VENOUS THROMBOSIS IN CHILDREN, ADOLESCENTS AND YOUNG ADULTS WITH LYMPHOMAS: INCIDENCE, CHARACTERISTICS, RISK FACTORS AND PROGNOSTIC VALUE

Objective. To define the epidemiology of venous thrombosis (VT) in children, adolescents and young adults with lymphomas, to identify the thrombotic risk factors and VT’s prognostic value.

Materials and methods. We reviewed the medical records of 513 lymphoma patients (284 with Hodgkin's lymphoma (HL) and 229 with non-Hodgkin lymphoma (NHL)) aged from 0,6 to 26 years (median – 14 years), diagnosed with lymphomas in 2005–2017. Risk thrombotic factors were assessed using binary Cox regression in univariate and multivariate models with calculation of the odds ratio (OR) with 95 % CIs.

 Results. Twenty-eight of 513 patients (5.5 %, 95 % CI, 4.5–6.5 %) were diagnosed as having VT with a total of 32 thrombotic events. The incidence of VT in NHL patients (23/229, 10.5 %, 95 % CI, 8.5–12.5 %) was higher than in HL patients (5/284, 1.8 %, 95 % CI, 1.0–2.6 %, p <0.0001). VT was associated with venous catheterization (VC) in 53.6 % and with local compressive effect in 32.1 % cases. VT occurred during the first 6 weeks after lymphoma diagnosis in 57.1 % patients. Genetic predisposition to thrombosis (FV Leiden и FII G20210A mutations) was revealed in 3 (10.7 %) patients. The recurrence rate of VT was 14.3 %. Age older than 13 years (ОR 2.5, 95 % CI, 1.1–6.0, p <0.05) and lymphoblastic lymphoma (LL) subtype (ОR 5.5, 95 % CI; 2.3–13.6, p <0.01) independently associated with the occurrence of VT in NHL patients. In HL group all cases of VT were detected in patients older than 15 years. The only risk factor predisposing patients with HL to VT was significant mediastinal lymphadenopathy (bulky disease) (ОR 7.0, 95 %; 1.2–42.3, p<0.05). The presence of VT did not influence OS of NHL patients (73.7 %, SE 9.2 % (n = 23) versus 83.4 %, SE 9.2 % (n = 206), p >0.05), but had a negative impact on the OS of HL patients (60.0 %, SE 21.9 % (n = 5) versus 94.8 %, SE 1.5 % (n = 279), p <0.001). HL patients older than 15 years with bulky disease (38/284, 13.4 %), had a high thrombotic risk with lower OS of 78.8 ± 8.3 %, p <0.001.

Conclusion. Cumulative incidence of VT in NHL patients was higher than in HL patients. Age older than 13 years and LL were independent thrombotic risk factors for NHL patients. Age older than 15 years and bulky disease increased risk of VT in HL patients. VT occurrence decreased OS of young HL patients. It may be necessary to delay the central VC of vena cava superior in children with massive mediastinal tumor. Prophylactic anticoagulation for high thrombotic risk patients might be warranted.

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