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