Triple A risk model: Novel tool predicting survival and thrombosis in ET

Results from a retrospective cohort study, evaluating Triple A, a novel risk model for predicting outcomes in essential thrombocythemia (ET), were published in Blood Advances by Sönmez et al. The model incorporated age, absolute neutrophil, and absolute lymphocyte counts, refined further by integrating absolute monocyte count and neutrophil-to-lymphocyte ratio (NLR), and was evaluated in 565 patients with ET. 

Key data: Patients were stratified into low risk (n = 250), intermediate-1 risk (n = 228), intermediate-2 risk (n = 37), and high risk (n = 50). Triple A successfully stratified overall survival (OS) and thrombosis-free survival (TFS) (p < 0.0001 and p = 0.0003, respectively); median OS was not reached in the low- and intermediate-1-risk groups and was 10.5 years and 8.7 years in the intermediate-2- and high-risk groups, respectively. The Triple A model showed better predictive performance vs the International Prognostic Score for ET (IPSET), International Prognostic Score of Thrombosis in ET (IPSET-T), and revised IPSET-T models. Monocytosis prevalence was associated with higher mortality; incorporation of monocyte count improved predictive accuracy of the model. NLR >3.21 predicted worse survival outcomes (HR, 2.04; 95% confidence interval [CI], 1.22–3.30; p = 0.006) but not thrombosis (p = 0.33). 

Key learning: Triple A is a novel, simple, complete blood count-based risk model for prognostic assessment in ET, with results suggesting incorporation of monocyte count may further refine survival and thrombosis stratification.