Mutation-enhanced international prognostic systems for essential thrombocythaemia and polycythaemia vera

Ayalew Tefferi, Paola Guglielmelli, Terra L. Lasho, Giacomo Coltro, Christy M. Finke, Giuseppe G. Loscocco, Benedetta Sordi, Natasha Szuber, Giada Rotunno, Annalisa Pacilli, Curtis A. Hanson, Rhett P. Ketterling, Animesh Pardanani, Naseema Gangat, Alessandro M. Vannucchi

Research output: Contribution to journalArticle

11 Scopus citations

Abstract

Survival prediction in essential thrombocythaemia (ET) and polycythaemia vera (PV) is currently based on clinically-derived variables; we examined the possibility of integrating genetic information for predicting survival. To this end, 906 molecularly-annotated patients (416 Mayo Clinic; 490 University of Florence, Italy), including 502 ET and 404 PV, were recruited. Multivariable analysis identified spliceosome mutations to adversely affect overall (SF3B1, SRSF2 in ET and SRSF2 in PV) and myelofibrosis-free (U2AF1, SF3B1 in ET) survival; TP53 mutations predicted leukaemic transformation in ET; “adverse” mutations occurred in 51 (10%) ET and 8 (2%) PV patients. We confirmed the independent survival effect of adverse mutations [hazard ratio (HR) 2·4, 95% CI 1·6–3·5], age >60 years (6·6, 4·6–9·7), male sex (1·8, 1·3–2·4) and leukocytosis ≥11 × 109/l (1·6, 1·1–2·2), in ET, and adverse mutations (7·8, 3·1–17·0), age >67 years (5·4, 3·6–8·1), leukocytosis ≥15 × 109/l (2·8, 1·8–4·2) and thrombosis history (2·0, 1·4–2·9), in PV. HR-based risk point allocation allowed development of three-tiered mutation-enhanced international prognostic systems (MIPSS) which were validated in both cohorts and performance was shown to be superior to conventional scoring systems. Spliceosome mutations enhance survival prediction in ET and PV and identify patients at risk for fibrotic progression. TP53 mutations predict leukaemic transformation in ET.

Original languageEnglish (US)
Pages (from-to)291-302
Number of pages12
JournalBritish journal of haematology
Volume189
Issue number2
DOIs
StatePublished - Apr 1 2020

Keywords

  • karyotype
  • leukemia
  • mutation
  • myelofibrosis
  • prognosis
  • survival

ASJC Scopus subject areas

  • Hematology

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    Tefferi, A., Guglielmelli, P., Lasho, T. L., Coltro, G., Finke, C. M., Loscocco, G. G., Sordi, B., Szuber, N., Rotunno, G., Pacilli, A., Hanson, C. A., Ketterling, R. P., Pardanani, A., Gangat, N., & Vannucchi, A. M. (2020). Mutation-enhanced international prognostic systems for essential thrombocythaemia and polycythaemia vera. British journal of haematology, 189(2), 291-302. https://doi.org/10.1111/bjh.16380