Background: Thrombotic complications frequently develop during the evolution of hematological malignancies, significantly influencing the rates of morbidity and mortality.

Aims: The study objectives were to identify the features and evaluate the results of treatment of venous thrombosis in non-Hodgkin lymphoma (NHL).

Methods: We performed a clinical-analytical, descriptive study of one case with stage IIA diffuse large B-cell NHL, which was treated and followed up at the Institute of Oncology between 2018–2020. The patient was a female of 46 years old, with concomitant pathology: Essential hypertension, gr. II, moderate additional risk. Hypertensive heart disease. Grade I obesity. The diagnosis was proved according to the Revised 2017 WHO Classification of Tumors of Hematopoietic and Lymphoid Tissues by the histopathological and immunohistochemical examinations of the biopsied lymph node and standard staging procedures, including CT scan.

Results: Three adjusted cycles of R-CHOP chemotherapy were performed for the remission induction on the background of cardiotropic and antiplatelet medication, with positive clinical-imaging dynamics and without side effects. Taking into account the persistence of residual tumor lymphadenopathy, the locoregional radiotherapy (LRT) was initiated at the ilioinguinal lymph nodes. The LRT was temporarily stopped at a dosage of 14 Gy due to the appearance of the clinical signs of venous thrombosis of the right femur and calf. Duplex sonography of the legs veins proved the diagnosis of the acute bilateral grade II phlebothrombosis. The patient responded with the tendency of venous recanalization to the daily oral antiplatelet and anticoagulant therapy under the control of INR, prothrombin index and the angiosurgeon follow-up (Figure 2). The patient accomplished the LRT, achieved the complete remission and underwent the maintenance Bleo-COP cycles.

Duplex sonography of the inferior limbs veins: phlebothrombosis before the treatment.Duplex sonography of the inferior limbs veins under the treatment: tendency to recanalization.

Conclusions: NHL in association with obesity may be complicated with phlebothrombosis during the LRT. The phlebothrombosis regression occurred after the complete remission and under the oral antiplatelet and anticoagulant therapy.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/management-of-venous-thrombosis-in-non-hodgkin-lymphoma/