The impact of thrombosis on probabilities of death and disease progression in polycythemia vera: a multistate transition analysis of 1,545 patients
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Published:2023-12-15
Issue:1
Volume:13
Page:
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ISSN:2044-5385
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Container-title:Blood Cancer Journal
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language:en
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Short-container-title:Blood Cancer J.
Author:
Barbui TizianoORCID, Carobbio AlessandraORCID, Thiele Juergen, Gangat NaseemaORCID, Rumi Elisa, Rambaldi Alessandro, Vannucchi Alessandro M.ORCID, Tefferi AyalewORCID, Jeryczynski Georg, Müllauer Leonhard, Vaidya Rakhee, Sulai Nanna H., Pardanani Animesh, Larson Dirk R., Cazzola Mario, Casetti Ilaria, Finazzi Guido, Pieri Lisa, Gisslinger Heinz, Gisslinger Bettina, Rodeghiero Francesco, Ruggeri Marco, Randi Maria Luigia, Bertozzi Irene, Passamonti Francesco,
Abstract
AbstractWe applied a parametric Markov five-state model, on a well-characterized international cohort of 1,545 patients with polycythemia vera (PV; median age 61 years; females 51%), in order to examine the impact of incident thrombosis on the trajectory of death or disease progression. At a median follow-up of 6.9 years, 347 (23%) deaths, 50 (3%) blast phase (BP), and 138 (9%) fibrotic (post-PV MF) transformations were recorded. Incident thrombosis occurred at a rate of 2.62% pt/yr (arterial 1.59% and venous 1.05%). The probability of death, in the first 10 years, for 280 (18%) patients who developed thrombosis during follow-up was 40%, which was two-fold higher than that seen in the absence of thrombosis or any other transition state (20%; p < 0.01); the adverse impact from thrombosis was more apparent for arterial (HR 1.74; p < 0.01) vs venous thrombosis (p=NS) and was independent of other fixed (i.e., age, prior venous thrombosis, leukocytosis) or time-dependent (i.e., progression to BP or MF) risk variables. The transition probability to post-PV MF increased over time, in a linear fashion, with a rate of 5% capped at 5 and 10 years, in patients with or without incident thrombosis, respectively. The impact of thrombosis on transition probability to death or post-PV MF tapered off beyond 10 years and appeared to reverse direction of impact on MF evolution at the 12-year time point. These observations suggest thrombosis in PV to be a marker of aggressive disease biology or a disease-associated inflammatory state that is consequential to both thrombosis and disease progression.
Funder
BCC Milano for "RICO" project Associazione Italiana per la Ricerca sul Cancro
Publisher
Springer Science and Business Media LLC
Subject
Oncology,Hematology
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