Venous thromboembolism (VTE) is a common complication in cancer patients and anticoagulation (AC) remains the standard of care for treatment. Inferior vena cava (IVC) filters may also used to reduce the risk of pulmonary embolism, either alone or in addition to AC. Although widely used, data are limited on the safety and efficacy of IVC filters in cancer patients. We performed a retrospective review of outcomes after IVC filter insertion in a database of 1270 consecutive patients with cancer-associated pulmonary embolism (PE) at our institution between 2008 and 2009. Outcomes measured included rate of all recurrent VTE, recurrent PE, and overall survival within 12 months. 317 (25%) of the 1270 patients with PE had IVC filters placed within 30 days of the index PE event or prior to the index PE in the setting of prior DVT. Patients with IVC filters had markedly lower overall survival (7.3 months) than the non-IVC filter patients (13.2 months). Filter patients also had a lower rate of AC use at time of initial PE. There was a trend towards higher recurrent VTE in patients with IVC filters (11.9%) compared to non-filter patients (7.7%), but this was not significant (p = 0.086). The risk of recurrent PE was similar between the IVC filter cohort (3.5%) and non-filter group (3.5%, p = 0.99). Cancer patients receiving IVC filters had a similar risk of recurrent PE, but a trend towards more overall recurrent VTE. The filter patients had poorer overall survival, which may reflect a poorer cancer prognosis, and had greater contraindication to AC; therefore these patients likely had a higher inherent risk for recurrent VTE. A prospective study would be helpful for further clarification on the partial reduction in the recurrent PE risk by IVC filter placement in cancer patients.

Human immunodeficiency virus (HIV)-1-infected individuals are affected by diseases at rates above those of their HIV-negative peers despite the increased life expectancy of the highly active antiretroviral therapy era. We followed a cohort of approximately 2000 HIV-1-infected patients for 5 years. The most frequent cause of death in this HIV-1-infected cohort was malignancy, with 39% of all classified deaths due to cancer. Among the cancer deaths, B-cell lymphomas were the most commonly seen malignancy, representing 34% of all cancer deaths. These lymphomas were very aggressive with a median survival of <2 months from time of diagnosis.

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2257 Venous thromboembolism (VTE) is a major cause of morbidity and mortality in cancer. In the context of frequent high-resolution imaging, pulmonary emboli (PE) are frequently identified incidental to other indications for imaging. Several key questions need answers. In cancer, are incidentally identified and symptomatic PEs of comparable clinical importance regarding risk of recurrent VTE and death? Can we identify a subgroup of patients with incidentally identified PEs for whom the risk of recurrent VTE is sufficiently low that long-term anticoagulation may not be necessary? Several recent studies suggest that incidental PE may result in comparable rates of recurrent VTE and death as symptomatic PE. However, those studies did not control for cancer type and anatomic distribution of the initial PE. We now report a comprehensive data set on PE in cancer, derived from MSKCC. All PE in a 2-year period (2008–9) were reviewed, with 2-year follow-up. We evaluated the cases for all cause mortality with time, as well as all recurrent VTE. There were 755 initial symptomatic PE with 122 recurrent VTE events and 574 initial incidental PEs with 124 recurrent VTE. 43.2% of all PEs were identified incidentally. The percent of total PEs that were identified incidentally varied markedly with different cancer types, pancreas (70.7%), colorectal (61.4%), hematologic (33.3%), gastro-esophageal (37.7%), lung (32.8%), breast (15.1%), gynecological (30.0%), brain (5.0%). Brain tumor patients less frequently undergo comprehensive body imaging for cancer staging, and therefore, asymptomatic PEs may be less likely identified incidentally. Because of the well-recognized differences in rates of recurrent VTE and mortality in different cancer types, differences in the percent of incidental PEs supports the necessity of considering cancer type in outcome analysis. The overall hazard ratios of death and recurrent VTE were highest in the first month after the initial PE, gradually declining with time. The cumulative rates of all cause mortality was higher for symptomatic PE in the initial 2 months, but equalized by 12 months. (All cause mortality, symptomatic PE: 1 month: 15%, 2 month: 24%, 6 month: 40%, 12 month: 53%. Incidental PE: 1 month: 6%, 2 month: 12%, 6 month: 30%, 12 month: 47%). Cumulative rates of recurrent VTE were similar in both cohorts. (Symptomatic PE: 3 month: 11.0%, 6 month: 13.6%, 12 month: 16.0%. Incidental PE: 3 month: 11.7%, 6 month: 17.1%, 12 month: 21.4%). For most major cancer types, early (1-month) mortality and 12-month recurrent VTE rates were similar regardless of the incidental versus symptomatic nature of the initial PE. However, for colorectal cancer, the 1-month mortality for symptomatic PE was 14.3% (8 of 56), but only 3.4% (3 of 89) for incidental PE, and the 12-month recurrent VTE rate was 17.9% for symptomatic PE and 5.6% for incidental PE. The anatomic location of the initial PE also evaluated. Segmental arteries were the most common initial location of symptomatic (45%) and incidental (47%) PE. Importantly, after an initial incidental PE, the risk of recurrent VTE was consistent, regardless of the initial anatomic location. For each category; main plus saddle, lobar, segmental, and subsegmental, the recurrent VTE rates were between 20 – 25%. The fact that a cancer patient exhibits a PE predicts recurrent VTE, with less relevance to the anatomic location of the initial event. Conclusions: In our institution, 43.2% of PEs in cancer patients were identified incidentally, by imaging studies performed for cancer staging, or evaluation of complaints not typically associated with PE. All cause mortality was twice as high in the first two months after a symptomatic PE as an incidental PE, but by the third month, the monthly rates became equivalent. The hazard ratio of recurrent VTE was similar between the symptomatic PE and incidental PE cohorts, including subgroups. A possible exception is in colorectal cancer, in which the 1- month mortality and 12-month recurrent VTE rates were higher for symptomatic PE. However, due to the retrospective nature of this study, and the multiple parameters considered, that observation needs confirmation. As even “small” subsegmental PEs are associated with recurrent VTE rates comparable to large proximal PEs, our data do not suggest that there are any subgroups for which anticoagulation is not justified. Disclosures: No relevant conflicts of interest to declare.

Chromosome 22q11.2 deletion syndrome, also known as DiGeorge or velocardiofacial syndrome, is associated with a wide spectrum of phenotypic features. It is known to be associated with severe macrothrombocytopenia. Postpartum hemorrhage is a leading cause of maternal morbidity and mortality globally. Chromosome 22q11.2 deletion syndrome is rare cause of thrombocytopenia that can be a significant risk factor for life-threatening postpartum hemorrhage. We report a case of postpartum hemorrhage in a woman with 22q11.2 deletion syndrome causing severe macrothrombocytopenia.