Abstract Number: PB2138
Meeting: ISTH 2020 Congress
Theme: Venous Thromboembolism and Cardioembolism » Cancer Associated Thrombosis
Background: Mechanisms underlying venous thromboembolism (VTE) vary among cancer types. Pathogenesis of VTE in non-Hodgkin lymphoma (NHL) remains undefined.
Aims: To investigate the hypercoagulability and its clinical impact on NHL patients.
Methods: During 2017-2019, platelet-poor plasma from NHL patients was collected at the diagnosis (T0), after 1-2 courses of chemotherapy (T1), and 4-8 weeks following the last treatment (Te). Normal controls were matched healthy volunteers (N=34). Global hemostasis was evaluated by thrombin generation assays (TGA) using 1.25-pM tissue factor (TF) and 1-µM phospholipids with/without 1-nM thrombomodulin (TM). D-dimer, fibrinogen, factor VIII coagulant activity (FVIII:C), von Willebrand factor antigen (VWF:Ag), C-reactive protein (CRP) and TF antigen were measured as the secondary outcomes.
Results: Of 49 NHL patients, diffuse large B-cell lymphoma was the most common diagnosis (51%). The median age was 59.2 yr (range 19.3-80.3) and 53.1% were male. TGA of NHL group at T0-T1 revealed significantly elevated peak thrombin, velocity index (VI, Figure 1, A-D) and endogenous thrombin potential (ETP) with TM. While ETP without TM, lag time and time to peak were not different between groups. Unlike peak thrombin, VI at disease remission (Te) remained high. D-dimer, fibrinogen, FVIII:C, VWF:Ag, CRP, but not TF antigen, levels (Figure 1, F), were elevated in NHL group (P< 0.001). However, only fibrinogen (Spearman r=0.274, P=0.001) and FVIII:C (r=0.302, P< 0.001) exhibited significant correlations with peak thrombin. Bulky disease (odds ratio [OR] 57.3, P=0.03) and poor performance status (OR 20.8, P=0.037), but not Khorana and ThroLy scores or hemostatic parameters, were associated with symptomatic VTE occurring in 14.3%. Notably, NHL patients with symptomatic VTE or FVIII:C ≥293 IU/dL had significantly diminished overall survival (Figure 2).
Conclusions: Without increase in circulating TF, NHL patients showed hypercoagulability by enhanced thrombin generation which was correlated with elevated fibrinogen and FVIII:C levels. High FVIII:C and VTE were associated with poor survival outcomes.
[Figure 1. Peak thrombin (A-B), velocity index (C-D), FVIII:C (E) and TF antigen (F) of NHL patients compared with controls.]
[Figure 2. Kaplan-Meier estimations of overall survival considering VTE (A) and elevated FVIII:C (B).]
To cite this abstract in AMA style:
Moonla C, Akkawat B, Sukperm A, Meesanun M, Jantasing R, Chiasakul T, Uaprasert N, Rojnuckarin P. Elevated Plasma Factor VIII Levels Are Associated with Hypercoagulability and Shorter Survival in Patients with Non-Hodgkin Lymphoma [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/elevated-plasma-factor-viii-levels-are-associated-with-hypercoagulability-and-shorter-survival-in-patients-with-non-hodgkin-lymphoma/. Accessed March 21, 2024.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/elevated-plasma-factor-viii-levels-are-associated-with-hypercoagulability-and-shorter-survival-in-patients-with-non-hodgkin-lymphoma/