VTE: Venous Thromboembolic events DLBCL: Diffuse large B-cell lymphoma
DLBCL patients present a high risk of VTE, with approximately half of all VTE events occurring early in the course of the disease. We were able to identify the presence of bulky disease at diagnosis and the absence of response to first line therapy as risk factors for developing VTE. Te use of anthracycline-containing regimens was protective against VTE, likely because of the increased rates of disease response. Patients with VTE had worsened outcomes, likely a result of the presence of persistent disease, although a direct effect of VTE on long-term outcomes cannot be ruled out. Our results highlight the need for a heightened awareness of the increased risk of VTE in DLBCL patients and the need for prevention strategies.
Low‐molecular‐weight heparin (LMWH), when compared with warfarin, has been shown to reduce the risk of recurrent VTE in patients with cancer‐associated thrombosis (CAT),4 and is therefore the standard treatment for acute CAT for the past 15 years. However, the high cost and significant lifestyle burden associated with LMWH have led many clinicians and investigators to wonder whether the direct oral anticoagulants (DOACs) might be a better choice for primary and/or secondary VTE prevention in patients with cancer.
Based on the aggregate of available evidence, warfarin and other VKA should be a “third choice” for cancer patients, used only in situations where neither a DOAC nor LMWH is feasible.
direct oral anticoagulants :
Direct oral anticoagulants (DOAC)
Four DOACs have been approved for the treatment of DVT and/or PE, including dabigatran, rivaroxaban, apixaban, and edoxaban. All have demonstrated a comparable efficacy and safety to VKA in the cancer subpopulation.37 However, the cancer subpopulation enrolled in these large studies was small and generally had lower risks of both recurrent VTE and hemorrhage when compared with patients enrolled in earlier studies specific to cancer patients (such as CLOT study).38Meta‐analyses have suggested that DOACs and LMWH may have similar efficacy and safety in cancer patients, but these were based on indirect comparisons.38, 39 A few single‐center cohort studies of rivaroxaban for CAT have yielded encouraging results, but all had significant methodologic limitations.40, 41, 42, 43 A recent study explored the use of rivaroxaban in cancer patients with catheter‐related thrombosis also had promising results.44 Overall, these preliminary results are encouraging, but not definitive.
Low molecular weight heparin (wikipedia) Patients with cancer are at higher risk of venous thromboembolism and LMWHs are used to reduce this risk. The CLOT study, published in 2003, showed that, in patients with malignancy and acute venous thromboembolism, dalteparin was more effective than warfarin in reducing the risk of recurrent embolic events. Use of LMWH in cancer patients for at least the first 3 to 6 months of long-term treatment is recommended in numerous guidelines and is now regarded as a standard of care.
Note (JJJ): Delteparin (Tinzaparin) and Nadroparin are better than Warfarin.
reference:  Nishioka J, Goodin S (2007). “Low-molecular-weight heparin in cancer-associated thrombosis: treatment, secondary prevention, and survival”. Journal of Oncology Pharmacy Practice. 13 (2): 85–97.doi:10.1177/1078155207079169. PMID17873108.
LMWH is also the favored treatment for cancer-related blood clots, since it has been shown to be more effective than warfarin (tablet).
LMWH is often used temporarily to help patients transition – or bridge – to long-term oral anticoagulant therapy, most commonly warfarin or Coumadin®. Your doctor will usually add warfarin to your medication schedule, so you take both warfarin and LMWH for several days under careful monitoring. Once your body achieves therapeutic blood levels of warfarin, your doctor will discontinue LMWH injections.
As with UFH, let your doctor know if you are taking aspirin, other non-steroidal anti-inflammatory drugs (NSAIDs) – such as ibuprofen or naproxen – or clopidogrel before starting LMWH treatment, because these drugs increase the risk of bleeding.
Ibrutinib plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) improves event-free survival, progression-free survival, and overall survival compared with R-CHOP alone in patients younger than 60 years with untreated non-germinal centre B-cell (non-GCB) diffuse large B-cell lymphoma (DLBCL), according to a recentstudy.
Infection with certain viruses and bacteria. Certain viral and bacterial infections appear to increase the risk of non-Hodgkin’s lymphoma. Viruses linked to increased non-Hodgkin’s lymphoma risk include HIV and Epstein-Barr infection. Bacteria linked to an increased risk of non-Hodgkin’s lymphoma include the ulcer-causing Helicobacter pylori.
Older age. Non-Hodgkin’s lymphoma can occur at any age, but the risk increases with age. It’s most common in people 60 or over.
Stage IV. This is the most advanced stage of non-Hodgkin’s lymphoma. Cancer cells are in several portions of one or more organs and tissues. Stage IV non-Hodgkin’s lymphoma may also affect other parts of the body, such as the liver, lungs or bones.
A means that you don’t have any significant symptoms as a result of the cancer.
B indicates that you may have significant signs and symptoms, such as a persistent fever, unintended weight loss or severe night sweats.
Bone marrow stem cell
Bone marrow transplant, also known as a stem cell transplant, involves using high doses of chemotherapy and radiation to suppress your bone marrow. Then healthy bone marrow stem cells from your body or from a donor are infused into your blood where they travel to your bones and rebuild your bone marrow. People who undergo bone marrow transplant may be at increased risk of infection.
Biological therapy drugs help your body’s immune system fight cancer. For example, one biological therapy called rituximab (Rituxan) is a type of monoclonal antibody that attaches to B cells and makes them more visible to the immune system, which can then attack. Rituximab lowers the number of B cells, including your healthy B cells, but your body produces new healthy B cells to replace these. The cancerous B cells are less likely to recur.
Also, a drug called ibrutinib (Imbruvica) has been approved by the Food and Drug Administration (FDA) for some people undergoing treatment for non-Hodgkin’s lymphoma.
Radioimmunotherapy drugs are made of monoclonal antibodies that carry radioactive isotopes. This allows the antibody to attach to cancer cells and deliver radiation directly to the cells. An example of a radioimmunotherapy drug used to treat non-Hodgkin’s lymphoma is ibritumomab tiuxetan (Zevalin).