Division of Immunohematology and Transfusion Medicine, Ospedali Riuniti di Bergamo, Bergamo, Italy.
Curr Opin Oncol. 2012 Nov;24(6):702-10. doi: 10.1097/CCO.0b013e3283592331.
This review summarizes the current knowledge of the epidemiology, prophylaxis, and treatment of venous thromboembolism (VTE) in patients with lymphoma, multiple myeloma or acute leukemia.
Hematologic malignancies are associated with a high risk of thrombotic complications. The incidence of these events is greatly variable and is influenced by many factors, including the type and the stage of disease, antitumor therapies, and the use of central venous device (CVD). Epidemiological data allow an estimate of the incidence of VTE in acute leukemia, lymphomas, and multiple myeloma. The effect of chemotherapy on the incidence of thrombosis is particularly evident in acute leukemia as it causes the exacerbation of the clotting/bleeding syndrome typical of this disease. The role of chemotherapy is also relevant in lymphoma, and in multiple myeloma, in which the use of immunomodulating agents, in combination with chemotherapy and steroids significantly increases the risk of VTE.
Thrombotic complications have a significant impact on morbidity and mortality of hematological cancer patients, therefore, in this setting, the issue of thromboprophylaxis to prevent VTE is important. However, no clear recommendation in these conditions is available, with the exception of multiple myeloma. Large prospective randomized clinical trials are needed to establish the best practice for prevention and treatment of VTE in these types of malignant diseases.
本文总结了淋巴瘤、多发性骨髓瘤或急性白血病患者静脉血栓栓塞症（VTE）的流行病学、预防和治疗的最新知识。
血液系统恶性肿瘤与血栓并发症的高风险相关。这些事件的发生率差异很大，受多种因素影响，包括疾病类型和分期、抗肿瘤治疗以及中央静脉置管（CVD）的使用。流行病学数据可估算急性白血病、淋巴瘤和多发性骨髓瘤患者 VTE 的发生率。化疗对血栓形成发生率的影响在急性白血病中尤为明显，因为它会加剧这种疾病特有的凝血/出血综合征。化疗在淋巴瘤中的作用也很重要，免疫调节剂与化疗和类固醇联合使用可显著增加多发性骨髓瘤患者 VTE 的风险。
血栓并发症对血液系统恶性肿瘤患者的发病率和死亡率有重大影响，因此在这种情况下，预防 VTE 的血栓预防问题很重要。然而，除了多发性骨髓瘤外，这些情况下没有明确的建议。需要进行大型前瞻性随机临床试验，以确定这些恶性疾病中预防和治疗 VTE 的最佳实践。
