Venous thromboembolism following hematopoietic stem cell transplantation—a systematic review and meta-analysis

Abstract

Venous thromboembolism (VTE) is a common complication of hematopoietic stem cell transplantation (HSCT). Graft-versus-host disease (GVHD) is another complication of HSCT that may modify the risk of VTE. Our objective was to explore the incidence of VTE (deep venous thrombosis and pulmonary embolism) following HSCT and to evaluate its association with GVHD. A comprehensive search of Medline In-Process & Other Non-Indexed Citations, MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Scopus was conducted to search for both retrospective and prospective HSCT studies which had reported VTE. Random-effects meta-analysis was used to pool incidence rates. We included 17 studies reporting on allogeneic- and 10 on autologous-HSCT; enrolling 6693 patients; of which 5 were randomized. The overall incidence of VTE after HSCT was 5 % (4-7 %). Incidence in allogeneic-HSCT was 4 % (2-6 %) and in autologous-HSCT was 4 % (1-15 %). Eleven and nine studies reported data on acute and chronic GVHD, respectively. The incidence of VTE in chronic GVHD was 35 % (20-54 %), whereas in acute GVHD it was 47 % (32-62 %). Based on the results of this meta-analysis, VTE is a fairly common complication after HSCT, emphasizing the importance of assimilating guidelines for both treatment and prophylaxis in this patient population.

Management of venous thromboembolism during thrombocytopenia after autologous hematopoietic cell transplantation

“…[1][2][3] Despite its common occurrence, VTE treatment in this population remains challenging due to the prolonged period of chemotherapy or conditioning-induced hypoproliferative thrombocytopenia. There is currently a lack of consensus on the right approach to anticoagulation during thrombocytopenia.…”

“…With these limitations in mind, we designed the current study using a large cohort of autologous HCT patients to explore antithrombotic management in patients on active anticoagulation for VTE. The objectives of the current study are threefold: (1) to determine the incidence of VTE recurrence and major bleeding in patients with lymphoma and multiple myeloma who undergo autologous HCT, (2) to assess the impact of continuing vs temporarily withholding anticoagulation during the period of thrombocytopenia, and (3) to explore the effect of platelet count on the risk of bleeding in patients who continued antithrombotic therapy.…”

Venous Thromboembolism in Pediatric Hematopoietic Cell Transplant: A Multicenter Cohort Study

“…VTE, a well-described morbidity post-HCT in adults [24], is also encountered clinically in children [16,23,25]. However, epidemiologic studies in pediatric HCT recipients are lacking.…”

“…In these studies pediatric HCT recipients, if any, were not analyzed separately. In a recent meta-analysis of 6693 HCT recipients (both adult and pediatric), Zahid et al [16] observed a 5% incidence (range, 4% to 7%) of VTE. Studies in pediatric HCT recipients have been largely isolated to single-center studies, with the largest study of 95 patients reporting a 5.4% incidence (n = 5) of VTE [25].…”

“…Incidence of VTE in adult HCT recipients has been reported to vary from 2.5% to 6% in several large retrospective studies [1][2][3]15,16]. Risk factors associated with VTE were prolonged length of hospital stay (LOS), presence of CVCs, GVHD, relapse of malignancy, and treatment with immunomodulatory agents such as lenalidomide [17][18][19][20].…”