Leukocytosis at diagnosis and the risk of subsequent thrombosis in patients with low-risk essential thrombocythemia and polycythemia vera

Naseema Gangat, Alexandra P. Wolanskyj, Susan M. Schwager, Curtis A. Hanson, Ayalew Tefferi

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: Advanced age and a history of thrombosis were well-established risk factors for thrombosis in essential thrombocythemia (ET) and polycythemia vera (PV); cytoreductive therapy was indicated in their presence. Recent studies have suggested leukocytosis as an additional risk factor; however, such an association would be treatment-relevant in the context of low-risk disease. METHODS: In this retrospective study, a Cox proportional hazards model was used to determine the impact of various clinical and laboratory variables, including leukocytosis, on thrombosis-free survival (TFS). Arterial-specific or venous-specific TFS curves for different leukocyte count-defined risk groups were constructed by the Kaplan-Meier method and compared using the log-rank test. RESULTS: A total of 407 low-risk patients (254 with ET and 153 with PV) were considered. After a respective median follow-up of 104 months and 130 months, respectively, 47 (19%) patients with ET and 41 (27%) with PV experienced a total of 55 (41 arterial and 14 venous) and 46 (22 arterial and 24 venous) thrombotic events, respectively. Leukocytosis at the time of diagnosis, defined by a cutoff level of either 15 or 9.4 × 109/L, did not appear to be predictive of either arterial or venous thrombosis during follow-up; similar results were obtained when analysis was restricted to patients with platelet counts of <1000 × 109/L. Instead, advanced age was found to be significantly associated with arterial thrombosis in patients with PV and higher hemoglobin level with venous thrombosis in patients with ET. CONCLUSIONS: In the current retrospective study, leukocytosis at diagnosis did not appear to influence the risk of thrombosis in either ET or PV. However, a prospective study is required before leukocytosis is taken into account during treatment decisions in these disorders.

Original languageEnglish (US)
Pages (from-to)5740-5745
Number of pages6
JournalCancer
Volume115
Issue number24
DOIs
StatePublished - Dec 15 2009

Fingerprint

Essential Thrombocythemia
Polycythemia Vera
Leukocytosis
Thrombosis
Venous Thrombosis
Retrospective Studies
Survival
Platelet Count
Leukocyte Count
Proportional Hazards Models
Hemoglobins
Therapeutics
Prospective Studies

Keywords

  • JAK2
  • Leukocytosis
  • Polycythemia
  • Thrombocythemia
  • Thrombosis

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Leukocytosis at diagnosis and the risk of subsequent thrombosis in patients with low-risk essential thrombocythemia and polycythemia vera. / Gangat, Naseema; Wolanskyj, Alexandra P.; Schwager, Susan M.; Hanson, Curtis A.; Tefferi, Ayalew.

In: Cancer, Vol. 115, No. 24, 15.12.2009, p. 5740-5745.

Research output: Contribution to journalArticle

Gangat, Naseema ; Wolanskyj, Alexandra P. ; Schwager, Susan M. ; Hanson, Curtis A. ; Tefferi, Ayalew. / Leukocytosis at diagnosis and the risk of subsequent thrombosis in patients with low-risk essential thrombocythemia and polycythemia vera. In: Cancer. 2009 ; Vol. 115, No. 24. pp. 5740-5745.
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abstract = "BACKGROUND: Advanced age and a history of thrombosis were well-established risk factors for thrombosis in essential thrombocythemia (ET) and polycythemia vera (PV); cytoreductive therapy was indicated in their presence. Recent studies have suggested leukocytosis as an additional risk factor; however, such an association would be treatment-relevant in the context of low-risk disease. METHODS: In this retrospective study, a Cox proportional hazards model was used to determine the impact of various clinical and laboratory variables, including leukocytosis, on thrombosis-free survival (TFS). Arterial-specific or venous-specific TFS curves for different leukocyte count-defined risk groups were constructed by the Kaplan-Meier method and compared using the log-rank test. RESULTS: A total of 407 low-risk patients (254 with ET and 153 with PV) were considered. After a respective median follow-up of 104 months and 130 months, respectively, 47 (19{\%}) patients with ET and 41 (27{\%}) with PV experienced a total of 55 (41 arterial and 14 venous) and 46 (22 arterial and 24 venous) thrombotic events, respectively. Leukocytosis at the time of diagnosis, defined by a cutoff level of either 15 or 9.4 × 109/L, did not appear to be predictive of either arterial or venous thrombosis during follow-up; similar results were obtained when analysis was restricted to patients with platelet counts of <1000 × 109/L. Instead, advanced age was found to be significantly associated with arterial thrombosis in patients with PV and higher hemoglobin level with venous thrombosis in patients with ET. CONCLUSIONS: In the current retrospective study, leukocytosis at diagnosis did not appear to influence the risk of thrombosis in either ET or PV. However, a prospective study is required before leukocytosis is taken into account during treatment decisions in these disorders.",
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T1 - Leukocytosis at diagnosis and the risk of subsequent thrombosis in patients with low-risk essential thrombocythemia and polycythemia vera

AU - Gangat, Naseema

AU - Wolanskyj, Alexandra P.

AU - Schwager, Susan M.

AU - Hanson, Curtis A.

AU - Tefferi, Ayalew

PY - 2009/12/15

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N2 - BACKGROUND: Advanced age and a history of thrombosis were well-established risk factors for thrombosis in essential thrombocythemia (ET) and polycythemia vera (PV); cytoreductive therapy was indicated in their presence. Recent studies have suggested leukocytosis as an additional risk factor; however, such an association would be treatment-relevant in the context of low-risk disease. METHODS: In this retrospective study, a Cox proportional hazards model was used to determine the impact of various clinical and laboratory variables, including leukocytosis, on thrombosis-free survival (TFS). Arterial-specific or venous-specific TFS curves for different leukocyte count-defined risk groups were constructed by the Kaplan-Meier method and compared using the log-rank test. RESULTS: A total of 407 low-risk patients (254 with ET and 153 with PV) were considered. After a respective median follow-up of 104 months and 130 months, respectively, 47 (19%) patients with ET and 41 (27%) with PV experienced a total of 55 (41 arterial and 14 venous) and 46 (22 arterial and 24 venous) thrombotic events, respectively. Leukocytosis at the time of diagnosis, defined by a cutoff level of either 15 or 9.4 × 109/L, did not appear to be predictive of either arterial or venous thrombosis during follow-up; similar results were obtained when analysis was restricted to patients with platelet counts of <1000 × 109/L. Instead, advanced age was found to be significantly associated with arterial thrombosis in patients with PV and higher hemoglobin level with venous thrombosis in patients with ET. CONCLUSIONS: In the current retrospective study, leukocytosis at diagnosis did not appear to influence the risk of thrombosis in either ET or PV. However, a prospective study is required before leukocytosis is taken into account during treatment decisions in these disorders.

AB - BACKGROUND: Advanced age and a history of thrombosis were well-established risk factors for thrombosis in essential thrombocythemia (ET) and polycythemia vera (PV); cytoreductive therapy was indicated in their presence. Recent studies have suggested leukocytosis as an additional risk factor; however, such an association would be treatment-relevant in the context of low-risk disease. METHODS: In this retrospective study, a Cox proportional hazards model was used to determine the impact of various clinical and laboratory variables, including leukocytosis, on thrombosis-free survival (TFS). Arterial-specific or venous-specific TFS curves for different leukocyte count-defined risk groups were constructed by the Kaplan-Meier method and compared using the log-rank test. RESULTS: A total of 407 low-risk patients (254 with ET and 153 with PV) were considered. After a respective median follow-up of 104 months and 130 months, respectively, 47 (19%) patients with ET and 41 (27%) with PV experienced a total of 55 (41 arterial and 14 venous) and 46 (22 arterial and 24 venous) thrombotic events, respectively. Leukocytosis at the time of diagnosis, defined by a cutoff level of either 15 or 9.4 × 109/L, did not appear to be predictive of either arterial or venous thrombosis during follow-up; similar results were obtained when analysis was restricted to patients with platelet counts of <1000 × 109/L. Instead, advanced age was found to be significantly associated with arterial thrombosis in patients with PV and higher hemoglobin level with venous thrombosis in patients with ET. CONCLUSIONS: In the current retrospective study, leukocytosis at diagnosis did not appear to influence the risk of thrombosis in either ET or PV. However, a prospective study is required before leukocytosis is taken into account during treatment decisions in these disorders.

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