Photo Credit: Dr Microbe
Given the heterogeneity in lymphoma types and presentations, researchers developed a new risk assessment model for predicting venous thromboembolism.
Venous thromboembolism (VTE) is a common occurrence in patients who receive treatment for cancer. Risk assessment models are a vital component of care; however, the nuanced pathways of various cancer types make the generalizability of VTE risk models less than ideal. Lymphoma, for example, has its own set of treatment challenges that could benefit from a more focused risk assessment model for VTE.
To that end, Shengling Ma, MD, PhD, Ang Li, MD, MS, and colleagues conducted a retrospective cohort study to develop a Fine and Gray subdistribution hazard model for VTE and pulmonary embolism/lower extremity deep vein thrombosis. The authors published the study’s results in the American Journal of Hematology.
Dr. Ma and Dr. Li spoke with Physician’s Weekly (PW) about the findings and their potential applicability in practice.
PW: Why did you feel this topic needed exploration?
Dr. Ma and Dr. Li: Thrombosis, as defined by a sudden blood clot in the lungs or legs, is a common complication of cancer treatment and can cause delayed treatment, prolonged hospital stay, increased anxiety and pain, and, in serious cases, death. While the risk of thrombosis is well explored in patients with solid tumors, its overall impact on patients with lymphoma is less clear.
A commonly used risk score, the Khorana Score, classifies all lymphomas as “intermediate risk.” Based on our clinical experience, lymphoma is a highly diverse group of blood cancers that likely has different risks of thrombosis related to the underlying tumor and treatment.
Therefore, we wanted to explore how we can predict this outcome in patients with lymphoma, as we can potentially offer preventive medications to reduce thrombotic risk.
What are the most important findings from your study?
The most important take-home message for physicians to understand is that lymphoma is not a singular cancer type but rather a heterogeneous cancer group with many histologic distinctions and managements. Not all patients with lymphoma receiving chemotherapy are at intermediate risk for thrombosis because certain aggressive lymphomas (eg, central nervous system lymphomas) have high risk for VTE, while other indolent lymphomas (eg, small lymphocytic lymphoma) have low risk. It is important to incorporate cancer histology distinction into thrombosis risk assessment.
How can physicians incorporate these findings into practice?
It is important to remember that we performed a retrospective cohort study using multiple large electronic healthcare databases. Our findings should be prospectively validated first before incorporation into practice.
To encourage others to test out this risk model in their own patient population, we have developed an online web application to calculate the variables associated with the risk model (ie, lymphoma histology, therapy type, body mass index, history of VTE, recent hospitalization, history of paralysis, and time to treatment initiation). This application can be found at https://dynamicapp.shinyapps.io/Lymph-CAT/.
What still needs to be explored?
Much work is needed for future research. We need:
- better risk models to predict bleeding as we do for thrombosis;
- multi-center, prospective validation studies, as mentioned previously; and
- implementation studies to help clinicians and hospital systems integrate these advanced models into their workflow.
With the rapid advances of electronic data warehouses and AI, these are now more doable and necessary than ever.
