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The newly developed risk assessment tool HIGH-2-LOW successfully stratified patients with solid tumors and hematologic malignancies for risk for venous thromboembolism (VTE). These findings were presented during the American Society of Hematology (ASH) 62nd Annual Meeting and Exposition.

Patients (N=1703) who underwent a first allogeneic hematopoietic cell transplant at the Fred Hutchinson Cancer Research Center in Washington between 2006 and 2015 were included in this study. Patients were assessed for radiologic-confirmed catheter-related deep venous thrombosis (CR-DVT), lower extremity DVT (LE-DVT), or pulmonary embolism (PE) through 1 year.


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VTE occurred in 4.9% of patients at 100 days (18.60 per 100 patient-years) and 8.0% at 360 days (10.26 per 100 patient years). The rate of PE was 2.0% (7.72 per 100 patient years) and LE-DVT was 3.9% (4.94 per 100 patient years).

The HIGH-2-LOW risk assessment model included history of CR-DVT, PE, or LE-DVT; 30-day inpatient status; presence of grade 3/4 graft-versus-host disease; diagnosis of lymphoma; obesity status (>40 kg/m2); and high white blood cell count (>11×109/L).

“Most of the variables included are well known risk factors for VTE among allogeneic transplant patients. Our primary goal was to create a user friendly and clinically meaningful tool for practitioners who are faced with this common clinical scenario,” stated Kylee L. Martens, MD, coauthor of this study.

The features that contributed the most to this model were history of PE or LE-DVT (hazard ratio [HR], 3.05; 95% CI, 1.52-6.11), obesity (HR, 2.36; 95% CI, 1.49-3.75), and white blood cell count (HR, 2.21; 95% CI, 1.38-3.53).

With the HIGH-2-LOW tool, 15% of patients were identified as high-risk for VTE. Among high-risk patients, the incidence of VTE at 100 days was 9.6% (52.44 per 100 patient years). The incidence among intermediate-risk (4.4%; 23.50 per 100 patient years) and low-risk (1.6%; 8.24 per 100 patient years) patients was lower.

Compared with the low-risk group, the intermediate-risk (HR, 2.16; 95% CI, 1.36-3.44) and high-risk (HR, 4.72; 95% CI, 2.94-7.58) patients had an increased risk of VTE.

Excluding patients who did not achieve adequate platelet engraftment by day 30, the HIGH-2-LOW model had a good fit for assessing VTE risk among patients (c-index, 0.71; 95% CI, 0.62-0.79).

This study was limited by not confirming the utility of their risk assessment model among an independent cohort.

The study authors concluded their HIGH-2-LOW tool effectively stratified patients after allogeneic hematopoietic stem cell transplantation for VTE risk.

Disclosure: An author declared affiliations with industry. Please refer to the original abstract for a full list of disclosures.

Reference

Martens KL, da Costa Jr WL, Davis C, et al. High-2-Low risk assessment model to predict venous thromboembolism in allogeneic transplant patients after platelet engraftment. Presented at: American Society of Hematology (ASH) 62nd Annual Meeting and Exposition; December 5-8, 2020. Abstr 137.