Work

Ferritin and LDH predict thrombotic risk beyond conventional scoring systems in DLBCL

Year: 2026

Type: article

Abstract: Background Thrombotic events are clinically significant complications in diffuse large B-cell lymphoma (DLBCL) that adversely affect treatment continuity and outcomes. Despite their importance, no standardized predictive approach exists, and traditional cancer-associated thrombosis models perform suboptimally in hematological malignancies. Methods We retrospectively analyzed 133 adult patients with DLBCL treated at a single center between 2009 and 2021. Thrombotic events required objective radiological confirmation. Baseline demographic, clinical, and laboratory parameters were compared between patients with and without thrombosis. ROC analysis determined the optimal ferritin cutoff, and Cox proportional hazards regression identified independent predictors. Results Thrombosis occurred in 16 patients (12.0%), all venous. Baseline age, sex, comorbidities, ECOG status, disease stage, IPI score, Khorana score, and catheter use did not differ between groups. Patients with thrombosis had significantly higher ferritin (median 331.5 vs. 113 ng/mL; p = 0.026) and LDH (median 459.5 vs. 256 U/L; p = 0.022). ROC analysis identified a ferritin cutoff of ≥ 227 ng/mL (AUC 0.686, 95% CI 0.532–0.840), associated with a 6.1-fold increased risk (OR 6.10, 95% CI 1.75–21.28). In multivariate Cox regression, ferritin ≥ 227 ng/mL (HR 3.77, 95% CI 1.13–12.60, p = 0.031) and LDH (HR 1.002 per unit increase, p = 0.034) were independent predictors. Conclusions In the absence of a standardized risk stratification approach for thrombosis in DLBCL, elevated serum ferritin and LDH levels at diagnosis independently predicted thrombotic events in our cohort. These readily available parameters may contribute to the development of lymphoma-specific thrombosis scoring systems and warrant prospective validation in larger cohorts.

Source: Annals of Hematology

DOI: 10.1007/s00277-026-07201-y