Venous‐thromboembolism and associated health care utilization in elderly patients with diffuse large B cell lymphoma

Abstract

BACKGROUND:Patients with lymphoma have an increased risk of venous thromboembolism (VTE). The authors examined the risk of VTE and subsequent health care utilization in elderly patients with diffuse large B cell lymphoma (DLBCL). METHODS: A total of 5537 DLBCL patients ≥66 years old enrolled in Medicare from the Surveillance, Epidemiology, and End Results registry and a noncancer control group of Medicare beneficiaries (n = 5537) were identified. Cumulative incidence function to examine the risk of VTE 12 months after DLBCL diagnosis was used. Fine and Gray method was used to examine the risk factors associated with VTE risk in multivariable models. Total number of hospitalizations, outpatient visits, and Medicare spending were compared in DLBCL patients with and without VTE. RESULTS: VTE was diagnosed in 8.3% DLBCL patients and 1.5% controls, yielding an 8.6-fold higher risk of VTE in DLBCL in adjusted analysis (95% confidence interval [CI], 6.62-11.20; P < .001). Multivariable regression analysis showed that precancer VTE history was associated with an increased risk of developing VTE after a DLBCL diagnosis (hazard ratio [HR], 5.39; 95% CI, 4.39-6.63), and Asian individuals were associated with a lower risk (HR, 0.54; 95% CI, 0.29-1.00). Patients newly diagnosed with VTE after lymphoma had a 1.7fold higher rate of hospitalization and a 1.2-fold higher rate of outpatient visits compared to those without, resulting in excess Medicare spending of $22,208 in the first year after DLBCL diagnosis. CONCLUSIONS: Elderly patients with DLBCL have an elevated risk of VTE resulting in excess health care utilization. VTE history before DLBCL was associated with increased risk of post-DLBCL VTE, and Asian individuals were associated with a lower risk of VTE.

Thrombosis risk prediction in lymphoma patients: A multi‐institutional, retrospective model development and validation study

“…Similarly, Santi et al showed that DLBCL patients had a higher risk of experiencing VTE (SHR: 3.42 [1.32–8.84]; p = 0.011) compared with those with FL 30 . VTE history was confirmed as prognostic factors in comparable lymphoma studies 7,31–33 . Recent hospitalization and history of paralysis/immobility were other well‐known predictors for VTE, 14,34–36 but they have not been explored in the lymphoma setting.…”

“…30 VTE history was confirmed as prognostic factors in comparable lymphoma studies. 7,[31][32][33] Recent hospitalization and history of paralysis/immobility were other well-known predictors for VTE, 14,34-36 but they have not been explored in the lymphoma setting. Also, the differential risk associated with chemotherapy versus targeted therapy has not been systematically incorporated into lymphoma-specific RAMs, although several studies have reported the increased VTE risk associated with cytotoxic therapy, 7,31,37,38 while one study has reported a lower incidence of VTE among patients receiving ibrutinib.…”