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 journalArticlepeer-review

2 Scopus citations

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)
Pages (from-to)4498-4508
Number of pages11
JournalCancer
Volume125
Issue number24
DOIs
StatePublished - Dec 15 2019

Bibliographical note

Funding Information:
This study was supported in part by grants from the National Cancer Institute (R01 CA078938) and the Leukemia and Lymphoma Society (R6502‐16; to Smita Bhatia).

Funding Information:
Daniel J. Weisdorf reports grants from Incyte and personal fees from FATE and Pharmacyclics outside the submitted work. The other authors made no disclosures.

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

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