Venous Thromboembolism in the Hematologic Malignancies

Abstract

Patients with hematologic malignancies are at high risk of thrombotic or hemorrhagic complications. The incidence of these events is greatly variable and is influenced by many factors, including the type of disease, the type of chemotherapy, and the use of a central venous device. As in solid tumors, a number of clinical risk factors have been identified and contribute to the increasing thrombotic rate in hematologic malignancies. Biologic properties of the tumor cells can influence the hypercoagulable state of patients with these malignancies by several mechanisms. Of interest, oncogenes responsible for neoplastic transformation in leukemia also may be involved in clotting activation. Epidemiologic data allow an estimate of the incidence of venous thromboembolism (VTE) in acute leukemia, lymphomas, and multiple myeloma (MM). In this review, we focus on the epidemiology, pathogenesis, and VTE management in these three hematologic malignancies. No recommendation for routine thromboprophylaxis in these conditions, with the exception of MM, is available. Large, prospective, randomized clinical trials are needed to establish the best practice for thromboprophylaxis and treatment of VTE in these types of cancers.

Venous thromboembolism prophylaxis in hematopoietic stem cell transplantation patients: an international web-based survey of healthcare providers

“…Only about 15 % of providers prescribed pharmacologic VTE prophylaxis. Despite differences in VTE incidence reported in some studies [1–5], we did not note any differences in the approach to VTE prophylaxis for patients undergoing allogeneic and autologous HSCT. Most providers cited a high perceived risk of bleeding, a relatively lower risk of VTE, a lack of efficacy data, and institutional policies as the basis for their practices.…”

“…We and others have previously shown that despite severe thrombocytopenia and a high incidence of bleeding complications, 3.7–4.5 % of patients undergoing HSCT suffer symptomatic venous thromboembolism (VTE) [1–5]. Despite the relatively common occurrence of deep venous thrombosis (DVT) and pulmonary embolism (PE), the optimal approach to VTE prophylaxis for patients undergoing HSCT remains undefined.…”

Elevated neutrophil-to-lymphocyte ratio and monocyte-to-lymphocyte ratio and decreased platelet-to-lymphocyte ratio are associated with poor prognosis in multiple myeloma

“…In addition, PLR is introduced as a potential marker to determine inflammation, and a higher platelet to lymphocyte ratio is associated with poor prognosis in a few types of cancer [25]. MM patients show evidence of platelet activation as measured by elevated plasma soluble P-selectin [26] and are highly susceptible to therapy-induced thrombosis [27]. Importantly, activated platelets secrete many cytokines that are required for growth of myeloma cells including IL-6, VEGF, SDF-1α, and IGF-1, suggesting that platelets may affect the microenvironments of MM.…”

CD138-negative myeloma cells regulate mechanical properties of bone marrow stromal cells through SDF-1/CXCR4/AKT signaling pathway

“…It accounts for 10% of all malignant hematological diseases [1]. According to National Cancer Institute cancer statistics, 24,050 new cancer cases of MM will be diagnosed in the United States in 2014, and an estimated 11,090 deaths will occur [2].…”