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2303 Venous Thromboembolism (VTE) in Patients with Hematologic and Non-Hematologic Malignancies: Incidence and Risk Factors for Recurrent VTE

Program: Oral and Poster Abstracts
Session: 331. Pathophysiology of Thrombosis: Poster II
Sunday, December 11, 2011, 6:00 PM-8:00 PM
Hall GH (San Diego Convention Center)

Saroj Vadhan-Raj, MD1, Xiao Zhou, MD, PHD2*, Jatin J Shah, MD3, Robert S Benjamin, MD4* and Gregory Gladish, MD5*

1Section of Cytokines and Supportive Oncology, Departments of Sarcoma, Lymphoma/Myeloma, UT MD Anderson Cancer Center, Houston, TX
2Section of Cytokines and Supportive Oncology, UT MD Anderson Cancer Center, Houston, TX
3Lymphoma/Myeloma, UT MD Anderson Cancer Center, Houston, TX
4Sarcoma Medical Oncology, UTMD Anderson Cancer Center, Houston
5Diagnostic Radiology, UTMD Anderson Cancer Center, Houston

The incidence of VTE and risk for recurrence is known to be higher in patients (pt) with malignancy than in other patients. However, the exact incidence and risk factors predictive of recurrent VTE in patients with hematologic malignancies (Hem) and solid tumors (ST) are not well defined. A retrospective study was conducted to evaluate the incidence of VTE and the recurrent events during one year period at MD Anderson Cancer Center. The medical records of all patients with VTE confirmed by the radiologic studies in 2006 were reviewed. The data were collected for the incidence and type of VTE, the recurrent events during a one year follow-up from the time of primary event, and the risk factors for recurrent events, including, the pt demographics, diagnosis, prior history of VTE, transfusions, use of erythropoiesis-stimulating agents, and the laboratory parameters at the time of the index VTE event. Cox proportional hazard models were established to determine the independent predictive factors for recurrent VTE. There were 24,806 unique patients (each patient counted once) in active treatment at the Cancer Center between January 2006 and December 2006. Of the 980 pts diagnosed with VTE (480 DVT, 477 PE, and 23 DVT/PE) during this period, there were 770 ST, 208 Hem, and 2 benign conditions. The incidence of VTE was higher in Hem pts than in ST pts [208/3603 (6%) vs. 770/20212 (4%), p<0.0001]. Among Hem pts, the incidence was significantly higher in myeloma as compared to lymphoma and leukemia (9%, 6%, and 4%, respectively, p<0.0001).  The proportion of VTE pts with PE was significantly higher among ST pts compared with Hem pts (55% vs 37%, p<0.0001). The incidence of recurrent VTE, as defined by any new event or progression of the index event, was 14% (140/978 pts) during one year follow-up period, and it was not different for Hem (16%) vs. ST (14%). Among Hem pts, the recurrence was higher for myeloma (19%) than lymphoma (16%) and leukemia (13%). Majority of the recurrent events (100/140, 71%) were seen during the initial 3 month period from the index event.  The independent risk factors for recurrent VTE during 3 months, 6 months and 1 year were summarized in the following table:

3 months

6 months

1 year

Risk factors

Hazard ratio (95% CI)

P

Hazard ratio (95% CI)

P

Hazard ratio (95%CI)

P

PE vs. non-PE

1.86(1.20-2.88)

0.005

1.67(1.12-2.42)

0.006

1.74(1.20-2.51)

0.003

Age (<60 vs. ≥60 years)

2.05(1.34-3.15)

0.001

1.55(1.08-2.23)

0.017

1.62(1.14-2.32)

0.008

Men vs. women

1.70(1.10-2.63)

0.018

1.44(0.994-2.07)

0.054

PE, pulmonary embolism; CI, confidence interval.

Conclusions: The incidence of VTE is higher in Hem pts, especially in myeloma. Younger age (<60 years) and PE are independent risk factors predictive of recurrence during 3 month, 6 month and 1 year period.

Disclosures: No relevant conflicts of interest to declare.

*signifies non-member of ASH