title: Monocytosis in polycythemia vera: Clinical and molecular correlates.
abstract: Monocytosis (absolute monocyte count, AMC ≥ 1 × 109/L) might accompany a spectrum of myeloid neoplasms, other than chronic myelomonocytic leukemia (CMML). In the current study, we examined the prevalence, laboratory and molecular correlates, and prognostic relevance of monocytosis in polycythemia vera (PV). Among 267 consecutive patients with World Health Organization (WHO)-defined PV, 55 (21%) patients displayed an AMC of ≥1 × 109/L and 18 (7%) an AMC of ≥1.5 × 109/L. In general, PV patients with monocytosis were significantly older and displayed higher frequencies of leukocytosis (81% vs. 50% at AMC ≥1 × 109/L) and TET2/SRSF2 mutations (57%/29% vs. 19%/1% at AMC ≥ 1.5 × 109/L). In univariate analysis, AMC ≥1.5 × 109/L adversely affected overall (OS; P = .004; HR 2.6, 95% CI 1.4-4.8) and myelofibrosis-free (MFFS; P = .02; HR 4.4, 95% CI 1.3-15.1) survival; during multivariable analysis, significance was borderline sustained for OS (P = .05) and MFFS (P = .06). Other independent risk factors for OS included unfavorable karyotype (P = .02, HR 3.39, 95% CI 1.17-9.79), older age (P < .0001, HR 3.34 95% CI 1.97-5.65), and leukocytosis ≥15 × 109/L (P = .004, HR 2.04, 95% CI 1.26-3.29). In conclusion, in the current study, we encountered a higher than expected prevalence of monocytosis in patients with PV and the mutation profile and age distribution of PV patients with monocytosis is akin to those of patients with CMML and might partly contribute to their worse prognosis.
authors.affiliation: Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Daniela
authors.identifier: http://orcid.org/0000-0001-6768-8987
authors.initials: D
authors.lastname: Barraco
authors.affiliation: Division of Hematology, Department of Internal Medicine, University of Calgary, Calgary, Alberta, USA.
authors.forename: Sonia
authors.initials: S
authors.lastname: Cerquozzi
authors.affiliation: Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Naseema
authors.initials: N
authors.lastname: Gangat
authors.affiliation: Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Mrinal M
authors.identifier: http://orcid.org/0000-0001-6998-662X
authors.initials: MM
authors.lastname: Patnaik
authors.affiliation: Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Terra
authors.initials: T
authors.lastname: Lasho
authors.affiliation: Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Christy
authors.initials: C
authors.lastname: Finke
authors.affiliation: Division of Hematopathology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Curtis A
authors.initials: CA
authors.lastname: Hanson
authors.affiliation: Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Rhett P
authors.initials: RP
authors.lastname: Ketterling
authors.affiliation: Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Animesh
authors.initials: A
authors.lastname: Pardanani
authors.affiliation: Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Ayalew
authors.initials: A
authors.lastname: Tefferi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004252:DNA Mutational Analysis; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007621:Karyotyping; D007958:Leukocyte Count; D007964:Leukocytosis / Q000097:blood* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000473:pathology*; D009154:Mutation; D010641:Phenotype; D011087:Polycythemia Vera / Q000097:blood* / Q000175:diagnosis / Q000235:genetics / Q000401:mortality; D011379:Prognosis; D055815:Young Adult