Prediction of thrombosis in post-polycythemia vera and post-essential thrombocythemia myelofibrosis: a study on 1258 patients

Barbara Mora, Paola Guglielmelli, Andrew Kuykendall, Elisa Rumi, Margherita Maffioli, Francesca Palandri, Valerio De Stefano, Marianna Caramella, Silvia Salmoiraghi, Jean Jacques Kiladjian, Jason Gotlib, Alessandra Iurlo, Francisco Cervantes, Marco Ruggeri, Richard T. Silver, Francesco Albano, Giulia Benevolo, David M. Ross, Matteo G. Della Porta, Timothy DevosGiada Rotunno, Rami S. Komrokji, Ilaria C. Casetti, Michele Merli, Marco Brociner, Domenica Caramazza, Giuseppe Auteri, Tiziano Barbui, Daniele Cattaneo, Lorenza Bertù, Luca Arcaini, Alessandro M. Vannucchi, Francesco Passamonti

Research output: Contribution to journalArticlepeer-review

15 Citations (Scopus)

Abstract

Patients with Philadelphia-negative myeloproliferative neoplasms are at high risk of thrombotic events (TEs). Predisposing factors have been identified in essential thrombocythemia (ET), polycythemia vera (PV) and primary myelofibrosis (primary MF, PMF), while yet not recognized in post PV/ET-MF (known as secondary MF, SMF). Within the 1258 SMF of the MYSEC (MYelofibrosis SECondary to PV and ET) dataset, 135 (10.7%) developed a TE at a median follow-up of 3.5 years (range, 1–21.4), with an incidence of 2.3% patients per year. Venous events accounted for two-thirds of the total. Cox multivariable analysis, supported by Fine-Gray models with death as competitive risk, showed that being on cytoreductive therapy at time of SMF evolution is associated with an absolute risk reduction of thrombosis equal to 3.3% within 3 years. Considering individually cytoreductive therapies, univariate regression model found that both conventional cytoreduction, mainly hydroxyurea, (HR 0.41, 95% CI: 0.26–0.65, p = 0.0001) and JAK inhibitors, mostly ruxolitinib, (HR 0.50, 95% CI: 0.24–1.02, p = 0.05) were associated with fewer thrombosis. Our study informs treating physicians of a non-low incidence of TEs in post PV/ET-MF and of the potential protective role of cytoreductive therapy in terms of thrombotic events.

Original languageEnglish
Pages (from-to)2453-2460
Number of pages8
JournalLeukemia
Volume36
Issue number10
Early online date30 Aug 2022
DOIs
Publication statusPublished - Oct 2022
Externally publishedYes

Keywords

  • Myeloproliferative disease
  • Risk factors

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