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Outcome of Cancer-associated Venous Thromboembolism Is More Favourable among Patients with Hematologic Malignancies than with Solid Tumors

1University Clinic of Navarra. IdISNA. CIBERCV, Pamplona, Spain, 2University Clinic of Navarra. CIBERES, Madrid, Spain, 3Rambam – Health Care Campus, Haifa, Israel, 4Hôpital Saint-Louis, AP-HP, Université de Paris, Paris, France, 5Hospital Universitario Virgen de Arrixaca, Murcia, Spain, 6Hospital Universitari de Girona Dr. Josep Trueta, Girona, Spain, 7Hospital General Universitario de Alicante. ISABIAL, Alicante, Spain, 8Hospital General Universitario Santa Lucía. Universidad Católica de Murcia, Murcia, Spain, 9Hospital Germans Trias i Pujol. CIBERES, Badalona, Spain

Abstract Number: LPB0089

Meeting: ISTH 2021 Congress

Theme: Venous Thromboembolism » Cancer Associated Thrombosis

Background: The incidence and prognosis of cancer-associated venous thrombosis (CAT) varies between different types of cancer. Current knowledge of specific outcomes among patients with hematologic malignancies (HM) is scarce, since these patients were poorly represented in pivotal clinical trials.

Aims: To evaluate the rates of recurrent venous thromboembolism (rVTE), major bleeding (MB) and death during anticoagulant therapy in patients with VTE associated to an HM vs solid tumors (ST).

Methods: Consecutive patients with an active cancer registered in the RIETE Registry until December 2020 were included. Baseline characteristics, treatments and outcomes were recorded. Univariate and multivariate competing-risk analysis were performed.

Results: 16,694 patients with CAT were included. 1,062 (6.4%) suffered a HM. Hematologic patients presented less often with pulmonary embolism (48% vs 63%) and more frequently with upper-limb deep vein thrombosis (25 vs 18%). Concomitant chemotherapy at the time of index VTE was more frequent among hematologic patients (67 vs 41%), as were the proportion of patients with anaemia (66% vs 61%) or with thrombocytopenia (<50x10e9/L) (5.6% vs 0.7%). Low-molecular weight heparin was used as initial and long-term therapy in most patients, for a median duration of 150 and 127 days, respectively. Compared to patients with ST, the rate ratios of events per 100 patient-years were: 0.73 (95%CI, 0.56-0.95) for rVTE; 0.72 (95%CI, 0.53-0.98) for MB, and 0.49 (95%CI, 0.41-0.57) for mortality (Table 1). All outcomes were particularly better in patients diagnosed with multiple myeloma. The multivariate analysis confirmed a lower incidence of rVTE or MB (HR 0.78; 95%CI, 0.64-0.96), and a lower mortality (HR 0.53; 95%CI, 0.43-0.66) among patients with HM.

  Hematologic malignancies  Solid tumors  Rate ratio 
(95% CI)		 p value
  N Events per 100
patient-years		 N Events per 100
patient-years
Patients, N 1,062 15,632    
Patient-years of treatment 756.19 9,625.86    
Median days (IQR) 150 (92-292) 127 (70-243)    
PE recurrences 19 2.51 (1.51-3.92) 461 4.79 (4.36-5.25) 0.52 (0.33-0.83) 0.003
DVT recurrences 39 5.16 (3.67-7.05) 552 5.74 (5.27-6.23) 0.90 (0.65-1.24) 0.261
VTE recurrences 58 7.67 (5.82-9.92) 1,013 10.52 (9.89-11.19) 0.73 (0.56-0.95) 0.009
Major bleeding 43 5.69 (4.12-7.66) 763 7.93 (7.37-8.51) 0.72 (0.53-0.98) 0.017
   Gastrointestinal 16 2.12 (1.21-3.44) 338 3.51 (3.15-3.91) 0.60 (0.37-0.99) 0.023
   Intracranial  6 0.79 (0.29-1.73) 123 1.28 (1.06-1.53) 0.62 (0.27-1.41) 0.125
Ischemic stroke 7 0.93 (0.37-1.91) 117 1.22 (1.01-1.46) 0.76 (0.36-1.63) 0.241
Myocardial infarction 4 0.53 (0.14-1.35) 43 0.45 (0.32-0.60) 1.18 (0.43-3.30) 0.373
Death 152 20.10 (17.03-23.56) 3,984 41.39 (40.11-42.69) 0.49 (0.41-0.57) <0.001
   Fatal PE 17 2.25 (1.31-3.60) 224 2.33 (2.03-2.65) 0.97 (0.59-1.58) 0.445
   Fatal bleeding 4 0.53 (0.14-1.35) 81 0.84 (0.67-1.05) 0.63 (0.23-1.72) 0.180
   Disseminated cancer 64 8.46 (6.52-10.81) 2,556 26.55 (25.53-27.60) 0.32 (0.25-0.41) <0.001

Outcomes during the course of anticoagulation.

Conclusions: Patients with VTE associated with a HM, particularly multiple myeloma, have lower rates of rVTE, MB and death than patients with ST. This finding can be relevant for the interpretation of previous clinical trials and the design of future studies.

To cite this abstract in AMA style:

Lecumberri R, Ruiz-Artacho P, Tzoran I, Brenner B, Farge-Bancel D, Rosa V, Francisco I, Hernández-Blasco L, Trujillo-Santos J, Monreal M, RIETE Investigators . Outcome of Cancer-associated Venous Thromboembolism Is More Favourable among Patients with Hematologic Malignancies than with Solid Tumors [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/outcome-of-cancer-associated-venous-thromboembolism-is-more-favourable-among-patients-with-hematologic-malignancies-than-with-solid-tumors/. Accessed November 30, 2023.

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