With hematologic malignancies (HMs), physicians often encounter a puzzling paradox of coagulation in which patients have a high risk of both venous thromboembolism (VTE) and bleeding. Cancer and associated treatments are known to increase the risk of VTE in patients with HMs, and multiple comorbidities are known to increase the incidence of VTE. On the other hand, risk of hemorrhage stems from using anticoagulation prophylaxis and treatment to mitigate VTE. In addition to this paradox, there is a paucity of data to guide risk assessment in this patient population, leaving physicians with the difficult task of determining which patients should receive prophylaxis.
Gary H. Lyman, MD, former cochair of the American Society of Clinical Oncology (ASCO) VTE guidelines and current chair of the forthcoming American Society of Hematology VTE guidelines, explained why risk assessments have not been established for patients with HMs. He told Cancer Therapy Advisor, “This is somewhat of an understudied area. Many VTE guidelines, including ASCO and others, have avoided the heme malignancy categories because the data [are] less robust than with solid-tumor patients who are at risk for thrombosis.”
Fortunately, the dearth of information grew a little smaller this year, with the publication of a retrospective study that focused on better quantifying VTE risk and incidence among hospitalized patients with HMs who had a secondary diagnosis of VTE.
Researchers from the Allegheny Health Network in Pittsburgh, Pennsylvania, and the Henry Ford Health System in Detroit, Michigan, used discharge data from the National Inpatient Sample (NIS), the “largest all-payer publicly available inpatient database in the United States” to identify more than 80,000 hospitalizations for HMs between 2011 and 2015.
Participants in the study had a diagnosis of 1 of 7 of the most common types of HMs: acute lymphocytic leukemia (ALL), chronic lymphocytic leukemia (CLL), acute myeloid leukemia (AML), chronic myeloid leukemia (CML), non-Hodgkin lymphoma (NHL), Hodgkin lymphoma (HL), and multiple myeloma (MM).
Approximately 44% of patients were female, 30% were people of color, and nearly all were 35 years or older (43% were aged 35-65 years; 49% were older than 65 years). The 3 most common comorbidities were anemia, hypertension, and electrolyte abnormalities. Approximately a third of patients received chemotherapy during hospitalization; patients with ALL, AML, and HL received chemotherapy most frequently.