Presentation Details
| Risk Factors Associated with Venous Thromboembolism in Chronic Lymphocytic Leukemia Ambarina Faiz1, Shuang Guo1, Ashwin Sridharan1, Yong Lin2, 3, Claire Philipp1. 1Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.2Rutgers School of Public Health, Piscataway, NJ, USA.3Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA |
Abstract
Background: Venous thromboembolism (VTE) is a major cause of morbidity and mortality in cancer patients both with solid tumors and hematological malignancies. Chronic lymphocytic leukemia (CLL) accounts for 30% of the cases of leukemia annually in the United States and predominantly affects elderly patients. However, risk factors associated with VTE are not known in this population.
Objective: To evaluate the risk factors and mortality associated with VTE among elderly patients diagnosed with CLL.
Methods: The SEER-Medicare merged database, 2000 to 2015, was used to evaluate the risk factors for VTE in Medicare patients 65 years or older diagnosed with CLL. Data were extracted for sociodemographic characteristics, comorbid medical conditions, chemotherapy, survival, and death. Race was defined as White, Black or Asian. Venous thromboembolism was defined as a diagnosis of deep vein thrombosis or pulmonary embolism during the study period. Chi-square (x2) test was used to compare the distribution of categorical variables in CLL patients with and without VTE. Logistic regression was used to examine the odds ratios for the risk factors associated with VTE. Cox proportional hazard model was used to evaluate risk of VTE associated mortality in this population.
Results: Among 34,705 patients with CLL, 11.7% patients had a diagnosis of VTE. VTE was diagnosed in 11.6% White patients, 14.6 Black and 6.3% Asian CLL patients. After adjusting for sociodemographic characteristics and comorbid medical conditions, odds of having VTE was higher for females (OR=1.1, 95% CI, 1.0-1.2) and for Black patients (OR=1.2, 95% CI, 1.0-1.4) and odds of having VTE was lower for Asian patients (OR=0.5, 95% CI, 0.4-0.7) compared to White patients. Risk factors associated with a diagnosis of VTE included anemia (OR= 2.1, 95% CI, 1.9-2.3) and chemotherapy (OR=1.4, 95% CI, 1.2-1.6). Comorbid medical conditions associated with VTE were hypertension (OR=1.8, 95% CI, 1.6-2.0), heart failure (OR=1.6, 95% CI, 1.4-1.7), obesity and chronic lung disease (OR=1.3, 95% CI, 1.2-1.4), kidney disease (OR=1.2, 95% CI, 1.1-1.3), diabetes (OR=1.2, 95% CI, 1.1-1.2), and myocardial infarction and hyperlipidemia (OR=1.1, 95% CI, 1.0-1.2). Adjusted risk of death was higher for CLL patients with a diagnosis of VTE (HR=1.06, 95% CI, 1.02-1.10). Mortality was also higher for CLL patients ≥ 75 years of age (HR=2.39, 95% CI, 2.32-2.46) and for Black patients (HR=1.30, 95% CI, 1.23-1.38).
Conclusion: VTE was diagnosed in 11.7% patients with CLL, and the adjusted risk of VTE was higher for Black patients and VTE risk was lower for Asian patients compared to White patients. Anemia and chemotherapy and several comorbid conditions were associated with the risk for VTE in elderly CLL patients. These findings may help to assess the risk of VTE in elderly patients diagnosed with chronic lymphocytic leukemia.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
Objective: To evaluate the risk factors and mortality associated with VTE among elderly patients diagnosed with CLL.
Methods: The SEER-Medicare merged database, 2000 to 2015, was used to evaluate the risk factors for VTE in Medicare patients 65 years or older diagnosed with CLL. Data were extracted for sociodemographic characteristics, comorbid medical conditions, chemotherapy, survival, and death. Race was defined as White, Black or Asian. Venous thromboembolism was defined as a diagnosis of deep vein thrombosis or pulmonary embolism during the study period. Chi-square (x2) test was used to compare the distribution of categorical variables in CLL patients with and without VTE. Logistic regression was used to examine the odds ratios for the risk factors associated with VTE. Cox proportional hazard model was used to evaluate risk of VTE associated mortality in this population.
Results: Among 34,705 patients with CLL, 11.7% patients had a diagnosis of VTE. VTE was diagnosed in 11.6% White patients, 14.6 Black and 6.3% Asian CLL patients. After adjusting for sociodemographic characteristics and comorbid medical conditions, odds of having VTE was higher for females (OR=1.1, 95% CI, 1.0-1.2) and for Black patients (OR=1.2, 95% CI, 1.0-1.4) and odds of having VTE was lower for Asian patients (OR=0.5, 95% CI, 0.4-0.7) compared to White patients. Risk factors associated with a diagnosis of VTE included anemia (OR= 2.1, 95% CI, 1.9-2.3) and chemotherapy (OR=1.4, 95% CI, 1.2-1.6). Comorbid medical conditions associated with VTE were hypertension (OR=1.8, 95% CI, 1.6-2.0), heart failure (OR=1.6, 95% CI, 1.4-1.7), obesity and chronic lung disease (OR=1.3, 95% CI, 1.2-1.4), kidney disease (OR=1.2, 95% CI, 1.1-1.3), diabetes (OR=1.2, 95% CI, 1.1-1.2), and myocardial infarction and hyperlipidemia (OR=1.1, 95% CI, 1.0-1.2). Adjusted risk of death was higher for CLL patients with a diagnosis of VTE (HR=1.06, 95% CI, 1.02-1.10). Mortality was also higher for CLL patients ≥ 75 years of age (HR=2.39, 95% CI, 2.32-2.46) and for Black patients (HR=1.30, 95% CI, 1.23-1.38).
Conclusion: VTE was diagnosed in 11.7% patients with CLL, and the adjusted risk of VTE was higher for Black patients and VTE risk was lower for Asian patients compared to White patients. Anemia and chemotherapy and several comorbid conditions were associated with the risk for VTE in elderly CLL patients. These findings may help to assess the risk of VTE in elderly patients diagnosed with chronic lymphocytic leukemia.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.