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Polycythemia vera (PV) is a type of chronic myeloproliferative neoplasm characterized by erythrocytosis, specific histological features in the bone marrow and commonly the presence of either V617F or exon 12 mutations in Janus Kinase 2 in myeloid cells.1 In some patients it may also result in high white blood cell counts (WBC), platelet counts, and erythrocytes.2 In addition, patients are susceptible to thrombotic events and the disease progression eventually evolving to myelofibrosis, myelodysplastic syndrome or acute myeloid leukemia (AML).3
Previous studies have investigated the association of leukocytosis with thrombotic events or disease evolution with discordant results, however mostly at a single time point (usually at diagnosis) rather than using a longitudinal analysis looking at leukocyte count evolution overtime.
This study used retrospective data from 520 patients to investigate the association of leukocyte level, hematocrit value and platelet count with thrombosis or disease evolution using group-based trajectory modeling (GBTM).4 Latent clusters of patients whose leukocyte, hematocrit or platelet count follow distinct trajectories over time were analyzed to evaluate the prognostic significance of blood cell counts over a 1-year period as biomarker.
Representation of cumulative “exposure” to an elevated leukocyte count, hematocrit, or platelet count accounting for the fact that events may result from cumulative damage
This longitudinal trial of 520 patients, retrospectively pooled and analyzed using GBTM, found that persistent leukocytosis was significantly associated with disease evolution to myelofibrosis, myelodysplastic syndrome or AML (p = 0.0002) but not with thrombosis.
No association with thrombosis or disease progression was found for long-term increases in hematocrit and thrombocyte counts.
A prospective trial of leukocyte control in otherwise uncontrolled patients with the endpoint being primary disease evolution may be warranted.
ASH 2019 | Protein arginine methyltransferase 5 (PRMT5) inhibition: a promising preclinical target for MPN
PRMT5 is a promising therapeutic target for MPN. To investigate this further, Friederike Pastore presented the results of their preclinical...
Results from a phase II trial of decitabine and ruxolitinib for patients with MPN-AP/BP
Myeloproliferative neoplasms (MPN) are chronic malignancies that can transform to the accelerated phase (AP) with 10–19% blast cells or the blast phase (BP), with...
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