Full Length ArticleRecurrence of venous thromboembolism among adults acute leukemia patients treated at the University of Texas MD Anderson Cancer Center: Incidence and risk factors

- After the first episode, leukemia patients have a high incidence of VTE recurrence
- Recurrence occurs anytime, mostly during the 1st two years of leukemia diagnosis
- VTE recurrence is higher in leukemia patients compared to patients with solid tumor
- Catheter thrombosis, hematological malignancy, co-morbid lung, liver, and psychiatric illnesses are important risk factors

The purpose was to determine the incidence and risk factors for venous thromboembolism (VTE) recurrence among adult acute leukemia patients. We performed a retrospective study of adult acute leukemia patients who were treated at our institution between November 1999 and May 2005. Medical records of 139 patients with an initial VTE were reviewed and followed up to May 2010 for VTE recurrence. Of these 139 patients [86 with acute myelogenous leukemia (AML), 53 with acute lymphocytic leukemia (ALL)], 27 (19.4%, 16 AML and 11 ALL) had VTE recurrence. The overall incidence rate of VTE was 8.6 per 100 person-years (median follow-up time: 0.9 years). It was 5.9 and 12.4 per 100 person-years among ALL and AML patients, respectively. The cumulative proportion of recurrent VTE was 2.16%, 10.9%, 16.6%, 25.9%, 30.6%, and 34.2% at 1 month, 6 months, 1 year, 3 years, 5 years, and 7 years, respectively. In a multivariate Cox hazards model, significant predictors for VTE recurrence included catheter thrombosis [adjusted hazard ratio (aHR)]:6.3, 95%CI:1.17-34.0), prior history of hematologic cancer (aHR:4.2, 95%CI:1.5-11.2), chronic lung disease (aHR: 3.4, 95%CI:0.92-12.5), psychological disorder (aHR: 4.3, 95%CI:1.5-12.2), and liver disease (aHR: 3.8, 95%CI: 1.04-14.3). VTE recurrence is common among adult acute leukemia patients and it continues up to 7 years after the initial episode. Catheter thrombosis, a history of hematologic malignancy antecedent to acute leukemia, and lung, liver and psychiatric co-morbidities increase the patient risk for VTE recurrence. Further studies should be conducted to improve the prevention of VTE recurrence in leukemia patients.