COLUMBIA, SC – Noting that chronic lymphocytic leukemia (CLL) patients are at increased risk for major hemorrhage (MH), a new study reported incidence of MH in veterans with CLL, as well as risk factors.

The study, published in Cancer Medicine, was conducted before the introduction of newer CLL therapies such as ibrutinib, which includes bleeding risk.1

William Jennings Bryan Dorn VAMC-led researchers focused on 24,198 CLL patients treated in the VA system before FDA approval of ibrutinib as CLL therapy. Data came from VA databases from 1999 to 2013.

Researchers determined that MH incidence was 1.9/100 person-years (95% CI: 1.8-1.9), with cumulative incidences of 2.3%, 5.2%, and 7.3% by year 1, 3, and 5, respectively. They also reported that median time from CLL diagnosis to MH was 2.8 years (range: 0-15.7 years).

Compared to patients not receiving those medications, concurrent anticoagulant and antiplatelet use (HR: 4.2; 95% CI: 3.2-5.6), anticoagulant use only (HR: 2.6; 95% CI: 2.3-3.1), and antiplatelet use only (HR: 1.5; 95% CI: 1.3-1.7) increased MH risk based on multivariate analyses.

Also associated with increased MH risk were being nonwhite and male, having MH history, renal impairment, anemia, thrombocytopenia, and alcohol abuse.

 “These pre-ibrutinib data are important for providing context for interpreting MH risk in ibrutinib-treated patients,” the authors wrote. “As ibrutinib clinical use is increasing, updated analyses of MH risk among ibrutinib-treated VA patients with CLL may provide additional useful insight.”

1.    Georgantopoulos P, Yang H, Norris LB, Bennett CL. Major hemorrhage in chronic  lymphocytic leukemia patients in the US Veterans Health Administration system in  the pre-ibrutinib era: Incidence and risk factors. Cancer Med. 2019May;8(5):2233-2240. doi: 10.1002/cam4.2134. Epub 2019 Apr 14. PubMed PMID:30983123; PubMed Central PMCID: PMC6536934.