RISK OF THROMBOSIS IN PATIENTS WITH NON-HODGKIN'S LYMPHOMA: A POPULATION-BASED COHORT STUDY
(Abstract release date: 05/18/17)
EHA Library. Birgisdottir A. 06/24/17; 181729; S442
Anna Maria Birgisdottir
Contributions
Contributions
Abstract
Abstract: S442
Type: Oral Presentation
Presentation during EHA22: On Saturday, June 24, 2017 from 11:45 - 12:00
Location: Room N103
Background
Lymphoma is a malignancy that originates in lymph nodes and lymphoid tissue. The main category of lymphomas is non-Hodgkin’s lymphoma (NHL). NHL comprise about 3% of all cancers in Sweden. Some are aggressive and fast growing, while others are more indolent and do not necessarily require treatment. It is well known that cancer increases the risk of thrombosis, especially venous thromboembolism, but data are scarce on the risk of thrombosis in NHL patients.
Aims
The aim of this study is to evaluate the risk of thrombosis in NHL patients compared to controls and to study time trends in the risk of thromboembolism with recent advances in the treatment of these diseases.
Methods
The study population consisted of individuals diagnosed with NHL in Sweden 1980-2013 (n=40,354), and up to four matched controls (n=115,677). The risk of the first thrombosis was evaluated after the diagnosis of NHL (and corresponding date for controls) and the ones that occurred less than 30 days prior to diagnosis of NHL. Kaplan-Meier survival analysis was used to estimate the risk of thrombosis and a log-rank test performed to assess statistical significance. Cox regression analysis was used to calculate hazard ratios (HRs) and 95% confidence intervals (CI) (adjusting for age, sex, year of diagnosis, and previous history of thrombosis). Risk of deep vein thrombosis, pulmonary embolism and arterial thrombosis was evaluated. Arterial thrombosis was defined as cerebral infarct, transient ischemic attack, angina pectoris, myocardial infarction, and arterial embolism and thrombosis.
Results
NHL patients had a statistically significant increase in risk of any type of thrombosis compared to controls (HR: 1.58, 95% CI: 1.53-1.62). The risk was significantly increased for all three types of thrombosis; deep vein thrombosis (HR: 3.11; 95% CI: 2.93-3.31), pulmonary embolism (HR: 3.16; 95% CI: 2.95-3.39) and arterial thrombosis (HR:1.20; 95% CI: 1.16-1.23). The risk of thrombosis did not change during the study period for the NHL patients. There was an increased risk of thrombosis for NHL patients when compared to controls, independent of previous history of thrombosis (HR: 1.64; 95% CI: 1.59-1.69 if no previous history, HR: 1.43; 95% CI: 1.37-1.50 if previous history of thrombosis). The incidence of thrombosis for NHL patients started to increase about five months before the diagnosis of NHL, and reached its peak a month before diagnosis. The incidence stayed increased for the first year after diagnosis.
Conclusion
In this large, population-based, study based on more than 40,000 patients with NHL and almost 116,000 controls, we demonstrated that there is an increased risk of thrombosis in patients with NHL when compared to controls. This is true for all types of thrombosis. We therefore conclude that hypercoagulability seems to increase with diagnosis of NHL. Several factors may contribute to this prothrombotic state, including chemotherapy and other treatment related factors as well as the disease itself. Considering that the increase in the incidence of thrombosis was highest before and around the time of diagnosis for NHL patients, that indicates that the tumor itself may have a great impact on the hypercoagulability of these patients.
Session topic: 34. Thrombosis and vascular biology
Keyword(s): Thrombosis, Non-Hodgkin's lymphoma, Arterial Thrombosis, Venous thromboembolism
Abstract: S442
Type: Oral Presentation
Presentation during EHA22: On Saturday, June 24, 2017 from 11:45 - 12:00
Location: Room N103
Background
Lymphoma is a malignancy that originates in lymph nodes and lymphoid tissue. The main category of lymphomas is non-Hodgkin’s lymphoma (NHL). NHL comprise about 3% of all cancers in Sweden. Some are aggressive and fast growing, while others are more indolent and do not necessarily require treatment. It is well known that cancer increases the risk of thrombosis, especially venous thromboembolism, but data are scarce on the risk of thrombosis in NHL patients.
Aims
The aim of this study is to evaluate the risk of thrombosis in NHL patients compared to controls and to study time trends in the risk of thromboembolism with recent advances in the treatment of these diseases.
Methods
The study population consisted of individuals diagnosed with NHL in Sweden 1980-2013 (n=40,354), and up to four matched controls (n=115,677). The risk of the first thrombosis was evaluated after the diagnosis of NHL (and corresponding date for controls) and the ones that occurred less than 30 days prior to diagnosis of NHL. Kaplan-Meier survival analysis was used to estimate the risk of thrombosis and a log-rank test performed to assess statistical significance. Cox regression analysis was used to calculate hazard ratios (HRs) and 95% confidence intervals (CI) (adjusting for age, sex, year of diagnosis, and previous history of thrombosis). Risk of deep vein thrombosis, pulmonary embolism and arterial thrombosis was evaluated. Arterial thrombosis was defined as cerebral infarct, transient ischemic attack, angina pectoris, myocardial infarction, and arterial embolism and thrombosis.
Results
NHL patients had a statistically significant increase in risk of any type of thrombosis compared to controls (HR: 1.58, 95% CI: 1.53-1.62). The risk was significantly increased for all three types of thrombosis; deep vein thrombosis (HR: 3.11; 95% CI: 2.93-3.31), pulmonary embolism (HR: 3.16; 95% CI: 2.95-3.39) and arterial thrombosis (HR:1.20; 95% CI: 1.16-1.23). The risk of thrombosis did not change during the study period for the NHL patients. There was an increased risk of thrombosis for NHL patients when compared to controls, independent of previous history of thrombosis (HR: 1.64; 95% CI: 1.59-1.69 if no previous history, HR: 1.43; 95% CI: 1.37-1.50 if previous history of thrombosis). The incidence of thrombosis for NHL patients started to increase about five months before the diagnosis of NHL, and reached its peak a month before diagnosis. The incidence stayed increased for the first year after diagnosis.
Conclusion
In this large, population-based, study based on more than 40,000 patients with NHL and almost 116,000 controls, we demonstrated that there is an increased risk of thrombosis in patients with NHL when compared to controls. This is true for all types of thrombosis. We therefore conclude that hypercoagulability seems to increase with diagnosis of NHL. Several factors may contribute to this prothrombotic state, including chemotherapy and other treatment related factors as well as the disease itself. Considering that the increase in the incidence of thrombosis was highest before and around the time of diagnosis for NHL patients, that indicates that the tumor itself may have a great impact on the hypercoagulability of these patients.
Session topic: 34. Thrombosis and vascular biology
Keyword(s): Thrombosis, Non-Hodgkin's lymphoma, Arterial Thrombosis, Venous thromboembolism
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