title: Lymphoma and venous thromboembolism: influence on mortality.
abstract: BACKGROUND
  The population-based incidence of acute venous thromboembolism (VTE) in adult patients diagnosed with non-Hodgkin's lymphoma has not been established, and the effect of VTE on survival is not clear.
  
  
  OBJECTIVE
  To determine the incidence of acute VTE in California residents diagnosed with lymphoma, and to determine the effect of acute VTE on survival.
  
  
  METHODS
  We used the California Cancer Registry coupled with the California Patient Discharge database to identify incident cases with lymphoma, 1991-1997, and the incidence of first-time VTE in these patients. Multivariable models were constructed to evaluate risk of developing acute VTE within 2 years, and a proportional hazard model was used to predict death within 2 years, using acute VTE as a time-dependent covariate.
  
  
  RESULTS
  There were 16,755 patients diagnosed with non-Hodgkin's lymphoma; 29% had low-grade, 66% intermediate/aggressive grade and 5.6% had high-grade lymphoma. Acute VTE developed in 3.6% of the patients by year 1 and 4.0% by the end of year 2. Significant predictors of acute VTE included advanced stage lymphoma, number of chronic comorbidities and advancing age. Significant predictors of death within 2 years included diagnosis of acute VTE, advanced stage disease, increasing number of co-morbidities, age over 75 years and intermediate or high grade histopathology. The effect of acute VTE on death increased as the time between lymphoma diagnosis and VTE diagnosis increased (HR=1.7 95%CI:1.5-1.9 for VTEs <6 months; HR=6.5 95%CI:4.7-8.9 VTEs 12-24 months).
  
  
  CONCLUSIONS
  Acute VTE developed frequently in patients with lymphoma, and VTE was a strong predictor of decreased survival.
authors.affiliation: Division of Hematology Oncology, University of California, San Francisco.
authors.forename: Anjlee
authors.initials: A
authors.lastname: Mahajan
authors.affiliation: Division of Hematology Oncology, University of California, San Francisco; UC Davis Clinical and Translational Sciences Center, University of California, Davis; Hematology Oncology, VA Northern California Health Care System.
authors.forename: Ted
authors.initials: T
authors.lastname: Wun
authors.affiliation: Division of Hematology Oncology, University of California, San Francisco.
authors.forename: Helen
authors.initials: H
authors.lastname: Chew
authors.affiliation: Division of General Internal Medicine, University of California, Davis. Electronic address: rhwhite@ucdavis.edu.
authors.forename: Richard H
authors.initials: RH
authors.lastname: White
mesh_terms: D000208:Acute Disease; D000368:Aged; D002140:California / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D008228:Lymphoma, Non-Hodgkin / Q000097:blood* / Q000401:mortality* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012042:Registries / Q000706:statistics & numerical data; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000097:blood* / Q000401:mortality*
keywords: Epidemiology; Lymphoma; Outcomes; Survival; Venous thromboembolism