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Assessing the risk of venous thromboembolism in patients with haematological cancers using three prediction models

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Abstract

Purpose

Assessment of individual VTE risk in cancer patients prior to chemotherapy is critical for determining necessity of interventions. Risk assessment models (RAM) are available but have not been validated for haematological malignancy. We aimed to assess the validity of the Vienna Cancer and Thrombosis Study (V-CATS) score in prediction of VTE in a variety of haematological malignancies.

Methods

This is a prospective cohort study conducted on 81 newly diagnosed cancer patients undergoing chemotherapy. Demographic, clinical and cancer related data were collected, patients were followed up for 6 months, and VTE events were recorded. Khorana score (KS) was calculated. Plasma D-dimer and sP-selectin were measured, and then, V-CATS score was calculated. Receiver operator curve (ROC) was used to assess the sensitivity and specificity of RAMs. A modified V-CATS was generated and subsequently assessed by using new cut-off levels of d-dimer and sP-selectin based on ROC curve of the patients’ results and compared the probability of VTE occurrence using all three RAMs.

Results

Among the 81 patients included in this study, a total of 2.7% were diagnosed with advanced metastatic cancer. The most frequent cancer was non-Hodgkin lymphoma (39.5%), and 8 patients (9.8%) developed VTE events. The calculated probability of VTE occurrence using KS, V-CATS and modified V-CATS scores at cut-off levels ≥ 3 was 87.5%, 87.5% and 100%, respectively. The AUC in ROC curve of modified Vienna CATS score showed significant difference when compared to that of V-CATS and KS (P = 0.047 and 0.029, respectively).

Conclusion

The findings of our study highlight the value of three VTE risk assessment models in haematological malignancies. The modified V-CATS score demonstrated higher specificity compared to both V-CATS and KS, while all three scores exhibited similar sensitivity. We encourage the implementation of RAMs in haematological cancers for an appropriate use of thromboprophylaxis.

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Data availability

The research data associated with this paper are available and can be accessed when needed.

Abbreviations

RAM:

Risk assessment models

V-CATS:

Vienna Cancer and Thrombosis Study

KS:

Khorana score

VTE:

Venous thromboembolism

BMI:

Body Mass Index

sP-sel:

Soluble P-selectin

IRB:

Institutional Review Board

CBC:

Complete Blood Count

INR:

International Normalized Ratio

NLR:

Neutrophil Lymphocyte Ratio

PLR:

Platelet Lymphocyte Ratio

DVT:

Deep vein thrombosis

PE:

Pulmonary embolism

ELISA:

Enzyme-linked immunosorbent assay

MM:

Multiple myeloma

CLL:

Chronic lymphocytic leukaemia

CML:

Chronic myeloid leukaemia

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Funding

This study was primarily personally funded. Mansoura University facilitated patient recruitment and provided research laboratory facilities.

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Authors and Affiliations

  1. Clinical Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt

    Hanaa Ali EL-Sayed, Maha Othman, Hanan Azzam, Yousra Tera, Hayam Rashad Ghoneim & Tarek El-Sayed Selim

  2. Department of Biomedical and Molecular Sciences, School of Medicine, Queen’s University, Kingston, ON, Canada

    Maha Othman, Regan Bucciol & Yousra Tera

  3. School of Baccalaureate Nursing, St Lawrence College, Kingston, ON, Canada

    Maha Othman

  4. Oncology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt

    Mohamed Awad Ebrahim, Mohammed Ahmed Mohammed Abdallah EL-Agdar & Doaa H. Sakr

Authors
  1. Hanaa Ali EL-Sayed
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  2. Maha Othman
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  3. Hanan Azzam
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  4. Regan Bucciol
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  5. Mohamed Awad Ebrahim
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  6. Mohammed Ahmed Mohammed Abdallah EL-Agdar
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  7. Yousra Tera
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  9. Hayam Rashad Ghoneim
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  10. Tarek El-Sayed Selim
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Contributions

HE conducted all practical work, tabulated and analyzed data and wrote the first draft of the manuscript. RB critically evaluated and wrote the manuscript. MO critically evaluated the data, guided data interpretation and data presentation, and critically reviewed and wrote the manuscript. AE, ME, YT, DS, HG reviewed the data and manuscript. TS designed the study and supervised the study. The contributions of authors were in accordance with the journal's guidelines.

Corresponding author

Correspondence to Maha Othman.

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Conflict of interest

All authors have no conflict of interest related to this work.

Ethical approval

The research adhered to the Code of Ethics of the World Medical Association (Declaration of Helsinki) for studies involving human subjects. The project was approved by Mansoura University Board of ethics.

Patient consent statement

All the patients involved in the study provided the written consent for participation and publication of scientific data.

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EL-Sayed, H.A., Othman, M., Azzam, H. et al. Assessing the risk of venous thromboembolism in patients with haematological cancers using three prediction models. J Cancer Res Clin Oncol 149, 17771–17780 (2023). https://doi.org/10.1007/s00432-023-05475-7

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  • DOI: https://doi.org/10.1007/s00432-023-05475-7

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