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Around 50% of patients with Philadelphia-negative myeloproliferative neoplasms (MPN) report adverse gastrointestinal symptoms, and several studies have suggested a link between hematological cancers and the development of inflammatory bowel disease (IBD).
IBD is a term covering ulcerative colitis and Crohn’s disease, and is characterized by prolonged inflammation of the gastrointestinal tract. Chronic inflammation is also a hallmark of MPN and contributes to the symptom burden in both IBD and MPN. Studies have shown that patients with IBD are at a greater risk of developing hematological cancers, however the converse has not been investigated.
To date, no studies have determined the risk of IBD in patients with MPN, therefore Marie Bak and colleagues conducted a nationwide study, published in Cancers, to evaluate the risk of IBD in patients with essential thrombocythemia (ET), polycythemia vera (PV), myelofibrosis (MF), or unclassifiable MPN (MPN-U).1
A nationwide, population-based cohort study to evaluate the risk of IBD in patients with MPN versus sex- and age-matched controls from the general population.
Table 1. Patient and comparisons characteristics1
CD, Crohn’s disease; CI, confidence interval; IBD, inflammatory bowel disease; MPN, myeloproliferative neoplasms; UC, ulcerative colitis. |
||
Patients with MPN |
Comparisons |
|
---|---|---|
Sex |
|
|
Men |
3,780 |
37,454 |
Women |
4,427 |
43,842 |
Mean age at MPN diagnosis, years |
67.0 |
67.0 |
Risk time, years |
45,232 |
504,818 |
Mean follow-up, years |
5.5 |
6.2 |
Number of IBD events |
80 |
380 |
UC, % |
68.8 |
63.4 |
CD, % |
20 |
23.4 |
IBD rate per 1,000 person-years (95% CI) |
1.8 (1.4–2.2) |
0.8 (0.7–0.8) |
Table 2. Risk of IBD in patients with MPN and matched comparisons1
CI, confidence interval; ET, essential thrombocythemia; IBD, inflammatory bowel disease; MPN, myeloproliferative neoplasms; MPN-U, unclassifiable MPN; PV, polycythemia vera. *Patients with MF are included in the overall analysis, but the absolute risk is not shown for MF patients, as only one patient was diagnosed with IBD. |
|||||
Absolute risks of IBD |
MPN |
Comparisons |
|||
---|---|---|---|---|---|
n |
% (95% CI) |
n |
% (95% CI) |
||
MPN, total* |
1-year |
22 |
0.3 (0.2–0.4) |
49 |
0.1 (0.0–0.1) |
3-year |
35 |
0.4 (0.3–0.6) |
153 |
0.2 (0.2–0.2) |
|
6-year |
51 |
0.6 (0.5–0.8) |
255 |
0.3 (0.3–0.4) |
|
10-year |
65 |
0.8 (0.6–1.0) |
330 |
0.4 (0.4–0.5) |
|
ET |
1-year |
11 |
0.4 (0.2–0.7) |
17 |
0.1 (0.0–0.1) |
3-year |
19 |
0.7 (0.4–1.1) |
47 |
0.2 (0.1–0.2) |
|
6-year |
26 |
1.0 (0.6–1.4) |
85 |
0.3 (0.3–0.4) |
|
10-year |
28 |
1.0 (0.7–1.5) |
110 |
0.4 (0.3–0.5) |
|
PV
|
1-year |
4 |
0.1 (0.0–0.3) |
19 |
0.1 (0.0–0.1) |
3-year |
6 |
0.2 (0.1–0.4) |
67 |
0.2 (0.2–0.3) |
|
6-year |
11 |
0.4 (0.2–0.6) |
112 |
0.4 (0.3–0.4) |
|
10-year |
22 |
0.7 (0.4–1.0) |
138 |
0.4 (0.4–0.5) |
|
MPN-U |
1-year |
7 |
0.4 (0.2–0.7) |
11 |
0.1 (0.0–0.1) |
3-year |
9 |
0.5 (0.2–0.9) |
30 |
0.2 (0.1–0.2) |
|
6-year |
13 |
0.7 (0.4–1.2) |
45 |
0.3 (0.2–0.3) |
|
10-year |
14 |
0.8 (0.4–1.3) |
62 |
0.3 (0.3–0.4) |
Table 3. HRs for IBD risk in patients with MPN compared with matched comparisons1
CD, Crohn’s disease; CI, confidence interval; ET, essential thrombocythemia; HR, hazard ratio; IBD, inflammatory bowel disease; MPN, myeloproliferative neoplasm; MPN-U, unclassifiable MPN; PV, polycythaemia vera; UC, ulcerative colitis. |
||||||
Risk of IBD, crude HRs (95% CI) |
Events, n |
MPN |
ET |
PV |
MPN-U |
|
---|---|---|---|---|---|---|
Patients |
Comparisons |
|||||
IBD |
80 |
380 |
2.4 (2.1–2.9) |
2.8 (2.1–3.7) |
2.1 (1.6–2.7) |
2.2 (1.3–3.7) |
UC |
55 |
241 |
2.6 (2.1–3.2) |
3.0 (2.2–4.3) |
2.2 (1.6–3.1) |
1.7 (0.9–3.4) |
CD |
16 |
89 |
2.4 (1.7–3.4) |
3.2 (1.9–5.3) |
2.1 (1.2–3.6) |
1.6 (0.4–6.9) |
The findings from this study suggest that patients with MPN are at a greater than 2-fold higher risk of developing IBD and are 40% more likely to have a prior IBD diagnosis when compared with matched controls. This association might be explained by a shared pathomechanism. Therefore, the increased IBD risk should be kept in mind when evaluating abdominal symptoms in patients with MPN; while, in IBD patients, persistent leukocytosis and thrombocytosis may indicate concomitant MPN.
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