Thromb Haemost 2022; 122(09): 1594-1602
DOI: 10.1055/a-1777-4006
Stroke, Systemic or Venous Thromboembolism

Outcome of Cancer-Associated Venous Thromboembolism Is More Favorable among Patients with Hematologic Malignancies than in Those with Solid Tumors

Ramón Lecumberri
1   Hematology Service, Clínica Universidad de Navarra, Pamplona, Spain
2   CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
,
3   Department of Internal Medicine, Clínica Universidad de Navarra, Madrid, Spain
4   CIBERES, Instituto de Salud Carlos III, Madrid, Spain
,
Inna Tzoran
5   Hematology Service, Rambam – Health Care Campus, Haifa, Israel
,
Benjamin Brenner
5   Hematology Service, Rambam – Health Care Campus, Haifa, Israel
,
Dominique Farge-Bancel
6   Internal Medicine Unit UF (04), Hôpital Saint-Louis, AP-HP, Université de Paris, Paris, France
,
Cihan Ay
7   Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
,
Vladimir Rosa
8   Department of Internal Medicine, Hospital Universitario Virgen de Arrixaca, Murcia, Spain
,
Iria Francisco
9   Department of Internal Medicine, Hospital Universitari de Girona Dr. Josep Trueta, Gerona, Spain
,
Luis Manuel Hernández-Blasco
10   Department of Pneumonology, Hospital General Universitario de Alicante, ISABIAL, UMH, Alicante, Spain
,
Javier Trujillo-Santos
11   Department of Internal Medicine, Hospital General Universitario Santa Lucía, Universidad Católica de Murcia, Murcia, Spain
,
Manuel Monreal
12   Department of Internal Medicine, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
13   Department of Thromboembolic Disease, Faculty of Health Sciences, UCAM - Universidad Católica San Antonio de Murcia, CIBERES, Instituto de Salud Carlos III, Madrid, Spain
,
the RIETE Investigators › Author Affiliations
Funding None.

Abstract

Background The natural history of patients with hematologic cancer and venous thromboembolism (VTE) has not been consistently evaluated. We aimed to compare the rates of symptomatic recurrent VTE, major bleeding, or death during anticoagulant therapy in patients with VTE associated with hematologic versus solid cancers.

Methods Consecutive patients with active cancer recruited in RIETE were evaluated. Their baseline characteristics, treatments, and outcomes during the course of anticoagulation were compared. Univariate and multivariate competing-risk analyses were performed.

Results As of December 2020, 16,694 patients with cancer and VTE were recruited. Of these, 1,062 (6.4%) had hematologic cancers. Hematologic patients were less likely to initially present with pulmonary embolism (46 vs. 55%) and more likely with upper extremity deep vein thrombosis (25 vs. 18%). They also were more likely to have severe thrombocytopenia at baseline (5.6 vs. 0.7%) or to receive chemotherapy (67 vs. 41%). During the course of anticoagulation (median, 150 vs. 127 days), 1,071 patients (6.4%) developed VTE recurrences, 806 (4.8%) suffered major bleeding, and 4,136 (24.8%) died. Patients with hematologic cancers had lower rates of recurrent VTE (rate ratio [RR]: 0.73; 95% confidence interval [CI]: 0.56–0.95), major bleeding (RR: 0.72; 95% CI: 0.53–0.98), or all-cause death (RR: 0.49; 95% CI: 0.41–0.57) than those with solid cancers. Patients with multiple myeloma showed the best outcomes.

Conclusion Patients with hematologic cancers, particularly multiple myeloma, and VTE had better outcomes than those with solid cancers. These findings are relevant for the interpretation of previous clinical trials and the design of future studies.

Author Contributions

R.L., I.T., and M.M. were involved in study design, data collection and interpretation, writing and critical review, and final approval of the manuscript. J.T-.S. was involved in data collection, data analysis and interpretation, writing and critical review, and final approval of the manuscript. All other authors were involved in data collection and interpretation, writing and critical review, and final approval of the manuscript.


* A full list of the RIETE investigators is included in [Supplementary Appendix A].


Supplementary Material



Publication History

Received: 05 November 2021

Accepted: 08 February 2022

Accepted Manuscript online:
21 February 2022

Article published online:
13 June 2022

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