Venous thromboembolism in children with Hodgkin lymphoma – A population-based study in Sweden, Finland, and Denmark

IF 3.7 3区医学 Q1 HEMATOLOGY

Thrombosis research Pub Date : 2025-02-20 DOI:10.1016/j.thromres.2025.109287

Mia Giertz , Henri Aarnivala , Sascha W. Michelsen , Caroline Björklund , Marika Grönroos , Lisa L. Hjalgrim , Pasi Huttunen , Riitta Niinimäki , Tuuli Pöyhönen , Päivi Raittinen , Susanna Ranta , Johan E. Svahn , Lisa Törnudd , Annika Englund , Arja Harila

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Abstract

Background

Children and adolescents with Hodgkin lymphoma (HL) are susceptible to developing venous thromboembolism (VTE) due to several predisposing factors such as cancer itself, central venous catheter use, mediastinal mass, and glucocorticoid therapy, yet reports on the topic are scarce.

Aim

To study incidence, risk factors, and treatment of VTE, and the use of thromboprophylaxis, in a retrospective clinical study on pediatric HL.

Methods

Children under 18, diagnosed with HL 2005–2019 in Sweden, Denmark, and Finland were included. Data on patient characteristics, treatment, thrombotic events and follow up were collected from patients' medical records.

Results

A total of 490 children were identified and data were assessed for 489. The cumulative 2-year incidence of VTE was 8.1 % (42/489). Older age at diagnosis (p = 0.004), mediastinal involvement (p = 0.024), and HL stage III + IV (p = 0.036) were significant risk factors for VTE. Children over 15 with mediastinal mass and HL stage III or IV had a 1-year cumulative incidence of VTE of 18 % and a nearly three-fold risk of developing VTE compared to all other patients (OR 2.94, 95 % CI 1.47–5.88, p = 0.002). The majority (39/42; 92.9 %) were treated with low-molecular-weight heparin. Four (9.5 %) patients developed post-thrombotic syndrome. Thromboprophylaxis was given to 18/489 (3.7 %) patients with HL, two of whom developed VTE.

Conclusion

VTE is a common complication in adolescents treated for HL with large tumor burden at diagnosis. Prospective studies should focus on identifying patients who would benefit from thromboprophylaxis.

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霍奇金淋巴瘤患儿静脉血栓栓塞——瑞典、芬兰和丹麦的一项基于人群的研究

背景：儿童和青少年霍奇金淋巴瘤（HL）容易发生静脉血栓栓塞（VTE），原因包括癌症本身、中心静脉导管的使用、纵隔肿块和糖皮质激素治疗等，但关于这一主题的报道很少。目的通过对儿童HL的回顾性临床研究，研究静脉血栓栓塞的发生率、危险因素、治疗和血栓预防的使用。方法纳入瑞典、丹麦和芬兰2005-2019年诊断为HL的18岁以下儿童。从患者病历中收集患者特征、治疗、血栓事件和随访的数据。结果共发现490例患儿，对其中489例进行数据评估。静脉血栓栓塞2年累计发生率为8.1%（42/489）。诊断年龄较大（p = 0.004）、纵隔受累（p = 0.024）和HL III + IV期（p = 0.036）是VTE的显著危险因素。与所有其他患者相比，15岁以上纵隔肿块和HL III期或IV期的儿童1年静脉血栓栓塞累积发生率为18%，发生静脉血栓栓塞的风险接近3倍（or 2.94, 95% CI 1.47-5.88, p = 0.002）。多数(39/42；92.9%)接受低分子肝素治疗。4例（9.5%）患者出现血栓形成后综合征。489例HL患者中有18例（3.7%）接受了血栓预防治疗，其中2例发生静脉血栓栓塞。结论静脉血栓栓塞是青少年HL患者诊断时肿瘤负担较大的常见并发症。前瞻性研究应侧重于确定将受益于血栓预防的患者。

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来源期刊

Thrombosis research 医学-外周血管病

CiteScore

14.60

自引率

4.00%

发文量

364

审稿时长

31 days

期刊介绍： Thrombosis Research is an international journal dedicated to the swift dissemination of new information on thrombosis, hemostasis, and vascular biology, aimed at advancing both science and clinical care. The journal publishes peer-reviewed original research, reviews, editorials, opinions, and critiques, covering both basic and clinical studies. Priority is given to research that promises novel approaches in the diagnosis, therapy, prognosis, and prevention of thrombotic and hemorrhagic diseases.