Venous Thromboembolism Post-allogeneic Hematopoietic Cell Transplant: Risk Factors, Incidence, and Outcomes.

IF 5 2区 医学 Q1 HEMATOLOGY
Lauren M Granat, Hong Li, Mariah Ondeck, Bennet Osantowski, Chana Peysin, Mailey Wilks, Christina Ferraro, Ronald Sobecks, Dana Angelini, Betty K Hamilton
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Abstract

Background:  Venous thromboembolism (VTE) is a well-documented complication of both solid and hematologic malignancies, but there are fewer data on allogeneic hematopoietic cell transplant (HCT) recipients. Therefore, we studied the incidence, risk factors, and impact of VTE on post-HCT outcomes in a contemporary cohort.

Methods:  We retrospectively reviewed patients who underwent allogeneic HCT between January 2014 and August 2019 to identify patients with post-HCT VTE. Patient, disease, and transplant-related risk factors for VTE were investigated using competing risk analysis.

Results:  A total of 431 patients were included in this study. Median (interquartile range [IQR]) age in years was 59 (46-65) at transplant. The most common indication for transplant was acute myelogenous leukemia (49.4%). Within our cohort, 64 patients (14.8%) developed post-HCT VTE with a median (IQR) follow-up time of 24.6 (8.4-47.1) months. The cumulative incidence of VTE was 4.2% at 6 months, 9.0% at 12 months, 12.6% at 24 months, and 13.8% at 36 months. In multivariable analysis, older age (hazard ratio [HR] per 10-year increase: 1.36, 95% confidence interval [CI]: 1.09-1.70), history of VTE (HR: 1.95, 95% CI: 1.09-3.49), and grade 2-4 acute graft versus host disease (GVHD; HR: 1.75, 95% CI: 1.05-2.94) were independently associated with VTE. VTE was significantly associated with an increased risk of nonrelapse mortality (NRM; HR: 4.09, 95% CI: 2.47-6.74) and decreased overall survival (OS; HR: 2.19, 95% CI: 1.48-3.24).

Conclusion:  VTE is an important complication after allogeneic HCT and is significantly associated with increased NRM and decreased OS. Older patients, those with prior VTE, and patients with acute GVHD are at increased risk for development of VTE after HCT.

同种异体造血细胞移植后静脉血栓栓塞症:风险因素、发病率和结果。
静脉血栓栓塞症(VTE)是实体瘤和血液系统恶性肿瘤的并发症,但有关异基因造血细胞移植(HCT)受者的数据较少。因此,我们研究了当代队列中 VTE 的发生率、风险因素及其对 HCT 后预后的影响。我们对 2014 年 1 月 1 日至 2019 年 8 月 8 日期间接受异基因 HCT 的患者进行了回顾性研究,以确定接受 HCT 后出现 VTE 的患者。我们使用竞争风险分析法调查了患者、疾病和移植相关的 VTE 风险因素。本研究共纳入了 431 例患者。移植时的中位(IQR)年龄为59(46-65)岁。最常见的移植适应症是急性髓性白血病(49.4%)。在我们的队列中,有64名患者(14.8%)在移植后发生了VTE,中位(IQR)随访时间为24.6(8.4-47.1)个月。VTE的累积发生率为:6个月时4.2%,12个月时9.0%,24个月时12.6%,36个月时13.8%。在多变量分析中,年龄较大(每增加10岁的HR,95% CI:1.36,1.09-1.70)、VTE病史(HR,95% CI:1.95,1.09-3.49)和2-4级急性GVHD(HR,95% CI:1.75,1.05-2.94)与VTE独立相关。VTE与非复发死亡率(NRM)风险增加(HR4.09,95% CI 2.47-6.74)和总生存率(OS)下降(HR 2.19,95% CI 1.48-3.24)明显相关。VTE是异基因造血干细胞移植后的一种重要并发症,与NRM增加和OS降低密切相关。年龄较大的患者、既往有 VTE 的患者和急性 GVHD 患者在 HCT 后发生 VTE 的风险更高。
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来源期刊
Thrombosis and haemostasis
Thrombosis and haemostasis 医学-外周血管病
CiteScore
11.90
自引率
9.00%
发文量
140
审稿时长
1 months
期刊介绍: Thrombosis and Haemostasis publishes reports on basic, translational and clinical research dedicated to novel results and highest quality in any area of thrombosis and haemostasis, vascular biology and medicine, inflammation and infection, platelet and leukocyte biology, from genetic, molecular & cellular studies, diagnostic, therapeutic & preventative studies to high-level translational and clinical research. The journal provides position and guideline papers, state-of-the-art papers, expert analysis and commentaries, and dedicated theme issues covering recent developments and key topics in the field.
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