Background
Venous thromboembolism (VTE), encompassing deep vein thrombosis and pulmonary embolism, is a major contributor to morbidity and mortality among cancer patients globally. Lymphoma is recognized as a malignancy with increased risk for thromboembolic events due to both cancer biology and treatment-related factors. Despite the global recognition of VTE risk in hematological malignancies, prospective real-world data are scarce in Southeast Asia, particularly Vietnam. This regional scarcity is important because genetic, environmental, and healthcare system factors may influence thrombosis risk and management.
This study by Nguyen et al. addresses this gap by prospectively investigating the incidence and risk factors for VTE among newly diagnosed Hodgkin and non-Hodgkin lymphoma patients at the Vietnam National Cancer Hospital. The findings help inform tailored risk stratification and prophylaxis in a resource-constrained clinical setting.
Study Design
A prospective descriptive observational methodology was employed involving 157 patients newly diagnosed with lymphoma between January 2022 and January 2024. The cohort included both Hodgkin and non-Hodgkin lymphoma subtypes, reflecting a representative real-world population. All patients were initiated on systemic therapy and underwent VTE risk assessment via the Khorana score—a validated risk stratification tool in cancer-associated thrombosis. Risk assessments were conducted at baseline and repeated throughout chemotherapy.
VTE screening was systematically performed using Doppler ultrasound and computed tomography imaging, facilitating detection of both symptomatic and asymptomatic VTE events. Multivariate logistic regression analyses determined independent predictors of VTE development.
Key Findings
The study documented an overall VTE incidence of 8.3% within the cohort. Notably, the majority (7.0%) of VTEs were diagnosed at baseline prior to commencement of systemic therapy, with only a minority (1.3%) developing VTE during chemotherapy. This highlights that VTE risk in lymphoma patients may be highest around diagnosis and underscores the importance of early assessment.
Risk stratification via the Khorana score classified the majority (68.2%) of patients as low-risk at baseline, with a small high-risk subgroup (7.6%). Interestingly, the proportion of high-risk patients decreased progressively during treatment, possibly reflecting changes in laboratory or clinical parameters.
Multivariate regression analysis revealed two independent predictive factors for VTE: elevated pretreatment plasma D-dimer levels exceeding 500 ng/mL (odds ratio [OR] 0.044; 95% confidence interval [CI]: 0.003–0.632; p=0.022) and presence of cardiovascular comorbidities (OR 0.036; 95% CI: 0.002–0.545; p=0.016). Elevated D-dimer, indicative of increased fibrin turnover and coagulation activation, aligns with pathophysiological mechanisms of cancer-associated thrombosis. Cardiovascular disease, often linked to endothelial dysfunction and prothrombotic states, further compounds VTE risk.
These results corroborate and extend existing knowledge on VTE risk factors in lymphoma, underscoring the importance of integrating clinical and laboratory markers into risk assessment frameworks.
Expert Commentary
The study’s prospective design and real-world Vietnamese patient population provide valuable regional data, though some limitations include the single-center setting and relatively modest sample size. The timing of VTE screening allowed early detection, which is critical for timely intervention.
The observed predominance of VTE events at diagnosis rather than during chemotherapy challenges the exclusive focus on chemotherapy-induced thrombosis, advocating for early thromboprophylaxis consideration based on comprehensive pretreatment evaluation.
The incorporation of D-dimer measurements as a routine pretreatment test holds promise in refining risk stratification beyond the Khorana score. However, validation in larger multicenter cohorts and the assessment of dynamic changes during therapy remain necessary.
Integration of cardiovascular comorbidity assessment into thrombosis risk models may improve personalized prophylaxis, particularly in aging lymphoma populations with increasing burden of chronic disease.
Conclusion
This real-world prospective study identifies an 8.3% incidence of venous thromboembolism in newly diagnosed lymphoma patients in Vietnam, with the majority of events occurring before treatment initiation. Elevated pretreatment D-dimer levels and cardiovascular comorbidities independently predict increased thrombotic risk. Routine incorporation of these parameters into pretreatment evaluation could enhance risk stratification and guide prophylactic strategies, potentially improving patient outcomes in lymphoma care. Future studies should prospectively validate these findings and optimize thromboprophylaxis protocols tailored to this population.
References
Nguyen TTH, Do HN, Le TY, Nguyen TT, Nguyen TL, Le VQ. Venous thromboembolism risk in newly diagnosed lymphoma patients: a real-world prospective observational study from Vietnam National Cancer Hospital. BMC Cancer. 2025 Aug 11;25(1):1301. doi: 10.1186/s12885-025-14719-3. PMID: 40790562; PMCID: PMC12337430.
