francisco, L, Kung, M, Ness, E, Parman, M, Weisdorf, DJ, Forman, SJ, Arora, M, Armenian, SH & Bhatia, S 2019, 'Risk of venous thromboembolism in patients with non-Hodgkin lymphoma surviving blood or marrow transplantation', Cancer. https://doi.org/10.1002/cncr.32488
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. / Risk of venous thromboembolism in patients with non-Hodgkin lymphoma surviving blood or marrow transplantation. In: Cancer. 2019.
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title = "Risk of venous thromboembolism in patients with non-Hodgkin lymphoma surviving blood or marrow transplantation",
abstract = "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/m2, 3.52; 95{\%} confidence interval [CI], 1.43-8.64; P =.006; HR for BMI > 30 kg/m2, 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.",
keywords = "allogeneic blood or marrow transplantation, autologous blood or marrow transplantation, blood or marrow transplantation survivors, graft-versus-host disease, non-Hodgkin lymphoma, venous thromboembolism",
author = "Radhika Gangaraju and Yanjun Chen and Lindsey Hageman and Jessica Wu and Liton Francisco and Michelle Kung and Emily Ness and Mariel Parman and Weisdorf, {Daniel J.} and Forman, {Stephen J.} and Mukta Arora and Armenian, {Saro H.} and Smita Bhatia",
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doi = "10.1002/cncr.32488",
language = "English (US)",
journal = "Cancer",
issn = "0008-543X",
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TY - JOUR

T1 - Risk of venous thromboembolism in patients with non-Hodgkin lymphoma surviving blood or marrow transplantation

AU - Gangaraju, Radhika

AU - Chen, Yanjun

AU - Hageman, Lindsey

AU - Wu, Jessica

AU - Francisco, Liton

AU - Kung, Michelle

AU - Ness, Emily

AU - Parman, Mariel

AU - Weisdorf, Daniel J.

AU - Forman, Stephen J.

AU - Arora, Mukta

AU - Armenian, Saro H.

AU - Bhatia, Smita

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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/m2, 3.52; 95% confidence interval [CI], 1.43-8.64; P =.006; HR for BMI > 30 kg/m2, 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.

AB - 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/m2, 3.52; 95% confidence interval [CI], 1.43-8.64; P =.006; HR for BMI > 30 kg/m2, 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.

KW - allogeneic blood or marrow transplantation

KW - autologous blood or marrow transplantation

KW - blood or marrow transplantation survivors

KW - graft-versus-host disease

KW - non-Hodgkin lymphoma

KW - venous thromboembolism

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DO - 10.1002/cncr.32488

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JF - Cancer

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