title: Decisional flow with a scoring system to start platelet-lowering treatment in patients with essential thrombocythemia: long-term results.
abstract: We prospectively tested, at diagnosis in essential thrombocythemia (ET) patients with no clear indication to platelet (PLT)-lowering treatment, a scoring system based on age, PLT level, cardiovascular diseases, previous thrombotic events, smoking and dysmetabolic diseases. From 04/92 to 03/98, 168 consecutive patients were enrolled. Hydroxyurea (HU) was started at diagnosis in 32 "symptomatic" patients and in 33 patients aged >70 years. The remaining 103 patients ("asymptomatic" and aged <70 years) were classified according to our scoring system. Thirty-two patients with score > or = 4 started HU early after diagnosis. The remaining 71 patients with score <4 at diagnosis received anti-aggregating agents only; of them, 24 (33.8%) started HU during follow-up after a median time from diagnosis of 28 months, while 47 (66.2%) did not start any PLT-lowering treatment. Thrombotic complications occurred in 9/103 patients (8.7%); in particular, they occurred in 4/32 patients (12.5%) with score > or = 4 receiving HU since diagnosis and in 5/71 (7%) with score <4 under anti-aggregating agents only. This scoring system appears effective to discriminate a different risk of thrombotic events, and could be useful to decide when a PLT-lowering therapy needs to be started.
authors.affiliation: Department of Cellular Biotechnology and Hematology, University "La Sapienza", Via Benevento 6, 00161, Rome, Italy. rob.lati@libero.it.
authors.forename: Roberto
authors.initials: R
authors.lastname: Latagliata
authors.affiliation: Department of Cellular Biotechnology and Hematology, University "La Sapienza", Via Benevento 6, 00161, Rome, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: Rago
authors.affiliation: Ematologia, Istituto Regina Elena, Rome, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Spadea
authors.affiliation: Department of Cellular Biotechnology and Hematology, University "La Sapienza", Via Benevento 6, 00161, Rome, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Santoro
authors.affiliation: Department of Cellular Biotechnology and Hematology, University "La Sapienza", Via Benevento 6, 00161, Rome, Italy.
authors.forename: Ida
authors.initials: I
authors.lastname: Carmosino
authors.affiliation: Department of Cellular Biotechnology and Hematology, University "La Sapienza", Via Benevento 6, 00161, Rome, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Breccia
authors.affiliation: Department of Cellular Biotechnology and Hematology, University "La Sapienza", Via Benevento 6, 00161, Rome, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Napoleone
authors.affiliation: Department of Cellular Biotechnology and Hematology, University "La Sapienza", Via Benevento 6, 00161, Rome, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Fama
authors.affiliation: Department of Cellular Biotechnology and Hematology, University "La Sapienza", Via Benevento 6, 00161, Rome, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Biondo
authors.affiliation: Department of Cellular Biotechnology and Hematology, University "La Sapienza", Via Benevento 6, 00161, Rome, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Volpicelli
authors.affiliation: Department of Cellular Biotechnology and Hematology, University "La Sapienza", Via Benevento 6, 00161, Rome, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Vozella
authors.affiliation: Department of Cellular Biotechnology and Hematology, University "La Sapienza", Via Benevento 6, 00161, Rome, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Stefanizzi
authors.affiliation: Ematologia, Istituto Regina Elena, Rome, Italy.
authors.forename: Maria Concetta
authors.initials: MC
authors.lastname: Petti
authors.affiliation: Department of Cellular Biotechnology and Hematology, University "La Sapienza", Via Benevento 6, 00161, Rome, Italy.
authors.forename: Giuliana
authors.initials: G
authors.lastname: Alimena
authors.affiliation: Department of Cellular Biotechnology and Hematology, University "La Sapienza", Via Benevento 6, 00161, Rome, Italy.
authors.forename: Maria Gabriella
authors.initials: MG
authors.lastname: Mazzucconi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D001792:Blood Platelets / Q000187:drug effects*; D002318:Cardiovascular Diseases / Q000150:complications; D002985:Clinical Protocols; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006918:Hydroxyurea / Q000627:therapeutic use*; D008297:Male; D008659:Metabolic Diseases / Q000150:complications; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D010976:Platelet Count; D012307:Risk Factors; D012907:Smoking; D016019:Survival Analysis; D013920:Thrombocythemia, Essential / Q000097:blood / Q000145:classification / Q000150:complications / Q000188:drug therapy*; D013927:Thrombosis / Q000150:complications / Q000517:prevention & control; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D006918:Hydroxyurea
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