Prediction of venous thromboembolism in newly diagnosed patients treated for lymphoid malignancies: validation of the Khorana Risk Score

Rupa‐Matysek, Joanna; Gil, Lidia; Kaźmierczak, Maciej; Barańska, Małgorzata; Komarnicki, Mieczysław

doi:10.1007/s12032-017-1065-4

Cited by 42 publications

(41 citation statements)

References 43 publications

(47 reference statements)

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“…[13][14][15][16]36,37 This is further supported by our study in which the KRS did not adequately predict VTE events in patients at a higher risk of VTE in a cohort of patients with lymphoid malignancies. 37 Therefore, Antic et al developed the prognostic Thrombosis Lymphoma (ThroLy) score which is more specific for lymphoma patients than any other available scores targeting thrombosis in cancer patients. 19 Although the ThroLy model has been evaluated in both an initial derivation and a validation cohort, it has not been externally evaluated yet.…”

Section: Discussionmentioning

confidence: 51%

Evaluation of the ThroLy score for the prediction of venous thromboembolism in newly diagnosed patients treated for lymphoid malignancies in clinical practice

Rupa‐Matysek

Brzeźniakiewicz‐Janus

Gil

et al. 2018

Cancer Medicine

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The utility in clinical practice of a recently developed and validated predictive model for venous thromboembolism (VTE) events in lymphoma patients, known as the thrombosis lymphoma (ThroLy) score, is unknown. We evaluated the association of ThroLy with VTE in patients treated for diffuse large B‐cell lymphoma (DLBCL) or Hodgkin lymphoma (HL) undergoing ambulatory first‐line chemotherapy. Retrospective analyses were performed on 428 patients (median age 50), 241 were newly diagnosed DLBCL, and 187 had HL. During initial chemotherapy, 64 (15%) patients developed VTE. According to the ThroLy, 322 (75.2%) patients were considered low risk, 88 (20.6%) patients had intermediate risk and 18 (4.2%) patients high risk for VTE development. Patients with DLBCL were more often in the high‐risk ThroLy group and had more VTE events than HL. VTE occurred in; 38.9% (n = 7) high‐risk patients, 29.5% (n = 26) intermediate risk, and 9.6% (n = 31) low risk according to the ThroLy score. However, in multivariate analysis, high ThroLy (OR 5.13; 95% CI: 1.83‐14.36, P = .002), intermediate ThroLy (OR 3.96; 95% CI: 2.19‐7.17, P < .001), and aggressive lymphoma‐DLBCL (OR 1.91; 95% CI: 1.05‐3.47, P = .034) were all significantly associated with development of VTE, 48% of the VTE events occurred in the low‐risk ThroLy score group (the ROC AUC (95% CI) 0.40‐0.70 and C statistic‐0.55). In our study, the ThroLy score was not a suitably accurate model for predicting VTE events in patients at higher risk of VTE. Further research should be conducted to identify new biomarkers that will predict these events and to establish a new VTE risk assessment model.

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Section: Discussionmentioning

confidence: 51%

Evaluation of the ThroLy score for the prediction of venous thromboembolism in newly diagnosed patients treated for lymphoid malignancies in clinical practice

Rupa‐Matysek

Brzeźniakiewicz‐Janus

Gil

et al. 2018

Cancer Medicine

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“…For example, the Khorana risk score for determining the risk of VTE in patients with cancer categorizes all patients with NHL in a high‐risk category . Because only a small proportion of the patients (12.8%) had NHL in this study, the utility of the Khorana score in lymphoid malignancies has been questioned . A majority of the subsequent VTE risk assessment models for patients with lymphoma have had poor clinical utility because of low discriminatory performance .…”

Section: Discussionmentioning

confidence: 99%

“…11 Because only a small proportion of the patients (12.8%) had NHL in this study, the utility of the Khorana score in lymphoid malignancies has been questioned. 12,13 A majority of the subsequent VTE risk assessment models for patients with lymphoma have had poor clinical utility because of low discriminatory performance. 14 development of neutropenia during therapy, and a hemoglobin level <10 g/dL increased the risk of VTE.…”

Section: Discussionmentioning

confidence: 99%

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

Gangaraju

Chen

Hageman

et al. 2019

Cancer

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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.

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“…and V.D.S.). Of the 25 studies included, 12 studies were retrospective single-center studies [7,8,[10][11][12][13][14][15][16][17][18][19], two studies were retrospective multicenter trials [20,21], two pooled analysis of clinical trials [9,22], two meta-analyses [23,24], two analyses of patients [25,26] and three analyses of population-based registries [27][28][29], and two prospective single-center studies [6,30] ( Table 1). Four additional studies were identified by cross-referencing in the 21 published reports.…”

Section: Methodsmentioning

confidence: 99%

Venous Thromboembolism in Lymphoma: Risk Stratification and Antithrombotic Prophylaxis

Hohaus

Bartolomei

Cuccaro

et al. 2020

Cancers

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Lymphoma is listed among the neoplasias with a high risk of venous thromboembolism (VTE). Risk factors for VTE appear to differ from risk factors in solid tumors. We review the literature of the last 20 years for reports identifying these risk factors in cohorts consisting exclusively of lymphoma patients. We selected 25 publications. The most frequent studies were analyses of retrospective single-center cohorts. We also included two reports of pooled analyses of clinical trials, two meta-analyses, two analyses of patient registries, and three analyses of population-based databases. The VTE risk is the highest upfront during the first two months after lymphoma diagnosis and decreases over time. This upfront risk may be related to tumor burden and the start of chemotherapy as contributing factors. Factors consistently reported as VTE risk factors are aggressive histology, a performance status ECOG ≥ 2 leading to increased immobility, more extensive disease, and localization to particular sites, such as central nervous system (CNS) and mediastinal mass. Association between laboratory values that are part of risk assessment models in solid tumors and VTE risk in lymphomas are very inconsistent. Recently, VTE risk scores for lymphoma were developed that need further validation, before they can be used for risk stratification and primary prophylaxis. Knowledge of VTE risk factors in lymphomas may help in the evaluation of the individual risk-benefit ratio of prophylaxis and help to design prospective studies on primary prophylaxis in lymphoma.

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Prediction of venous thromboembolism in newly diagnosed patients treated for lymphoid malignancies: validation of the Khorana Risk Score

Cited by 42 publications

References 43 publications

Evaluation of the ThroLy score for the prediction of venous thromboembolism in newly diagnosed patients treated for lymphoid malignancies in clinical practice

Evaluation of the ThroLy score for the prediction of venous thromboembolism in newly diagnosed patients treated for lymphoid malignancies in clinical practice

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

Venous Thromboembolism in Lymphoma: Risk Stratification and Antithrombotic Prophylaxis

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