Outcomes of Venous Thromboembolism (VTE) Treatment in Thrombocytopenic Leukemic Patients

BACKGROUND

The current standard of care for the treatment of cancer-related VTE is low molecular heparin. Treatment of VTE in leukemia is complicated as patients suffer severe thrombocytopenia during the different phases of their malignant disease. The optimal treatment of cancer-related VTE in this population has still not been widely studied. Therefore, there is a dire need for research to provide evidence-based guidance on the optimal management of cancer related-VTE in leukemia population.

OBJECTIVES

The primary objective of the study was to estimate the recurrence rate of VTE (proximal lower extremity, pulmonary embolism or both) at 6 months from the institution of VTE-related treatment. Secondary objectives included overall survival, recurrent VTE event-free survival, and rate of complications attributed to therapies for VTE.

METHODS

A retrospective chart review of adult patients with thrombocytopenic leukemia patients who suffered VTE and were treated at MD Anderson Cancer Center between January 2002 and March 2016. Demographic, clinical, and VTE treatment-related data were collected. Primary and secondary outcomes were compared among the different VTE treatment-modalities using non-parametric methods. Kaplan-Meier curves were calculated and compared between the groups of VTE-treatment modalities using Log-Rank test. All comparisons were performed with a test significance of 0.05.

RESULTS:

At the time of abstract submission, a total of 101 patient-data have been analyzed. The most common type of leukemia was AML (2/3 of all cases). Study outcomes were compared between three groups: anticoagulation only, inferior vena cava filter only and no VTE-treatment intervention. We found no statistically significant differences in the demographic and clinical characteristics between the three groups, except for a lower median platelet count in the patients in whom no VTE-treatment intervention was performed (p<0.05). The VTE recurrence rate was low (<5%) and not different between the intervention groups. The median overall survival of the general population was poor (< 6 months) and significantly worse in patients who did not receive anticoagulation therapy for the management of VTE (p<0.01).

CONCLUSION:

Our study is the largest cohort reported to date on management of VTE in thrombocytopenic leukemia patients. Our preliminary data indicated that anticoagulation therapy and non-pharmacologic interventions for the management of VTE seemed to be safe and equivalent for the secondary prevention of recurrent VTE in that population. Future prospective cohort studies will likely confirm these findings.