Division of Hematology, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Division of Hematology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA.
Blood Rev. 2019 Jan;33:24-32. doi: 10.1016/j.blre.2018.06.002. Epub 2018 Jun 21.
Venous thromboembolism (VTE) remains a major cause of morbidity and mortality in patients with cancer. Although some very well validated scores delineate the risk of VTE by cancer subtype and other risk factors, hematologic malignancies are underrepresented in these models. This subgroup represents a unique entity that undergoes therapy that can be thrombogenic. The overall risk of VTE in patients with leukemia depends on the use of L-asparaginase treatment, older age, comorbidities and central venous catheters. Patients with acute promyelocytic leukemia are at particularly high risk of VTE but also have an increased risk of bleeding. Patients with aggressive lymphomas have a high incidence of VTE, roughly 10%. Patients with multiple myeloma at highest risk of VTE are those receiving immunomodulatory agents such as thalidomide or lenalidomide. Allogeneic stem cell transplantation carries a risk of thrombosis, particularly in patients developing graft versus host disease. This review summarizes the incidence of VTE in leukemia, lymphoma, myeloma and stem cell transplantation and provides practical guidance for preventing and managing VTE in patients with hematologic malignancies.
静脉血栓栓塞症（VTE）仍然是癌症患者发病率和死亡率的主要原因。尽管一些经过充分验证的评分系统可以根据癌症亚型和其他风险因素来划分 VTE 的风险，但这些模型中血液恶性肿瘤的代表性不足。这一亚组代表了一种独特的实体，其接受的治疗可能具有血栓形成性。白血病患者发生 VTE 的总体风险取决于 L-门冬酰胺酶治疗的使用、年龄较大、合并症和中心静脉导管。急性早幼粒细胞白血病患者发生 VTE 的风险特别高，但出血风险也增加。侵袭性淋巴瘤患者 VTE 的发病率很高，约为 10%。接受免疫调节药物（如沙利度胺或来那度胺）治疗的多发性骨髓瘤患者发生 VTE 的风险最高。异基因干细胞移植有发生血栓的风险，特别是在发生移植物抗宿主病的患者中。本综述总结了白血病、淋巴瘤、骨髓瘤和干细胞移植中 VTE 的发生率，并为血液恶性肿瘤患者预防和管理 VTE 提供了实用指导。
