title: Blood tests may predict early primary myelofibrosis in patients presenting with essential thrombocythemia.
abstract: According to World Health Organization (WHO)-defined criteria, patients presenting clinically as essential thrombocythemia (ET) may show early primary myelofibrosis (PMF) with accompanying thrombocythemia [1]. Previous clinicopathological studies revealed that laboratory parameters like gender-matched hemoglobin (Hb), white blood cell (WBC) count, and particularly lactate dehydrogenase (LDH) values are significantly different in PMF [2]. By strictly applying the WHO criteria, our investigation was aimed to study sensitivity and specificity of these features in an exploratory cohort of 536 patients and to validate the results on an independently recruited series of 321 strictly corresponding patients. The discriminatory power of these parameters (Hb, WBC, and LDH) was tested by plotting their receiver operating characteristic curves. The best performance was found for LDH (areas under the curve, AUC 5 0.7059). WBC and Hb had superimposable curves, with AUC of 0.6279 and 0.6257, respectively. A diagnostic algorithm was generated by applying these parameters in a stepwise fashion. Nearly half of the patients could be correctly allocated to WHO-defined ET or early PMF in both cohorts investigated. It is important to note that this result does not substitute bone marrow morphology with hematological parameters, however, in clinical practice may alert physicians to get more suspicious of early PMF in a patient presumably presenting with ET.
authors.affiliation: Division of Hematology, Ospedali Riuniti di Bergamo, Bergamo, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Carobbio
authors.forename: Guido
authors.initials: G
authors.lastname: Finazzi
authors.forename: Juergen
authors.initials: J
authors.lastname: Thiele
authors.forename: Hans-Michael
authors.initials: HM
authors.lastname: Kvasnicka
authors.forename: Francesco
authors.initials: F
authors.lastname: Passamonti
authors.forename: Elisa
authors.initials: E
authors.lastname: Rumi
authors.forename: Marco
authors.initials: M
authors.lastname: Ruggeri
authors.forename: Francesco
authors.initials: F
authors.lastname: Rodeghiero
authors.forename: Maria
authors.initials: M
authors.lastname: Luigia Randi
authors.forename: Irene
authors.initials: I
authors.lastname: Bertozzi
authors.forename: Alessandro M
authors.initials: AM
authors.lastname: Vannucchi
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Antonioli
authors.forename: Heinz
authors.initials: H
authors.lastname: Gisslinger
authors.forename: Veronika
authors.initials: V
authors.lastname: Buxhofer-Ausch
authors.forename: Naseema
authors.initials: N
authors.lastname: Gangat
authors.forename: Alessandro
authors.initials: A
authors.lastname: Rambaldi
authors.forename: Ayalew
authors.initials: A
authors.lastname: Tefferi
authors.forename: Tiziano
authors.initials: T
authors.lastname: Barbui
mesh_terms: D001853:Bone Marrow / Q000201:enzymology / Q000473:pathology*; D015331:Cohort Studies; D003937:Diagnosis, Differential; D005260:Female; D006403:Hematologic Tests; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008297:Male; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D055728:Primary Myelofibrosis / Q000175:diagnosis* / Q000201:enzymology / Q000473:pathology; D012372:ROC Curve; D013920:Thrombocythemia, Essential / Q000175:diagnosis* / Q000201:enzymology / Q000473:pathology; D014944:World Health Organization
chemical_list: D006454:Hemoglobins; D007770:L-Lactate Dehydrogenase