Deep venous thrombosis and pulmonary artery embolism in high‐grade non Hodgkin's lymphoma: incidence, causes and prognostic relevance

Abstract

To analyse incidence, risk factors, causes and prognostic significance of venous thromboembolism (VTE) in high‐grade non‐Hodgkin's lymphoma (HG‐NHL) a prospective clinical trial (N = 593), also undertaken to analyse other aspects of HG‐NHL, a study of haemostasis (N = 25) and a post‐mortem analysis (N = 70) were performed. Clinical analysis documented a 6.6% incidence of VTE, and 77% of all cases occurred before or within the first 3 months of chemotherapy. Ann Arbor stage IV and B‐mediastinal clear cell histology were risk factors for VTE, while rapid changes in tumour load or application of consolidation chemotherapy were not. Vessel compression by HG‐NHL was the leading cause of VTE, whereas a significant (paraneoplastic or chemotherapy‐induced) thrombophilic state was not disclosed by haemostatic tests. While VTE‐related fatality was found to be low in the clinical trial (1.7%) and at necropsy (8.5%), the occurrence of VTE was associated with an unsatisfactory response of HG‐NHL to chemotherapy and a high incidence of treatment‐related mortality due to diffuse alveolitis. Thus, fatal VTE in HG‐NHL is rare, but VTE is associated with an unfavourable clinical course of HG‐NHL.