venous thromboembolism

VTE Risk Elevated in Survivors of Childhood Cancer

Survivors of childhood cancer likely have an increased long-term risk of venous thromboembolism (VTE), according to findings from a new study.


These findings emerged from the Childhood Cancer Survivor Study, which included 24,344 five-year cancer survivors who received their diagnosis between 1970 and 1999. Mean age at follow-up was 28.7 years, and median follow-up since diagnosis was 21.3 years. A total of 5051 sibling participants were included.

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Results of the study indicated that late VTE occurred at a rate of 1.1 and 0.5 events per 1000 person-years among survivors and siblings, respectively (risk ratio [RR] 2.2). A total of 2.5 excess events per 100 survivors occurred over a period of 35 years.


In this cohort, factors associated with VTE risk among childhood cancer survivors were:

  • Female sex (RR 1.3).
  • Cisplatin (reference none; RRs 3.0, 1.9, and 2.0 for 1 to 199 mg/m2; 200 to 399 mg/m2; at least 400 mg/m2, respectively).
  • l-asparaginase (RR, 1.3).
  • Obesity or underweight (reference body mass index [BMI]: 18.5 to 24.9 kg/m2; RRs 1.6 and 2.4 for BMI of at least 30.0 kg/m2 or less than 18.5 kg/m2, respectively).
  • Late cancer recurrence or subsequent malignant neoplasm (RR 4.6).


Independent risk factors for late VTE among survivors of lower-extremity osteosarcoma were:

  • Limb salvage (reference: amputation; RR 3.1).
  • Cisplatin 200 mg/m2 to 399 mg/m2 or at least 400 mg/m2 (reference: none; RR 4.0 and 2.9, respectively).


The authors of the study also noted an association between VTE and elevated risk for non-external cause late mortality (RR 1.9).


“Interventions that target potentially modifiable comorbidities, such as obesity, warrant consideration, with prophylaxis for high-risk survivors, including those treated with cisplatin and limb-sparing approaches,” the authors wrote.


—Christina Vogt



Madenci AL, Weil BR, Liu Q, et al. Long-term risk of venous thromboembolism in survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. J Clin Oncol. 2018;36(31):3144-3151. doi:10.1200/JCO.2018.78.4595.