Epidemiology of venous thromboembolism in hematological cancers: The Scandinavian Thrombosis and Cancer (STAC) cohort

doi:10.1016/j.thromres.2017.09.002

Thrombosis Research

Volume 158, October 2017, Pages 157-160

https://doi.org/10.1016/j.thromres.2017.09.002 Get rights and content

Highlights

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Incidence of venous thromboembolism (VTE) differed by type of hematological cancer.
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Incidence rate (IR) of VTE in CLL was higher than matched referene subjects.
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IR of VTE in follicular lymphoma was not higher compared with references.
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In myeloma and CLL, IR of VTE remained higher for years after cancer diagnosis.

Abstract

Introduction

Venous thromboembolism (VTE) is an important cause of morbidity and mortality in cancer patients, however the risk of VTE differs according to cancer type. Hematological cancers have varying phenotypes. Incidence rates (IR) of VTE in different hematological cancer types have not been investigated in a cancer-exposed subset of the general population.

Methods

In a population-based cohort, we estimated incidence rates of VTE among patients with six subtypes of hematological cancer and among age and sex matched reference subjects.

Results

During a mean follow-up of 4.8 years, 30 objectively confirmed first-time symptomatic VTEs occurred among 838 subjects with hematological cancer. The IR of VTE was higher in all types of cancer except for indolent lymphoma but including chronic lymphocytic leukemia compared with reference subjects both during the first year after cancer diagnosis and 1–5 years after diagnosis. IR of VTE for indolent lymphoma was not higher than controls.

Conclusion

The IRs of VTE were increased in all types of hematological cancer (including chronic lymphocytic leukemia) compared with reference subjects except indolent lymphomas.

Introduction

Cancer patients who develop venous thromboembolism (VTE), i.e. deep vein thrombosis and pulmonary embolism, have a lower life expectancy and quality of life compared with cancer patients without VTE [1], [2]. The risk of VTE in hematological cancers as a group exceeds that of many solid cancers [3]. The hematological cancers do however have very different phenotypes, and the predisposition to VTE may vary by type. The epidemiology of VTE is largely unknown for some of the hematological cancer types. Two large studies have compared incidences of VTE in different cancer types, including leukemia, lymphoma and myeloma with reference populations, but none of these studies described the incidences of VTE in indolent lymphomas or chronic lymphocytic leukemia separately [4], [5]. Recently Cohen AT et al. reported incidence rates (IR) of VTE in the cancer-exposed subset of a general population cohort, but hematological cancers were combined into one group [6]. However, hematological cancers range from chronic diseases without need of treatment to highly aggressive cancers. Few studies have examined the IR of VTE in different subtypes of hematological cancers.

The aim of this study was to estimate the IR of VTE in six types of hematological cancers in a large, population-based cohort with prospectively collected data, i.e. the Scandinavian Thrombosis and Cancer (STAC) cohort. Incidence rates of VTE in each of the hematological cancer types were compared with IR in age and gender matched reference populations sampled from the STAC cohort.

Section snippets

Study population

The STAC cohort consists of merged data from two Norwegian population-based cohorts (the Tromso Study and the Nord-Trondelag Health Study (HUNT2)), and the Danish Diet, Cancer and Health Study (DCH) [7]. The STAC cohort contains individual data from 144.952 study participants followed prospectively from inclusion, which ran from 1993 to 1997 until death, emigration or last date of follow-up. All study participants were free of previous cancer or VTE at inclusion, where they permitted linkage to

Results

During follow-up (mean = 4.8 years) 30 VTEs occurred in the group with hematological cancer patients, 21 occurred in the identified reference population including 4190 study participants. Mean age was 66.9 years. (Table 1).

The IR of VTE for most of the hematological cancer types was higher than in the reference population although the exposed person time was low in some of the types, especially acute leukemia and Hodgkin Lymphoma. In CLL the IR of VTE was higher compared with controls during the

Discussion

Based on person-time data from a large population-based cohort, we found higher incidence rates (IR) of VTE in CLL both during the first year after cancer diagnosis and one to five years after, compared with reference subjects. In indolent lymphoma, we did not observe an increased IR of VTE in this group compared with reference subjects. Myeloma and aggressive lymphomas were also associated with higher IR than reference subjects, for the latter however mainly during the first year after cancer

Conclusion

In conclusion, IR of VTE in different hematological cancer types were compared with matched reference subjects at different time points from cancer diagnosis/index date. Incidence rates were higher than the background population in the first year after cancer diagnosis in CLL, aggressive lymphomas and myeloma, but not in indolent lymphoma. The IR remained higher than the background population in CLL and myeloma for years after cancer diagnosis.

Acknowledgements

The authors are indebted to Helle Højmark Eriksen, M.Sc., Biostatician at Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark for invaluable support in data management and analysis. The work was supported by independent research grants from The Obel Family Foundation (26145) donated to Professor Søren Risom Kristensen and from Stiftelsen Kristian Gerhard Jebsen (SKGJ-MED-012) to K.G. Jebsen – Thrombosis Research and Expertise Center (TREC).

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^☆: Presented in part at: 57th American Society of Hematology (ASH) Annual Meeting, 2015, Orlando, Florida, USA.

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Full Length ArticleEpidemiology of venous thromboembolism in hematological cancers: The Scandinavian Thrombosis and Cancer (STAC) cohort☆

Highlights

Abstract

Introduction

Methods

Results

Conclusion

Introduction

Section snippets

Study population

Results

Discussion

Conclusion

Acknowledgements

Prognosis of cancers associated with venous thromboembolism

N. Engl. J. Med.

Patients' experiences of LIving with CANcer-associated thrombosis: the PELICAN study

Patient Prefer Adherence.

Epidemiology of cancer-associated venous thrombosis

Blood

Hospitalisation for venous thromboembolism in cancer patients and the general population: a population-based cohort study in denmark, 1997–2006

Br. J. Cancer

Incidence of venous thromboembolism in patients with cancer - a cohort study using linked united kingdom databases

Eur. J. Cancer

Epidemiology of first and recurrent venous thromboembolism in patients with active cancer. A population-based cohort study

Thromb. Haemost.

Existing data sources in clinical epidemiology: the Scandinavian thrombosis and cancer cohort

Clin. Epidemiol.

A retrospective study of venous thromboembolism in acute leukemia patients treated at the university of Texas MD Anderson cancer center

Cancer Med.

Full Length Article
Epidemiology of venous thromboembolism in hematological cancers: The Scandinavian Thrombosis and Cancer (STAC) cohort☆