Incidence of Upper Extremity Deep Vein Thrombosis in Acute Leukemia and Effect on Mortality.

Anjlee Mahajan,Theresa Keegan,Ted Wun,Christina Poh,Ann Brunson

doi:10.1055/s-0040-1718883

Abstract

The cumulative incidence, risk factors, rate of subsequent venous thromboembolism (VTE) and bleeding and impact on mortality of isolated upper extremity deep vein thrombosis (UE DVT) in acute leukemia are not well-described. The California Cancer Registry, used to identify treated patients with acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) diagnosed between 2009 and 2014, was linked with the statewide hospitalization database to determine cumulative incidences of UE DVT and subsequent VTE and bleeding after UE DVT diagnosis. Cox proportional hazards regression models were used to assess the association of UE DVT on the risk of subsequent pulmonary embolism (PE) or lower extremity deep vein thrombosis (LE DVT) and subsequent bleeding, and the impact of UE DVT on mortality. There were 5,072 patients identified: 3,252 had AML and 1,820 had ALL. Three- and 12-month cumulative incidences of UE DVT were 4.8% (95% confidence interval [CI]: 4.1–5.6) and 6.6% (95% CI: 5.8–7.5) for AML and 4.1% (95% CI: 3.2–5.1) and 5.9% (95% CI: 4.9–7.1) for ALL, respectively. Twelve-month cumulative incidences of subsequent VTE after an incident UE DVT diagnosis were 5.3% for AML and 12.2% for ALL. Twelve-month cumulative incidences of subsequent bleeding after an incident UE DVT diagnosis were 15.4% for AML and 21.1% for ALL. UE DVT was associated with an increased risk of subsequent bleeding for both AML (hazard ratio [HR]: 2.07; 95% CI: 1.60–2.68) and ALL (HR: 1.62; 95% CI: 1.02–2.57) but was not an independent risk factor for subsequent PE or LE DVT for either leukemia subtype. Isolated incident UE DVT was associated with increased leukemia-specific mortality for AML (HR: 1.42; 95% CI: 1.16–1.73) and ALL (HR: 1.80; 95% CI: 1.31–2.47). UE DVT is a relatively common complication among patients with AML and ALL and has a significant impact on bleeding and mortality. Further research is needed to determine appropriate therapy for this high-risk population.

Highlights

Venous thromboembolism (VTE) is a known complication of cancer
We identified 5,072 patients between October 1, 2009 and December 31, 2014 with first primary diagnosis of acute leukemia who were treated with chemotherapy: 3,252 had acute myeloid leukemia (AML) and 1,820 had acute lymphoblastic leukemia (ALL)
While upper extremity deep vein thrombosis (UE DVT) was not a risk factor for development of subsequent pulmonary embolism (PE) or lower extremity deep vein thrombosis (LE DVT) in AML or ALL, it was associated with an increased risk for subsequent bleeding in both AML and ALL, suggesting these patients may have received anticoagulation

Summary

Introduction

Venous thromboembolism (VTE) is a known complication of cancer. The risk of VTE in cancer patients varies widely among different malignancies. It is generally thought that adenocarcinomas such as pancreatic and gastric cancer are associated with a much higher VTE risk than hematologic malignancies such as myeloma, lymphoma, or leukemia.[4,5] a population-based cohort analysis found the incidence of VTE in acute leukemia to be comparable with the incidence in many solid tumors.[6] In addition, another population-based study concluded that patients with hematologic malignancies were up to 26 times more likely to develop VTE compared with the general population.[7]

Methods

Results

Conclusion