Immunopharmacological Modulation of Coagulation and Blood Physiology in Hematologic Malignancies: Implications for Thrombosis and Hemostasis

Abstract

The presence of hematologic malignancies frequently causes a number of changes in the mechanisms of coagulation and blood physiology, which increases the risk of both thrombotic and hemorrhagic complications. Immunopharmacology has gained prominence in recent years and has revolutionized the management of patients with leukemia, lymphoma, and multiple myeloma through an improved ability to stimulate the destruction of malignant cells via immunity. Despite their beneficial effects, there is increasing evidence that the use of immune-based pharmacological strategies might affect coagulation processes, platelets, the integrity of the endothelium, and hemostasis overall. This review aims at analyzing scientific literature on the issue of immunopharmacological modulation of coagulation and blood physiology in the case of hematologic malignancies and its consequences for thrombosis and hemostasis. In the analysis, the PRISMA statement was followed to provide methodological transparency and reproducibility. Thus, a systematic search was conducted using several scientific databases, including PubMed, Scopus, Web of Science, ScienceDirect, and SpringerLink for articles published within 2020-2025. A total of 1,463 articles were found initially; out of these, 267 were duplicates. After that, a screening process was conducted to eliminate irrelevant articles based on title and abstract information, thus leaving 373 potential sources to be assessed further. Out of 373 articles, 312 papers did not meet the criteria for inclusion into the analysis, and only 61 were selected. According to the results obtained from the analysis, immunopharmacological therapy significantly influences coagulation through inflammation, stimulation of the endothelium, increased tissue factor expression, and platelet activation. Some authors have mentioned a significant increase in the number of pro-inflammatory cytokines and markers of hypercoagulability among patients receiving modern immunotherapy. Clinically, the frequency of thrombotic events such as deep vein thrombosis and pulmonary embolism increased significantly; however, thrombocytopenia induced by treatment increased the risk of bleeding. Thus, according to this review, immunopharmacological strategies cause significant changes in the regulation of coagulation and hemostasis in the case of hematologic malignancies. This makes it crucial to maintain a balance between thrombosis and hemostasis. Future research should be aimed at identifying new prognostic factors for complications related to these processes.