Incidence of Venous Thromboembolism in Acute Leukemia: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
Abstract Background: Venous thromboembolism (VTE) incidence in hematological cancer patients greatly influences their morbidity and mortality. However, VTE complications in acute leukemia (AL) received little attention in comparison to other more frequently occurring complications, such as thrombocytopenia-associated bleeding and granulocytopenia related severe infection. Methods: We conducted a systematic review to systematically assess the incidence rate of VTE in the setting of AL, including acute myeloid leukemia (AML), acute promyelocytic leukemia (APL), and acute lymphoid leukemia (ALL), using the information from available observational studies and randomized trials. A meta-analysis of proportions using fixed and random effects models was performed. Herein, we report all the outcomes in random model estimates. Results: Thirty studies were included (29 observational and 1 case control) with a total of 15,491 AL participants in (age range: 15-91). Of the total participants, the number of evaluable patients was 10,788 in AML, 3,242 in ALL, and 1,031 in APL. The VTE rate was found to be 8.8% (95%CI: 8.78-8.81) in all AL patients, 8.2% (95%CI: 8.21-8.23) in AML, 9.7% (95%CI: 9.68-9.75) in ALL, and 10.8% (95%CI: 10.79-10.85) in APL. The recurrence rate was 12% (95%CI: 9.03-15.08) in AL patients (n=435); 17% (95%CI: 11.02-24.26) with AML (n=135); 12% (95%CI: 7.61-18.33) with ALL (n=142) (AML vs. ALL: p=0.233). A subgroup analysis of catheter related thrombosis (CRT) demonstrated a rate of 4.95% in all AL participants (95%CI: 4.94-4.96), 4.7% (95%CI: 4.68-4.77) in AML, 4.3% (95%CI: 4.27-4.32) in ALL, and 7% (95%CI: 6.99-7.10) in APL. The rate of cerebral vein thrombosis in ALL patients treated with l-asparaginase was 2.8% (95%CI: 2.78-2.90). Conclusion: Our data demonstrates a significant incidence of venous thrombosis in AL patients, with a high recurrence rate among those patients. L-asparaginase seems to be particularly associated with a considerably high rate of cerebral thrombosis in ALL. However, there was a lack in randomized trials addressing thrombosis incidence in AL as a primary outcome. Given these significant incidence rates of thromboembolism, future studies are warranted to address the efficacy and safety of thromboprophylaxis in AL patients. Download : Download high-res image (187KB) Download : Download full-size image Disclosures Lazo-Langner: Bayer: Honoraria; Daiichi Sankyo: Research Funding; Alexion: Research Funding; Pfizer: Honoraria.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.026 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.015 | 0.028 |
| Bibliometrics | 0.006 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".