Incidence of venous thromboembolism in patients with non-Hodgkin lymphoma.

INTRODUCTION: Patients with non-Hodgkin lymphoma (NHL) have an increased risk of venous thromboembolism (VTE). Current risk-prediction models classify NHL as a single entity. We aimed to quantify the difference in VTE risk in follicular lymphoma (FL) versus diffuse large B cell lymphoma (DLBCL). METHODS: Using a prospective cohort study, we identified 2730 patients (2037 DLBCL; 693 FL) within the Veteran's Administration Central Cancer Registry. A competing risk model assessed the association between VTE risk and histology in the first year after NHL diagnosis. We assessed the effect of additional risk factors for VTE in NHL. RESULTS: In univariate analysis, DLBCL was associated with increased risk of VTE compared to FL in the first year after diagnosis; this association was no longer significant in adjusted analysis (adjusted hazard ratio (aHR) 1.52; 95% CI 0.97-2.40). Major risk factors for VTE included history of VTE before NHL diagnosis (aHR 4.73, p≤0.0001) and time period during chemotherapy administration (aHR 7.60, p≤0.0001). Additional risk factors included: stage III/IV disease (p=0.02), BMI≥30 (p=0.02), B-symptoms (p=0.02), and doxorubicin (p=0.04). The cumulative incidence of VTE was highest in the period following diagnosis and decreased over time for both histologies. CONCLUSION: DLBCL is associated with increased risk of VTE compared to FL. This risk is markedly attenuated when adjusting for additional risk factors. The strongest predictors for development of VTE included: time period during chemotherapy administration (especially doxorubicin) and history of VTE. This knowledge can assist clinicians in identifying NHL patients at high risk for VTE.

Comparative effectiveness on survival of zoledronic acid versus pamidronate in multiple myeloma.

Zoledronic acid and pamidronate are the two bisphosphonates approved in the United States to reduce multiple myeloma skeletal complications. Little prior evidence exists comparing survival outcomes between the two. We evaluated the incidence of skeletal-related events and overall survival in patients with myeloma treated with zoledronic acid versus pamidronate using a cohort of 1018 United States veterans. At a median follow-up of 26.9 months, patients receiving zoledronic acid had a 22% reduction in risk of death compared to pamidronate (hazard ratio 0.78; 95% confidence interval, 0.67-0.92). The benefit persisted after controlling for potential confounders. Adjusted Cox modeling with inverse probability weighting and propensity score matching supported these findings. Zoledronic acid was also associated with a 25% decrease in skeletal-related events. Zoledronic acid is associated with increased overall survival and decreased skeletal-related events compared to pamidronate in patients with multiple myeloma and should become the preferred bisphosphonate.