Persistent leukocytosis in polycythemia vera is associated with disease evolution but not thrombosis

There are unresolved questions regarding the association between persistent leukocytosis and risk of thrombosis and disease evolution in polycythemia vera (PV), as much of the published literature on the topic does not appropriately use repeated-measures data or time-dependent modeling to answer the...

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Bibliographic Details
Published in:Blood 2020-05, Vol.135 (19), p.1696-1703
Main Authors: Ronner, Lukas, Podoltsev, Nikolai, Gotlib, Jason, Heaney, Mark L., Kuykendall, Andrew T., O'Connell, Casey, Shammo, Jamile, Fleischman, Angela G., Scherber, Robyn M., Mesa, Ruben, Yacoub, Abdulraheem, Perkins, Cecelia, Meckstroth, Shelby, Behlman, Lindsey, Chiaramonte, Matthew, Salehi, Mahta, Ziadkhanpour, Kimia, Nguyen, Hellen, Siwoski, Olivia, Hung, Annie Kwok, Janania Martinez, Michelle, Nguyen, Jenny, Patel, Sagar, Kollipara, Revathi, Dave, Ami, Randall, Megan, Grant, Michael, Harrison, Mitchell, Fernandez Soto, Paola, Tremblay, Douglas, Hoffman, Ronald, Moshier, Erin, Mascarenhas, John
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Female
Follow-Up Studies
Humans
Leukemia, Myeloid, Acute - etiology
Leukemia, Myeloid, Acute - pathology
Leukocytosis - physiopathology
Male
Middle Aged
Myelodysplastic Syndromes - etiology
Myelodysplastic Syndromes - pathology
Myeloid Neoplasia
Polycythemia Vera - complications
Polycythemia Vera - pathology
Primary Myelofibrosis - etiology
Primary Myelofibrosis - pathology
Prognosis
Retrospective Studies
Survival Rate
Thrombosis
Young Adult
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Summary:There are unresolved questions regarding the association between persistent leukocytosis and risk of thrombosis and disease evolution in polycythemia vera (PV), as much of the published literature on the topic does not appropriately use repeated-measures data or time-dependent modeling to answer these questions. To address this knowledge gap, we analyzed a retrospective database of 520 PV patients seen at 10 academic institutions across the United States. Taking hematologic laboratory data at ∼3-month intervals (or as available) for all patients for duration of follow-up, we used group-based trajectory modeling to identify latent clusters of patients who follow distinct trajectories with regard to their leukocyte, hematocrit, and platelet counts over time. We then tested the association between trajectory membership and hazard of 2 major outcomes: thrombosis and disease evolution to myelofibrosis, myelodysplastic syndrome, or acute myeloid leukemia. Controlling for relevant covariates, we found that persistently elevated leukocyte trajectories were not associated with the hazard of a thrombotic event (P = .4163), but were significantly associated with increased hazard of disease evolution in an ascending stepwise manner (overall P = .0002). In addition, we found that neither hematocrit nor platelet count was significantly associated with the hazard of thrombosis or disease evolution. •Elevated yearlong leukocyte trajectories predicted PV disease evolution.•No yearlong hematologic laboratory value trajectories predicted thrombosis. [Display omitted]
ISSN:0006-4971
1528-0020
DOI:10.1182/blood.2019003347