- Natasha Kekre1,
- Haesook T. Kim2,
- Vincent T. Ho3,
- Corey Cutler3,
- Philippe Armand3,
- Sarah Nikiforow3,
- Edwin P. Alyea3,
- Robert J. Soiffer3,
- Joseph H. Antin3,
- Jean M. Connors4 and
- John Koreth3,*
- 1 Ottawa Hospital Research Institute, Ottawa, Canada;
- 2 Dept Biostatistics/Computational Biology, Dana-Farber Cancer Institute, Boston, USA;
- 3 Dana-Farber Cancer Institute, Harvard School of Public Health, Boston, USA;
- 4 Division of Hematology, Brigham & Women Hospital, Harvard Medical School, Boston, USA
- ↵* Corresponding author; email:
Although venous thromboembolism rates and risk factors are well described in patients with cancer, there are limited data on the incidence, risk factors and outcomes of thrombosis after allogeneic stem cell transplantation, a curative therapy for patients with hematologic malignancies. We aimed to determine the incidence and risks associated with venous thrombosis in allogeneic stem cell transplant. We studied 2276 recipients of first transplant between 2002-2013 at our institution with a median follow-up of 50 months (range 4-146). Using pharmacy records and subsequent chart review, 190 patients who received systemic anticoagulation for venous thrombosis were identified. The 1 and 2-year cumulative incidence of all venous thrombotic events were 5.5% (95% CI 4.6-6.5%) and 7.1% (95% CI 6.1-8.2%) respectively. There was no difference in age, gender, body mass index, diagnosis, disease risk index, conditioning intensity, donor type or graft source between transplant recipients with and without subsequent thrombosis. In multivariable models, both acute and chronic graft-versus-host disease were independently associated with thrombosis occurrence (HR=2.05, 95% CI 1.52-2.76; HR=1.71, 95% CI 1.19-2.46 respectively). Upper extremity thrombosis differed from all other thrombosis in timing, risk factors and clinical impact, and was not associated with non-relapse mortality (HR=1.15; 95% CI 0.69-1.90), unlike all other thrombosis which did increase non-relapse mortality (HR=1.71; 95% CI 1.17-2.49). In subgroup analysis evaluating conventional thrombosis predictors by comparing patients with and without thrombosis, history of prior venous thrombosis was the only significant predictor. Venous thromboembolism has a high incidence after allogeneic stem cell transplant and is associated with graft-versus-host disease and non-relapse mortality.
- Received January 11, 2017.
- Accepted March 17, 2017.
- Copyright © 2017, Ferrata Storti Foundation