Venous thromboembolism in hematopoietic stem cell transplant recipients

Chaturvedi, Shruti; Neff, Anne T.; Nagler, Arnon; Savani, Ujjawal; Mohty, Mohamad; Savani, Bipin N.

doi:10.1038/bmt.2015.308

Cited by 33 publications

(29 citation statements)

References 79 publications

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“…4 We found that double lumen catheters in the internal jugular vein were most commonly associated with thrombosis then single lumen or subclavian vein catheters, suggesting more caution is needed in some CVC approaches. Previous VTE is a well-recognized risk factor for subsequent VTE 8, 27 and we show this holds true for CRT as well. While we identified number of risk factors for post-AHCT VTE, we also acknowledge the retrospective nature of this study, incomplete list of potential risk factors analyzed and inherent bias of case-control analysis.…”

Section: Discussionsupporting

confidence: 67%

“…The risk of thrombosis in multiple myeloma is low despite the use of lenalidomide after AHCT which may have added thrombotic risk. 8 The need for prophylactic anticoagulation therapy has been based on medical history and most patients receive aspirin or LMWH prophylaxis. 8 We showed that the majority of CRT events occurred at median 4 weeks post-transplant period which is consistent with Gerber et al report of thromboembolic events occurring at median interval of 35 days from either autologous or allogeneic transplantation.…”

Section: Discussionmentioning

confidence: 99%

“…8 The need for prophylactic anticoagulation therapy has been based on medical history and most patients receive aspirin or LMWH prophylaxis. 8 We showed that the majority of CRT events occurred at median 4 weeks post-transplant period which is consistent with Gerber et al report of thromboembolic events occurring at median interval of 35 days from either autologous or allogeneic transplantation. 13 For the 7 cases of CRT that occurred greater then 100 days after AHCT, 5 occurred in relation to a subsequent allogeneic transplant suggesting that stem cell transplantation procedure itself is a highly pro-thrombotic state.…”

Section: Discussionmentioning

confidence: 99%

“…For acute CRT, anticoagulation is recommended regardless of whether the catheter is removed to reduce symptoms, maintain venous access, and prevent chronic venous stenosis or clot extension. 8, 31-33 Catheter removal is not absolutely necessary if symptoms improve. 8, 31 We showed that LMWH was well-tolerated with minimal bleeding complications despite concerns given to increased bleeding risk from mucositis and thrombocytopenia posttransplant.…”

Section: Discussionmentioning

confidence: 99%

“…5-7 Standard treatment guidelines are not available for the AHCT population with special concerns such as prolonged severe thrombocytopenia, platelet tranfusion dependence, and ongoing need for catheter placement. 1, 8 Furthermore, whether prompt CVC removal and anticoagulation prophylaxis might reduce the incidence of CRT in transplant patients has not been studied systematically. This study aimed to evaluate the incidence, risk factors, management patterns and outcomes of CRT in patients with lymphoma or myeloma undergoing AHCT in our transplantation center.…”

Section: Introductionmentioning

confidence: 99%

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Catheter-Related Thrombosis in Patients with Lymphoma or Myeloma Undergoing Autologous Stem Cell Transplantation

Hegerova

Bachan

Cao

et al. 2018

Biology of Blood and Marrow Transplantation

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Catheter-related thrombosis (CRT) occurs frequently during autologous hematopoietic cell transplantation (AHCT) and data regarding the incidence, risk factors, and management are understudied. We evaluated 789 consecutive patients with lymphoma and myeloma that underwent AHCT over 10 years (2006 to 2016) and detected the incidence of CRT was 6.3%; only 32% of CRT were symptomatic. The majority occurred within 100 days of AHCT (86%) and median time from tunneled line placement to CRT was 44 days (range, 11 to 89 days). Outcomes of these 50 patients with CRT were compared with age- and disease-matched AHCT control subjects to identify risk factors. History of prior venous thromboembolism (VTE) (20.9% versus 7.0%, P = .02) was the only significant risk factor. Treatment with low-molecular-weight heparin was tolerated with rare minor bleeding (4%), although CRT recurrence or extension (10%) and subsequent VTE (12%) were common. CRT did not impact on nonrelapse mortality or risk of relapse; 2-year progression-free survival was 55% in CRT cases versus 54% in control subjects (P = .42). CRT appears to be common in patients with lymphoma and myeloma undergoing AHCT and significantly contributes to morbidity. Further study to determine mitigating strategies and modify risk factors for CRT is warranted.

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Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Catheter-Related Thrombosis in Patients with Lymphoma or Myeloma Undergoing Autologous Stem Cell Transplantation

Hegerova

Bachan

Cao

et al. 2018

Biology of Blood and Marrow Transplantation

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Impact of anticoagulation on recurrent thrombosis and bleeding after hematopoietic cell transplantation

et al. 2021

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History of venous thromboembolism (VTE) is prevalent among patients undergoing hematopoietic cell transplantation (HCT). Management of anticoagulation is particularly challenging as most patients will have chemotherapy-induced thrombocytopenia while awaiting engraftment post-HCT. We conducted a retrospective study of autologous and allogeneic HCT recipients with prior VTE from 2006-2015 to 1) compare anticoagulant strategies on short-term VTE recurrence and bleeding and 2) assess predictors for VTE recurrence beyond 30 days. Patients with VTE were allocated to two cohorts based on anticoagulant strategy at thrombocytopenia onset and underwent inverse probability weighting to assess primary outcomes of VTE recurrence and bleeding within 30 days post-HCT. Subsequently, multivariable logistic regression model was used to assess the association of 100-day VTE recurrence by the HIGH-2-LOW VTE risk assessment score and whether patients resumed anticoagulation at platelet recovery. Thirteen percent of recipients had VTE prior to HCT; of those meeting inclusion criteria, 227 continued anticoagulation and 113 temporarily discontinued it. Anticoagulant strategy was not significantly associated with decreased risk of VTE recurrence within 30 days (3% vs 4%, p = 0.61); however, risk of overall bleeding was non-significantly higher in those who continued vs discontinued anticoagulation (41% vs 31%, p = 0.08). In a subgroup of 250 allogeneic HCT patients, every one-point increase of HIGH-2-LOW score was significantly associated with VTE recurrence at 100 days (OR 1.57 [95% CI 1.10-2.23]), while anticoagulation resumption upon platelet engraftment was associated with lower

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External validation of the HIGH‐2‐LOW model: A predictive score for venous thromboembolism after allogeneic transplant

Martens

Nguyen

et al. 2022

American J Hematol

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In patients undergoing hematopoietic cell transplantation (HCT), venous thromboembolism (VTE) remains a serious complication that lacks validated risk assessment models (RAMs) to guide thromboprophylaxis. To address this dilemma, we performed a temporal and external validation study of the recently derived HIGH‐2‐LOW RAM. We selected adult patients undergoing allogeneic HCT from Fred Hutchinson Cancer Research Center (FHCRC) and MD Anderson Cancer Center (MDACC). Patients who died, received anticoagulation, or did not engraft platelets by day 30 were excluded. Primary outcomes were defined as overall VTE and pulmonary embolism ± lower‐extremity deep venous thromboembolism (PE/LE‐DVT) by day 180. Covariates were weighted according to the original model, except that grade 2–4 GVHD was substituted for grade 3–4. Discrimination and calibration were assessed. A total of 765 patients from FHCRC and 954 patients from MDACC were included. Incident VTE by day 180 was 5.1% at FHCRC and 6.8% at MDACC. The HIGH‐2‐LOW score had a c‐statistic of 0.67 (0.59–0.75) for VTE and 0.75 (0.64–0.81) for PE/LE‐DVT at FHCRC and 0.62 (0.55–0.70) for VTE and 0.70 (0.56–0.83) for PE/LE‐DVT at MDACC. Twenty‐five percent and 23% of patients were classified as high risk (2+ points) in the two cohorts, respectively. High versus low‐risk was associated with odds ratio (OR) of 2.80 (1.46–5.38) for VTE and 4.21 (1.82–9.77) for PE/LE‐DVT at FHCRC and OR of 3.54 (2.12–5.91) for VTE and 6.82 (2.30–20.16) for PE‐LE‐DVT at MDACC. The HIGH‐2‐LOW RAM identified allogeneic HCT recipients at high risk for VTE in both validation cohorts. It can improve evidence‐based decision‐making for thromboprophylaxis post‐transplant.

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Venous thromboembolism in hematopoietic stem cell transplant recipients

Cited by 33 publications

References 79 publications

Catheter-Related Thrombosis in Patients with Lymphoma or Myeloma Undergoing Autologous Stem Cell Transplantation

Catheter-Related Thrombosis in Patients with Lymphoma or Myeloma Undergoing Autologous Stem Cell Transplantation

Impact of anticoagulation on recurrent thrombosis and bleeding after hematopoietic cell transplantation

External validation of the HIGH‐2‐LOW model: A predictive score for venous thromboembolism after allogeneic transplant

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