title: Neurological symptoms in essential thrombocythemia: impact of JAK2V617F mutation and response to therapy.
abstract: Patients with essential thrombocythemia (ET) often suffer from neurological symptoms (NS) not ever resulting from previous thrombotic cerebral events (TCE). We reported NS occurred in 282 patients, in order to identify the factors influencing ET-related NS in the absence of TCE, and the response to therapy. Overall, 116 of 282 patients (41%) presented NS; 101 of them (87%) reported subjective transient and fluctuating NS, without concurrent TCE, which we defined as ET-related NS, by frequency: cephalalgia, chronic paresthesias, dizziness or hypotension, visual disturbances, and tinnitus. In univariate analysis, ET-related NS resulted more frequently in young people (P = 0.017) and in females (P = 0.025). We found a higher prevalence of JAK2V617F mutation in ET-related NS patients (P = 0.021). In multivariate analysis, gender (P = 0.024) and JAK2V617F mutation (P = 0.041) remained significantly associated with the development of ET-related NS, with a risk of about four times higher for JAK2V617F-mutated patients (OR = 3.75). Ninety-seven of 101 patients with ET-related NS received an antiplatelet (AP) agent at the time of NS, whereas only selected high-risk ET-related NS patients were treated with a cytoreductive drug, according to the published guidelines and similarly to patients without NS. We observed that only 32 of 97 (33%) patients with ET-related NS achieved a complete response after AP treatment. Among the 65 non-responder patients, 36 (55.4%) improved NS after the introduction of cytoreductive therapy; therefore, the addition of cytoreductive treatment should be considered in this setting.
authors.affiliation: Hematology Division, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Aroldi
authors.affiliation: Hematology Division, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Cecchetti
authors.affiliation: Centro Ricerca Tettamanti, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
authors.forename: Arianna
authors.initials: A
authors.lastname: Colombo
authors.affiliation: Hematology Division, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Cattaneo
authors.affiliation: Hematology Division, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
authors.forename: Pietro Enrico
authors.initials: PE
authors.lastname: Pioltelli
authors.affiliation: Dipartimento di Scienze della Salute, University of Milano-Bicocca, Monza, Italy.
authors.forename: Enrico Maria
authors.initials: EM
authors.lastname: Pogliani
authors.affiliation: Hematology Division, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
authors.forename: Elena Maria
authors.initials: EM
authors.lastname: Elli
mesh_terms: D000328:Adult; D000368:Aged; D003062:Codon; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D053614:Janus Kinase 2 / Q000235:genetics; D008297:Male; D008875:Middle Aged; D009154:Mutation; D009422:Nervous System Diseases / Q000175:diagnosis* / Q000209:etiology*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011379:Prognosis; D012307:Risk Factors; D013920:Thrombocythemia, Essential / Q000150:complications* / Q000188:drug therapy / Q000235:genetics / Q000401:mortality; D016896:Treatment Outcome
chemical_list: D003062:Codon; D010975:Platelet Aggregation Inhibitors; D053614:Janus Kinase 2
keywords: JAK2V617F mutation; essential thrombocythemia; myeloproliferative neoplasm; neurological symptoms; platelets