A retrospective study of venous thromboembolism in acute leukemia patients treated at the University of Texas MD Anderson Cancer Center

Abstract

The purpose was to determine the incidence and prevalence of venous thromboembolism (VTE) in acute leukemia patients from our institution. We conducted a retrospective study on newly diagnosed acute leukemia patients who presented at our institution from November 1999 to May 2005. Descriptive statistics and cross-tabulation were used to describe patient characteristics. Measures of morbidity were used to address VTE risk. Chi-square testing, Fisher's exact testing, Mann–Whitney analyses, or median testing were used to determine between-group differences. Data analyses were conducted using Stata version 11 (Stata Corp., College Station, TX). Two hundred and ninety-nine patients with acute lymphoblastic leukemia (ALL) and 996 patients with acute myeloid leukemia (AML) were included. After excluding patients diagnosed with VTE prior to or at the time of leukemia diagnosis, during the mean time follow-up period of 2.5 years (range: 0.0025–10.3 years), the overall incidence rate of VTE was 3.7 per 100 person-years: 4.2 per 100 person-years for ALL and 3.4 per 100 person-years for AML. Among all patients, the majority (80.6%) developed VTE within 12 months after diagnosis and during thrombocytopenia. The most common VTE was central venous catheter (CVC)-associated upper-extremity deep venous thrombosis. Pulmonary embolism occurred in 15% of ALL patients and 8% of AML patients. VTE recurred in 20.7% of ALL patients and 18.6% of AML patients. VTE occurs frequently in patients with acute leukemia. Studies are needed to identify risk factors for the development and recurrence of VTE among patients with acute leukemia and to establish more effective methods for preventing and treating VTEs in leukemia patients who have thrombocytopenia and/or CVC.

Venous thromboembolism in hematopoietic stem cell transplant recipients

“…[1][2] In addition to increased prevalence in patients with cancer, venous thromboembolism (VTE) has been identified as an independent predictor of reduced survival in these patients. [3][4][5] Although most commonly associated with solid malignancies, VTE is increasingly recognized as a complication in patients with hematologic malignancies and various studies have reported rates of VTE as high as 6% in patients with lymphoma, 6,7 5-20% in patients with acute leukemia 8,9 and 5-10% in multiple myeloma (MM) that can increase to as high as 23-75% in patients treated with chemotherapy, thalidomide or lenalidomide, and dexamethasone. 10,11 A large number of patients with hematologic malignancies undergo hematopoietic stem cell transplantation (HSCT); however, there is limited information regarding the incidence, risk factors, and the optimal approach to prevention and treatment of VTE in these patients.…”

Massive Thrombosis of the Right Atrium Extended to the Superior Vena Cava at the Diagnosis of Acute Myeloid Leukemia

“…Thrombosis in AML preferentially seats in the upper and lower limbs and the lungs [3]. Generally, the thrombus formation is less frequent in the right atrium compared with the left atrium [7].…”

“…It is associated in 13.5% with the presence of a central venous catheter, or the steroids use, asparagine in acute lymphoblastic leukemia or inherited thrombophilic abnormalities [2]. It is found in approximately 8% of acute myeloid leukemia (AML) patients [1] and sits in 73.3% of cases in the deep veins of the upper limbs: axillary vein under subclavian and jugular veins and 16% in the deep veins of the lower limbs: femoral vein, superficial femoral, popliteal, and iliac veins [3]. Pulmonary embolism represents 7.8% of the locations and is potentially fatal [3].…”

“…It is found in approximately 8% of acute myeloid leukemia (AML) patients [1] and sits in 73.3% of cases in the deep veins of the upper limbs: axillary vein under subclavian and jugular veins and 16% in the deep veins of the lower limbs: femoral vein, superficial femoral, popliteal, and iliac veins [3]. Pulmonary embolism represents 7.8% of the locations and is potentially fatal [3]. Intracardiac thrombosis localizations in AML are rare and scarcely reported in the literature.…”

Can Biomarkers of Coagulation, Platelet Activation, and Inflammation Predict Venous Thromboembolism in Patients with Haematological Malignancies?

“…Five patients (13.2%) diagnosed with AML developed VTE (none of whom were diagnosed with acute promyelocytic leukaemia), and this is a higher incidence of VTE than reported in other studies, in which the VTE incidence ranged from 5 to 8%. This difference may be due to the infrequent use of thromboprophylaxis in AML inpatients due to a low platelet count or other bleeding risk factors (8/38) [10, 26-28]. Concerning ALL patients, in the literature, the overall risk of VTE in patients with ALL remains high, at close to 10% at 6 months from diagnosis, with the use of L-asparaginase in ALL treatment, an older age, comorbidities, and CVAD insertion identified as risk factors.…”