Abstract
Introduction
Venous thromboembolism (VTE) is a known complication of malignancy. While brain tumors in general predispose to VTE, the incidence in primary central nervous system lymphoma (PCNSL) is poorly characterized. We sought to characterize incidence, risk factors, management, and outcome of VTE in PCNSL
Method
Retrospective study of 78 PCNSL patients from 2/1/2002 to 4/1/2020 at the University of Virginia
Results
31% (24/78) of patients developed VTE. 12.8% (10/78) had deep venous thrombosis (DVT) alone, 11.5% (9/78) isolated pulmonary embolism (PE) and 6.4% (5/78) both. The median time from PCNSL diagnosis to VTE was 3 months. In a univariate competing risks analysis, previous VTE (p < 0.001), impaired ambulation (p = 0.035), baseline hemoglobin < 10 g/dL (p = 0.025) and history of diabetes mellitus (type 1 or 2) (p = 0.007) were associated with increased VTE risk. 34.8% were anticoagulated acutely with heparin (8/23) or 65.2% LMWH (15/23), and 25.0% (6/24) received warfarin, 41.7% (10/24) LMWH, and 33.3% (8/24) DOACs long-term. One adverse event was attributable to anticoagulation (arm hematoma with hemoglobin decrease). Five patients received IVC filters with concomitant oral anticoagulation; one experienced IVC thrombosis after anticoagulation discontinuation. Six of the 24 patients experienced recurrent VTE, four while anticoagulated.
Conclusion
Patients with PCNSL are at high risk of VTE, most of which accrues in the first few months. History of VTE, diabetes mellitus (type 1 or 2), impaired ambulatory status, or hemoglobin < 10 g/dL may predispose patients to this complication. While optimal management is uncertain, anticoagulation prevented recurrent VTE in most patients without intracranial bleeding.
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This dataset does not reside in a publicly available repository but is available upon request.
Change history
14 July 2021
A Correction to this paper has been published: https://doi.org/10.1007/s11060-021-03809-4
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MS abstracted the data and co-wrote the manuscript. NAW performed statistical analysis and edited the manuscript. DS conceived of the study, provided the data, and co-wrote the manuscript.
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The original version of this article has been revised: In the Abstract, the median time to VTE diagnosis and the unit of concentration of the hemoglobin level have been corrected; in the Abstract and in the Results, the term ‘diabetes mellitus’ has been corrected to read ‘diabetes mellitus (type 1 or 2)’.
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Saito, M., Wages, N.A. & Schiff, D. Incidence, risk factors and management of venous thromboembolism in patients with primary CNS lymphoma. J Neurooncol 154, 41–47 (2021). https://doi.org/10.1007/s11060-021-03791-x
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DOI: https://doi.org/10.1007/s11060-021-03791-x