Risk assessment of venous thromboembolism in hematological cancer patients: a review

ABSTRACT

Introduction

Venous thromboembolism (VTE) is a frequent and serious complication in cancer patients. Nonetheless, patients with hematological cancers receive less attention as compared with their solid tumor counterparts regarding this potentially fatal complication.

Areas covered

Risk factors that are associated with the development of VTE in hematological cancers are discussed, based on a PubMed literature search. Since different hematological malignancies carry different risks of VTE, risk assessment in individual types of hematological cancers, including acute leukemias, lymphomas, myeloma, and myeloproliferative neoplasms are examined separately. Clinical relevance of VTE assessment and current guidelines on thromboprophylaxis in patients with hematological malignancies are also briefly reviewed.

Expert opinion

When assessing VTE risk in patients with hematological cancers, in addition to the non-cancer specific risk factors, individual cancer-type-specific and the therapy-related factors must be taken into consideration. Primary thromboprophylaxis should be considered in high-risk patients.

KEYWORDS:

• Venous thromboembolism
• myeloproliferative neoplasm
• myeloma
• JAK2
• immunomodulatory agents
• l-asparaginase

Article highlights

• Patients with hematological cancers were under-represented in the cohorts used for the derivation of the current VTE risk assessment models for cancer patients.

• Different hematological malignancies are inherently associated with different risks for VTE.

• Patients with MPNs have a higher life-time risk of developing VTE as compared with other hematological cancers. The genetic landscape further modifies the thrombotic risk. Aspirin is used as primary thromboprophylaxis and high risks patients are recommended to received cytoreductive therapy.

• The therapeutic interventions employed also contribute to the development of VTE. In ALL, the use of L-asparaginase substantially increases the risk of VTE. In myeloma patients receiving IMiDs, primary thromboprophylaxis is warranted in view with a high incidence of VTE associated with the use of IMiDs.

• Physicians and patients should be aware of the risk of VTE such that prompt attention and treatment can be given.

• When deciding to use anticoagulants either as prophylaxis or treatment, the risk of bleeding complication should be taken into consideration.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.