Clinical Characteristics And Prognostic Analysis Of Malignant Lymphoma-related Venous Thromboembolism

Objective:Malignant lymphoma (ML) is a malignant cancer of the lymph nodes or extranodal tissues or organs,its easier to merge venous thromboembolism (VTE). The ML combined VTE incidence of continuous improvement,greater harm.But at home and abroad,about the ML combined VTE is limited in clinical studies.This study aimed to investigate the ML combined VTE,the incidence of VTE by analyzing the clinical data of the initial treatment or retreatment ML at Tianjin Medical University Cancer Hospital of4126cases treated between January2000to December2009a total of10years,the formation of the time,location,clinical manifestations,and associated risk factors,in order to improve the understanding of ML combined VTE, reduce misdiagnosis,raise awareness,reduce morbidity and mortality,improve quality of life,prolong survival time.Methods:Retrospective analysis of ML patients admitted to our hospital from January2000to December2009,confirmed by pathology of4256cases.Pathological diagnosis is based on the Kiel/WHO classification criteria.Of these,130cases were due to inaccurate,incomplete (including the pathological diagnosis is not accurate;did not receive at least one cycle of chemotherapy) to be bound by the study,and ultimately incorporated into the study a total of4126cases.Collection of general characteristics, including:age,gender,body mass index,pathological type,clinical stage, an IPI score or IPS score,ECOG score,B symptoms,thrombosis time,thrombosis parts; baseline laboratory data,including:hemoglobin,white blood cell count,platelet count, blood type, creatinine, lactate dehydrogenase, B-2microglobulin, D-dimer; treatment information:chemotherapy, chemotherapy cycles, central venous catheter (CVC), including the:subclavian vein catheter (SVC), peripherally inserted central venous catheters (PICC), femoral vein cannulation (FVC);complications:recent surgery and history of fracture,renal function insufficiency,diabetes,infections such as pneumonia or post-chemotherapy neutropenia and fever.Follow-up mainly by telephone and correspondence,deadline for December31,2011.using SPSS17.0statistical software, survival analysis using Kaplan-Meier method,Univariate analysis by Log-rank test and multivariate prognostic analyzes using Cox proportional hazards model, the use of Forward the LR method to filter the variable.Results:1)4126cases of ML in patients with293cases of patients with VTE, a total of302VTE events occurred, the ML patients with VTE incidence rate was7.1%. DVT event235(77.8%),PE events57(18.9%), DVT merge PE event, only10(3.3%). NHL patients with VTE incidence rate of5.7%; HL patients with the incidence rate of VTE was1.3%.2) Upper limb and neck vein thromboembolic events of a total of146times, lower limb thromboembolic events of89, significantly lower than the upper limbs and neck vein thrombosis.3)48(16.4%) patients were formed thrombosis before chemotherapy,222(75.8%) patients with thrombosis after chemotherapy, especially,the first three cycles during treatment.4) The clinical manifestations of DVT formation can be expressed as:limb pain, swelling, increased skin temperature, skin and nutritional status change. The clinical manifestations of PE formation:the unexplained difficulty in breathing, chest pain, syncope, and blood oxygen saturation decreased, and then, not all patients with these clinical manifestations.5) DVT formation imaging mainly as follows:vascular wall echogenic endometrial rough cavity filled with substantive weak or strong echo, the diameter widened lumen irregular stenosis. PE formed by imaging studies were as follows:pulmonary artery filling defects; pulmonary expansion; small blood vessel cross-section, lack of support; severe cases may be associated with pulmonary embolism formation.6) The results of univariate analyzes:gender, age, clinical stage, ECOG performance score, chemotherapy, infection, and D-dimer, and ML patients related to VTE formation prognosis. Multivariate analysis showed that:age, clinical stage, ECOG performance score, infection, D-dimer is an independent prognostic factor of ML in patients with VTE formation.7) ML concurrent VTE patients, the median survival time was20months,1year-,2 year-,5-year-survival were88.6%,63.3%,30.4%; without VTE of patients with a median survival time of59months,1year-,2year-,5-year-survival rates were99.6%,98.9%,82.3%.Conclusions:1) ML patients with VTE have a higher prevalence of upper limb and neck vein thrombosis than lower limb venous thrombosis.2) The highest incidence of thrombosis ML patient-related VTE events in the first three cycles of chemotherapy.3) No specific clinical features of ML patient-related VTE formation. DVT formation as follows:limb pain, swelling, skin temperature, changes in the skin of nutritional status. PE formation expressed as:unexplained difficulty in breathing, chest pain, syncope, and oxygen saturation decreased.4) The results of univariate analyzes:gender, age, clinical stage, ECOG performance score, chemotherapy, infection, and D-dimer, and ML patients related to VTE formation prognosis.Multivariate analysis showed that:age, clinical stage, ECOG performance score, infection, D-dimer is an independent prognostic factor of ML in patients with VTE formation.5) The ML in patients with concurrent VTE have a poor prognosis, and short survival time.