A dynamic prognostic model to predict survival in post-polycythemia vera myelofibrosis.
Post-polycythemia vera myelofibrosis (post-PV MF) is a late evolution of PV. In 647 patients with PV, we found that leukocytosis leukocyte count>(15x10(9)/L) at diagnosis is a risk factor for the evolution of post-PV MF. In a series of 68 patients who developed post-PV MF, median survival was 5.7 years. Hemoglobin level less than 100 g/L (10 g/dL) at diagnosis of post-PV MF was an independent risk factor for survival. The course of post-PV MF, however, is a dynamic process that implies a progressive worsening of clinical parameters. Using a multivariate Cox proportional hazard regression with time-dependent covariates, we found that a dynamic score based on hemoglobin level less than 100 g/L (10 g/dL), platelet count less than 100x10(9)/L, and leukocyte count more than 30x10(9)/L is useful to predict survival at any time from diagnosis of post-PV MF. The resulting hazard ratio of the score was 4.2 (95% CI: 2.4-7.7; P<.001), meaning a 4.2-fold worsening of survival for each risk factor acquired during follow up. In conclusion, leukocytosis at diagnosis of PV is a risk factor for evolution in post-PV MF. A dynamic score based on hemoglobin level, and platelet and leukocyte count predicts survival at any time from diagnosis of post-PV MF.
Passamonti
Francesco
F
Department of Hematology, Fondazione Istituto di ricovero e cura a carattere scientifico Policlinico San Matteo, University of Pavia, Italy. f.passamonti@smatteo.pv.it
Rumi
Elisa
E
Caramella
Marianna
M
Elena
Chiara
C
Arcaini
Luca
L
Boveri
Emanuela
E
Del Curto
Cecilia
C
Pietra
Daniela
D
Vanelli
Laura
L
Bernasconi
Paolo
P
Pascutto
Cristiana
C
Cazzola
Mario
M
Morra
Enrica
E
Lazzarino
Mario
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005500:Follow-Up Studies; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007958:Leukocyte Count; D007964:Leukocytosis / Q000097:blood / Q000175:diagnosis / Q000401:mortality; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D010976:Platelet Count; D011087:Polycythemia Vera / Q000097:blood* / Q000150:complications / Q000175:diagnosis / Q000401:mortality*; D011237:Predictive Value of Tests; D055728:Primary Myelofibrosis / Q000097:blood* / Q000175:diagnosis / Q000209:etiology / Q000401:mortality*; D011379:Prognosis; D012044:Regression Analysis; D012307:Risk Factors; D015996:Survival Rate
D006454:Hemoglobins