A 19-year retrospective analysis of venous thromboembolism trends in chemotherapy-induced anemia: Red blood cell transfusion versus erythrocyte stimulating agent administration

Abstract

Abstract Background Chemotherapy-induced anemia (CIA) contributes to poor patient outcomes and increased mortality. Prompt and effective treatment of CIA is essential to prevent fewer chemotherapy dose delays and reductions. Optimal therapy of CIA involves intravenous iron, red blood cell (RBC) transfusions, and erythrocyte stimulating agents (ESAs). Despite the baseline coagulopathies present in patients with malignancy, administration of both RBC transfusions and ESAs is independently associated with venous thromboembolism (VTE). It remains unknown whether the risk of VTE in patients with CIA is greater among patients who receive RBC transfusions or ESAs and whether or not this risk is consistent across gender and age. Methods A retrospective study analyzed 13,334 patients with various malignancies who developed CIA between 1998-2017. Using multivariate Cox regression, we determined adjusted hazard ratios (and corresponding 95% confidence intervals) of VTE development after controlling for RBC and ESA intervention (within 90 days after CIA diagnosis). Data was then stratified by gender and age ( Results Among the 13,334 patients with CIA, 2,620 (19.7%) developed a VTE. Despite stratification by gender, VTE risk following RBC transfusion was approximately four-fold the VTE risk following ESA administration (Table). Among patients with CIA who were Table: 106P . Treatment and outcomes within 90 days following CIA diagnosis No treatment RBC only ESA only RBC and ESA Patients with VTE (All Patients) 2028 (10,948) 538 (1,892) 42 (368) 12 (126) 18.5% 28.4% (HR = 2.18, 95% CI 1.98-2.39, p 11.4% (HR = 0.55, 95% CI 0.42-0.72, p 9.5% Men with VTE (All male patients) 970 (5428) 269 (917) 21 (182) 5 (61) 17.9% 29.3% (HR = 2.33, 95% CI (2.04-2.67, p 11.5% (HR = 0.55, 95% CI (0.37-0.81, p = 0.002) 8.3% Women with VTE (All female patients) 1058 (5519) 269 (975) 21 (186) 7 (65) 19.2% 27.6% (HR = 2.04, 95% CI (1.79-2.33), p 11.3% (HR = 0.56, 95% CI (0.38-0.81), p = 0.002) 10.8% Conclusions Among patients with CIA, there is an approximate four-fold increased risk of VTE development with RBC transfusion as compared with ESA administration. Legal entity responsible for the study The authors. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.