A Nationwide Analysis of Acute Ischemic Stroke in Intravascular Large B-Cell Lymphoma: The Needle in a Haystack
Brittany Russo1, Adithya Nagaraja1, Ariel Sacknovitz2, Michael Fortunato3, Martin Kafina1, Ankita Jain2, Eris Spirollari2, Anaz Uddin3, Esewi Aifuwa3, Chaitanya Medicherla1, Sarah Parauda1, Stephanie Gandelman1, Fawaz Al-Mufti1
1Neurology, Westchester Medical Center at New York Medical College, 2Brain and Spine Institute, Westchester Medical Center at New York Medical College, 3School of Medicine, New York Medical College
Objective:
To investigate the incidence of acute ischemic stroke (AIS) amongst patients diagnosed with intravascular large B-cell lymphoma (IVLBCL) and characterize predictors of stroke in this population. We also aim to explore outcomes of AIS patients with IVLBCL as compared to their counterparts without IVLBCL.
Background:
A significantly increased risk of cerebrovascular disease is well-documented in patients diagnosed with malignancy. VLBCL is a rare and aggressive subtype of non-Hodgkin B-cell lymphoma characterized by the proliferation of neoplastic lymphoma cells within the blood vessels of various organs. Literature regarding patients with IVLBCL and their stroke risk, has previously been limited to small single-center analyses.
Design/Methods:
The National Inpatient Sample (NIS) was queried from 2010 to 2019 using the International Classification of Diseases (ICD) 9th and 10th edition codes to identify patients admitted for AIS with and without IVLBCL.
Results:
We identified 44 IVLBCL cases amongst 705,928 AIS patients. We found that AIS patients with IVLBCL were older (74.50 vs 70.14 years, p<0.0001) and had less severe strokes (0.33 vs 0.47, p<0.01). They also had longer hospital stays (12.22 vs 5.99 days, p<0.01); however, they received similar rates of intravenous thrombolysis and mechanical thrombectomy and had similar rates of poor functional outcome and in-hospital mortality when compared to non-IVLBCL AIS patients. Multivariate regression identified age, hypertension, hyperlipidemia, congestive heart failure (CHF), and substance abuse as significant predictors of AIS in IVLBCL patients (OR > 1.0, p<0.05).
Conclusions:
Patients with AIS and IVLBCL are more likely to have favorable stroke severity rates despite their cancer diagnosis. Additionally, they had similar rates of reperfusion therapies as compared to AIS patients without IVLBCL, indicating their utility in this population. Similar to that of the general population, age, hypertension, hyperlipidemia, CHF, and substance abuse are important risk factors for AIS in patients with IVLBCL.
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