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. 2013 Mar;98(3):437-43.
doi: 10.3324/haematol.2012.069559. Epub 2012 Aug 16.

Analysis of incidence, risk factors and clinical outcome of thromboembolic and bleeding events in 431 allogeneic hematopoietic stem cell transplantation recipients

Jorge Labrador  1 , Lucia Lopez-Anglada, Estefania Perez-Lopez, Francisco S Lozano, Lucia Lopez-Corral, Fermin M Sanchez-Guijo, Lourdes Vazquez, Jose Angel Perez Rivera, Francisco Martin-Herrero, Mercedes Sanchez-Barba, Carmen Guerrero, Maria Consuelo del Cañizo, Maria Dolores Caballero, Jesus Fernando San Miguel, Ignacio Alberca, Jose Ramon Gonzalez-Porras
Affiliations

Analysis of incidence, risk factors and clinical outcome of thromboembolic and bleeding events in 431 allogeneic hematopoietic stem cell transplantation recipients

Jorge Labrador et al. Haematologica. 2013 Mar.

Abstract

Allogeneic hematopoietic stem cell transplantation recipients have an increasing risk of both hemorrhagic and thrombotic complications. However, the competing risks of two of these life-threatening complications in these complex patients have still not been well defined. We retrospectively analyzed data from 431 allogeneic transplantation recipients to identify the incidence, risk factors and mortality due to thrombosis and bleeding. Significant clinical bleeding was more frequent than symptomatic thrombosis. The cumulative incidence of a bleeding episode was 30.2% at 14 years. The cumulative incidence of a venous or arterial thrombosis at 14 years was 11.8% and 4.1%, respectively. The analysis of competing factors for venous thrombosis revealed extensive chronic graft-versus-host disease to be the only independent prognostic risk factor. By contrast, six factors were associated with an increased risk of bleeding; advanced disease, ablative conditioning regimen, umbilical cord blood transplantation, anticoagulation, acute III-IV graft-versus-host disease, and transplant-associated microangiopathy. The development of thrombosis did not significantly affect overall survival (P=0.856). However, significant clinical bleeding was associated with inferior survival (P<0.001). In allogeneic hematopoietic stem cell transplantation, significant clinical bleeding is more common than thrombotic complications and affects survival.

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Figures

Figure 1.
Figure 1.
Cumulative incidence of a venous TEE was 3.6% (95% CI: 2.2–5.9%; 256 patients at risk) at 1 year, 4.8% (95% CI: 3.1–7.5%; 104 patients) at 5 years, 8.1% (95% CI: 5.2–12.6%; 37 patients) at 10 years, and 11.8% (95% CI: 7.1–19.6%; 3 patients) at 14 years.
Figure 2.
Figure 2.
The cumulative incidence of an arterial TEEs was 2.2% (95% CI: 1.1–4.2%; 256 patients at risk) at 1 year, 2.5% (95% CI: 1.4–4.7%; 104 patients) at 5 years, and 4.1% (95% CI: 1.8–9.3%; 3 patients) at 14 years.
Figure 3.
Figure 3.
The cumulative incidence of a bleeding episode was 21.3% (95% CI: 17.7–25.5%; 237 patients at risk) at 1 year, 26.1% (95% CI: 22.1–30.8%; 100 patients) at 5 years, 28.9% (95% CI: 24.3–34.4%; 34 patients) at 10 years, and 30.2% (95% CI: 25.2–36.2%; 3 patients) at 14 years.
Figure 4.
Figure 4.
Overall survival of patients with and without bleeding after allogeneic HSCT.
Figure 5.
Figure 5.
Overall survival of patients with and without thrombosis after allogeneic HSCT.
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