Decisional flow with a scoring system to start platelet-lowering treatment in patients with essential thrombocythemia: long-term results.
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.
Latagliata
Roberto
R
Department of Cellular Biotechnology and Hematology, University "La Sapienza", Via Benevento 6, 00161, Rome, Italy. rob.lati@libero.it.
Rago
Angela
A
Department of Cellular Biotechnology and Hematology, University "La Sapienza", Via Benevento 6, 00161, Rome, Italy.
Spadea
Antonio
A
Ematologia, Istituto Regina Elena, Rome, Italy.
Santoro
Cristina
C
Department of Cellular Biotechnology and Hematology, University "La Sapienza", Via Benevento 6, 00161, Rome, Italy.
Carmosino
Ida
I
Department of Cellular Biotechnology and Hematology, University "La Sapienza", Via Benevento 6, 00161, Rome, Italy.
Breccia
Massimo
M
Department of Cellular Biotechnology and Hematology, University "La Sapienza", Via Benevento 6, 00161, Rome, Italy.
Napoleone
Laura
L
Department of Cellular Biotechnology and Hematology, University "La Sapienza", Via Benevento 6, 00161, Rome, Italy.
Fama
Angelo
A
Department of Cellular Biotechnology and Hematology, University "La Sapienza", Via Benevento 6, 00161, Rome, Italy.
Biondo
Francesca
F
Department of Cellular Biotechnology and Hematology, University "La Sapienza", Via Benevento 6, 00161, Rome, Italy.
Volpicelli
Paola
P
Department of Cellular Biotechnology and Hematology, University "La Sapienza", Via Benevento 6, 00161, Rome, Italy.
Vozella
Federico
F
Department of Cellular Biotechnology and Hematology, University "La Sapienza", Via Benevento 6, 00161, Rome, Italy.
Stefanizzi
Caterina
C
Department of Cellular Biotechnology and Hematology, University "La Sapienza", Via Benevento 6, 00161, Rome, Italy.
Petti
Maria Concetta
MC
Ematologia, Istituto Regina Elena, Rome, Italy.
Alimena
Giuliana
G
Department of Cellular Biotechnology and Hematology, University "La Sapienza", Via Benevento 6, 00161, Rome, Italy.
Mazzucconi
Maria Gabriella
MG
Department of Cellular Biotechnology and Hematology, University "La Sapienza", Via Benevento 6, 00161, Rome, Italy.
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
D010975:Platelet Aggregation Inhibitors; D006918:Hydroxyurea
Blood. 2007 Mar 15;109(6):2310-3
17110452
Blood. 2006 Oct 1;108(7):2493-4
16988161
Best Pract Res Clin Haematol. 2006;19(3):439-53
16781482
N Engl J Med. 1995 Apr 27;332(17):1132-6
7700286
Haematologica. 2004 Feb;89(2):215-32
15003898
Br J Haematol. 2006 Jan;132(2):244-5
16398659
N Engl J Med. 2005 Jul 7;353(1):85-6
16000360
Int J Hematol. 2008 May;87(4):446-448
18409076
Curr Opin Hematol. 2006 Mar;13(2):93-8
16456375
Br J Haematol. 2008 Mar;140(5):488-95
18275426
Semin Hematol. 1997 Jan;34(1):29-39
9025160
Leukemia. 1999 Feb;13(2):150-4
10025886
Int J Hematol. 2006 Jun;83(5):443-9
16787877