Thrombosis and hemostatic abnormalities in non-Hodgkin lymphoma

Abstract

Introduction. Non-Hodgkin lymphoma is a heterogeneous group of malignant lymphoid tumors. Hemostasis disorders in non-Hodgkin lymphoma are often asymptomatic but can develop into severe complications. The risk of venous thromboembolism increases according to the totality of risk factors assessed directly in each individual patient, based on age, gender, comorbidities, performance status, and both congenital and acquired thrombophilia.

Objective. This study aims to evaluate the incidence of hemostasis disorders based on age, gender, NHL type, degree of dissemination, B symptoms, disease onset, tumor size, positivity of anticardiolipin, anti-β2-glycoprotein I, and lupus anticoagulant antibodies, fibrinogen level, lactate dehydrogenase, D-dimers, and Eastern Cooperative Oncology Group performance status.

Material and methods. A total of 161 patients diagnosed with NHL at the Oncology Institute of the Republic of Moldova were evaluated in a prospective cross-sectional descriptive study. Anticardiolipin and anti-β2-glycoprotein I antibodies were measured by enzyme-linked immunosorbent assay, and lupus anticoagulant was assessed by the turbidimetry method. Quantitative testing of D-dimers was performed using automatic latex-agglutination with photometric detection. Plasma fibrinogen levels were assessed by coagulometry. The data were statistically analyzed using Microsoft Excel, GraphPad Prism ver. 9.3.0, Epi Info 7.2, EpiMax Table, and IBM SPSS Statistics version 26.0.

Results. The study included 161 de novo patients, with 48% women and 52% men, and a median age of 59 years. Among them, 56.5% had aggressive non-Hodgkin lymphoma (NHL), and 43.5% had indolent NHL, with a higher prevalence of advanced stages (65.8%). Hemostatic disorders were observed in 10.6% of cases, with venous thromboembolism occurring in 6.7%, more frequently in patients with aggressive non-Hodgkin lymphoma, tumor sizes ≥ 7 cm, a mean age of 50 years, in men (82%), mainly in the first 3-4 weeks, with higher levels of fibrinogen and D-dimer at diagnosis. Anticardiolipin, anti-β2-glycoprotein I, and lupus anticoagulant antibodies were recorded in 3.7% cases of venous thromboembolism cases. Statistical significance was not reached when analyzing thrombosis according to performance status.

Conclusions. The risk of venous thromboembolism in non-Hodgkin lymphoma is dependent on gender, type, tumor size, mediastinal onset, hyperfibrinogenemia, antibody synthesis, and high LDH level. The distribution of patients with non-Hodgkin lymphoma and venous thromboembolism according to disease stage, B symptoms, and performance status was statistically insignificant.