Venous Thromboembolism in the Hematologic Malignancies

Patients with hematologic malignancies are at high risk of thrombotic or hemorrhagic complications. The incidence of these events is greatly variable and is influenced by many factors, including the type of disease, the type of chemotherapy, and the use of a central venous device. As in solid tumors, a number of clinical risk factors have been identified and contribute to the increasing thrombotic rate in hematologic malignancies. Biologic properties of the tumor cells can influence the hypercoagulable state of patients with these malignancies by several mechanisms. Of interest, oncogenes responsible for neoplastic transformation in leukemia also may be involved in clotting activation. Epidemiologic data allow an estimate of the incidence of venous thromboembolism (VTE) in acute leukemia, lymphomas, and multiple myeloma (MM). In this review, we focus on the epidemiology, pathogenesis, and VTE management in these three hematologic malignancies. No recommendation for routine thromboprophylaxis in these conditions, with the exception of MM, is available. Large, prospective, randomized clinical trials are needed to establish the best practice for thromboprophylaxis and treatment of VTE in these types of cancers.