OC 03.5 - Risk of early venous thromboembolism in patients with acute leukemia

Saturday, June 22, 2024

14:00 – 14:15 ICT

Room: Ballroom B3

Co-Author(s)

KB

Karan Bansal

Clinical Research Coordinator
Institute of Cancer Outcomes and Survivorship- UAB Medicine
Birmingham, Alabama, United States
CD

Chen Dai

Statistician Lead
Institute for Cancer Outcomes and Survivorship
Birmingham, Alabama, United States
SD

Sindhu Dwarampudi

Student Research Assistant
Institute of Cancer Outcomes and Survivorship- UAB Medicine
Birmingham, Alabama, United States
EJ

Ella Johnson

Clinical Research Coordinator
Institute for Cancer Outcomes and Survivorship
Birmingham, Alabama, United States
WM

Wajiha Mekki

Student Researcher
Institute for Cancer Outcomes and Survivorship
Birmingham, Alabama, United States
LH

Lindsey Hageman

Research Operations Administrator
Institute for Cancer Outcomes and Survivorship
Birmingham, Alabama, United States
NB

Nora Balas

Clinical Data Analyst
Institute of Cancer Outcomes and Survivorship- UAB Medicine
Birmingham, Alabama, United States
JK

Joshua Knapp

Clinical Research Coordinator
Division of Hematology Oncology, University of Alabama at Birmingham
Birmingham, Alabama, United States
SR

Sravanti Rangaraju

Assistant Professor
Division of Hematology Oncology, University of Alabama at Birmingham
Birmingham, Alabama, United States
RB

Ravi Bhatia

Professor
Division of Hematology Oncology, University of Alabama at Birmingham
Birmingham, Alabama, United States
SB

Smita Bhatia

Director, Professor
Institute for Cancer Outcomes and Survivorship
Birmingham, Alabama, United States

Presenting Author(s)

Radhika Gangaraju, MD, MSPH

Assistant Professor
Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
Birmingham, Alabama, United States

Background: Venous thromboembolism (VTE) is one of the major causes of early morbidity in patients with acute leukemia. Cancer-associated VTE risk models have generally excluded patients with acute leukemia, thus limiting our understanding of factors associated with VTE risk in these patients.

Aims: To examine the incidence and risk factors (including neighborhood disadvantage) for early VTE in acute leukemia patients.

Methods: We conducted a retrospective study of 838 consecutive adult (≥18y) patients diagnosed with acute leukemia at the University of Alabama at Birmingham, US between January 2008 and December 2021. We collected clinical data from medical records. Distance to hospital and county level income was obtained by linkage to US Department of Agriculture public datasets, based on zip code of residence. Primary outcome was VTE (any site, including superficial thrombosis) occurring Day -14 to 30 days after leukemia diagnosis. We examined the cumulative incidence of VTE. Fine-Gray subdistribution hazard model was used to identify VTE risk factors, using death as a competing risk.

Results: The cohort of 838 patients with acute leukemia included acute promyelocytic leukemia (APL: n=82), non-APL acute myeloid leukemia (AML: n=568) and acute lymphoblastic leukemia (ALL: n=188). Median age at diagnosis was 58y; 56.4% were males and 74.3% non-Hispanic Whites. The 30-day cumulative incidence of VTE was 6.6% (95% confidence interval [CI]: 5.1%-8.5%). Cumulative incidence by leukemia type is shown in Fig 1. Risk factors for VTE included high white count (>100,000 cells/µL: HR=2.21, 95%CI=1.01-4.87; ref: normal), platelets >20,000 cells/µL (HR=2.56, 95%CI=1.12-5.87; ref: < 20,000), D-dimer >1200 ng/ml DDU (HR=2.22, 95%CI=1.19-4.14; ref: ≤1200), low/normal creatinine (HR=2.18, 95%CI=1.02-4.66; ref: elevated level ≥1.2), residence in a county with >17.4% poverty rate (HR=1.79, 95%CI=1.01-3.17) (Table 1).

Conclusion(s): Risk of early VTE is high in all types of acute leukemia. This study identifies factors that increase the risk of early VTE.