title: Thrombosis and hemostatic abnormalities in hematological malignancies.
abstract: There is a paucity of data that pertain to thrombosis in patients with hematological malignancies. Recent studies showed that patients with lymphoma, multiple myeloma, and acute leukemia have an increased thrombotic risk, particularly at the time of diagnosis and during chemotherapy. We searched the PubMed database for articles on thromboembolic complications in patients with hematological malignancies published between 1996 and 2013. The incidence of thrombotic events is variable, and is influenced by the type and the stage of hematological malignancy, the antitumor therapy, and the use of central venous devices. The pathogenesis of thromboembolic disease in hematological malignancies is multifactorial. Tumor cell-derived procoagulant, fibrinolytic, or proteolytic factors, and inflammatory cytokines affect clotting activation, and chemotherapy and immunomodulatory drugs increase the thrombotic risk in patients with lymphoma, acute leukemia, and multiple myeloma. Infections might also contribute to the pathogenesis of the thromboembolic complications: endotoxins from gram-negative bacteria induce the release of tissue factor, tumor necrosis factor and interleukin-1b, and gram-positive organisms can release bacterial mucopolysaccharides that directly activate factor XII. In the setting of plasma cell dyscrasias, hyperviscosity, decreased fibrinolysis, procoagulant autoantibody production, inflammatory cytokines, acquired activated protein C resistance, and the prothrombotic effects of antimyeloma agents might be the cause of thromboembolic complications. Anticoagulant therapy is very complicated because of high risk of hemorrhage. Therefore, an accurate estimate of a patient's thrombotic risk is essential to allow physicians to target thromboprophylaxis in high-risk patients.
authors.affiliation: Department of Pathophysiology and Transplantation, Internal Medicine Section, University of Milan, and Department of Haematology, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Colombo
authors.affiliation: Department of Haematology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK.
authors.forename: Paolo
authors.initials: P
authors.lastname: Gallipoli
authors.affiliation: Department of Pathophysiology and Transplantation, Internal Medicine Section, University of Milan, and Department of Haematology, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy. Electronic address: roberto.castelli@unimi.it.
authors.forename: Roberto
authors.initials: R
authors.lastname: Castelli
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D016026:Bone Marrow Transplantation / Q000009:adverse effects; D019337:Hematologic Neoplasms / Q000097:blood* / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D016298:Hematopoietic Cell Growth Factors / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D013927:Thrombosis / Q000097:blood* / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control / Q000628:therapy
chemical_list: D000970:Antineoplastic Agents; D016298:Hematopoietic Cell Growth Factors
keywords: Blood coagulation; Blood malignancies; Haematology; Proinflammatory cytokines; Thromboembolic disease