Predictors and Risk Assessment Models for Venous Thromboembolism in Patients Diagnosed with Lymphoma: A Systematic Review
Round 1
Reviewer 1 Report
Comments and Suggestions for AuthorsThe authors have performed a systematic analysis of an important and clinically relevant topic, given that a lymphoma-specific, well-performing RAM is missing. I do, however, have some concerns which I believe should be addressed prior to publication.
Major comments:
1. I think the title should be revised as it emphasizes the “prevalence of venous thromboembolism,” whereas the review primarily focuses on risk assessment models and prediction tools, not epidemiology.
2. Method section: I would recommend adding a supplement to include more detail like full electronic search strategies for each database (PubMed, Embase, Scopus), clarification regarding whether MeSH terms and EMTREE terms were used, information regarding duplicate screening and data extraction, description of how disagreements were resolved. I would also recommend further clarification regarding whether calibration assessment, discrimination statistics and validation methods were predefined outcomes.
3. The PRISMA flowchart is useful, but several required PRISMA items are missing. There is no explicit risk-of-bias summary figure/table and no detailed explanation of excluded full-text studies. Perhaps a PRISMA checklist and a PROBAST summary figure should be included.
4. The manuscript correctly identifies major methodological limitations of available RAMs, but the interpretation of prediction model performance requires more information. There is an overemphasis on AUC/C-statistic which alone is not sufficient to assess a prediction model. External validation, decision-curve analysis and calibration metrics are also important. The discussion should better explain why apparent discrimination may not translate into clinical utility. Perhaps also discuss the importance of EPV more systematically
5. I would also recommend adding a table which summarizes the most frequent predictors across RAMs, frequency of inclusion of each predictor and whether predictors were independently validated. This would improve readability and provide practical value.
6. The manuscript contains numerous grammatical issues, typographical errors, and inconsistencies.
Examples include:
- “alongside with” → “alongside”
- “criterion” instead of “criterium”
- “guideline-changing” used repeatedly in questionable contexts
- “lymphoma-specific and-tailored parameters”
- “The thrombosis risk in lymphoma patients is considered high during the first chemotherapy cycles”
Several sentences are excessively long and difficult to follow.
Author Response
Dear Reviewer,
Thank you for reviewing our manuscript and for your valuable suggestions for improving the paper. You may find our response to your comments in the attached file.
Author Response File: 
Author Response.pdf
Reviewer 2 Report
Comments and Suggestions for AuthorsPop and colleagues present a study where they analyze the existing evidence regarding new developed risk assessment models for VTE in lymphoma patients as well as evaluating previously established VTE risk stratification models in oncology patients.
Following a systematic literature search, the authors identified 592 studies, of which 18 met the inclusion criteria according to the predefined selection protocol.
The study is well designed, includes both ambulatory and hospitalized patients undergoing treatment, and is adequately structured to address the research questions. However, several critical issues should be considered:
-One limitation is that the authors excluded studies that did not include a thrombosis prediction model. As shown in Figure 2, these studies account for only 26 papers. Including them could broaden the scope of the analysis and strengthen the final discussion.
-Of the 18 selected studies, 13 were single-center investigations and were predominantly conducted in Asian populations. This may represent a potential source of bias and may limit the generalizability of the findings.
-In Table 1, the authors did not report whether enrolled patients received anticoagulant therapy at diagnosis or underwent thrombophilia screening. These factors may significantly influence the patients’ prothrombotic status. Could the authors include and discuss these variables?
-Among the 18 selected studies, only one specifically analyzed PICC-associated thrombosis separately. This may represent an additional limitation, since a VTE risk assessment model should account for catheter-related thrombosis, considering its distinct pathogenesis and prophylactic management.
Author Response
Dear Reviewer,
Thank you for reviewing our manuscript and for your valuable suggestions for improving the paper. You may find our response to your comments in the attached file.
Author Response File: Author Response.pdf
Round 2
Reviewer 2 Report
Comments and Suggestions for AuthorsThe authors addressed all queries and substantiately improved the manuscript.
Author Response
Dear Reviewer,
Thank you very much for your support in improving our manuscript.
