1087P - Leukocytosis in polycythemia vera and splenomegaly in essential thrombocythemia are independent risk factors of hemorrhage

Date 30 September 2012
Event ESMO Congress 2012
Session Poster presentation II
Topics Haematologic Malignancies
Presenter Yi-Sheng Chou
Authors Y. Chou1, J. Gau1, J. Liu2, Y. Yu3, J. Pai4, L. Hsiao3, Y. Hong3, C. Liu3, P. Chen3, C. Tzeng3
  • 1Division Of Hematology And Oncology,department Of Medicine, Taipei Veterans General Hospital, 11217 - Taipei/TW
  • 2Medical Oncology, Taipei Veterans General Hospital, 11217 - Taipei/TW
  • 3Department Of Medicine, Division Of Hematology And Oncology, Taipei Veterans General Hospital, 11217 - Taipei/TW
  • 4Department Of Medicine, National Yang-Ming University Hospital, 26042 - Yilan/TW

Abstract

Background

Long term outcomes are generally favorable for patients with polycythemia vera (PV) or essential thrombocythemia (ET), however, complications of thrombosis and hemorrhage do cause significant morbidity and mortality.

Methods

Patients diagnosed with PV (n = 101) and ET (n = 146) in a single medical center from 2001 to 2010 were retrospectively recruited for analysis.

Results

The median overall survival (OS) was 111 months for patients with PV and not reached for ET (p = 0.872) after a median follow-up period of 36 months. Patients with PV and ET shared similar hemorrhage-free survival (HFS) (p =0.410). 17.8% of patients with PV and 18.5% of ET has experienced complications of hemorrhage (p =1.000) while 9.9% of patients with PV and 14.4% of ET had major bleeding which necessitated blood transfusion, hospitalizations or caused mortality. Upper gastrointestinal bleeding was most frequently encountered followed by intracranial hemorrhage (ICH) and subdural hemorrhage (SDH). Univariate analysis revealed age ≥ 60 years (OR: 4.77, 95% CI: 1.03-22.15, p = 0.046) and WBC ≥ 16 x10^9/L (OR: 4.15, 95% CI: 1.41-12.24, p = 0.010) as risk factors predicting hemorrhage in PV patients, while for ET patients, the risk factors of hemorrhage includes age ≥ 60 years (OR: 3.25, 95% CI: 1.06-10.03, p = 0.040), WBC ≥ 16 x10^9/L (OR: 2.89, 95% CI: 1.15-7.25, p = 0.024), albumin< 4.0 g/dl (OR: 4.10, 95% CI: 1.67-10.09, p = 0.002), and splenomegaly (OR: 5.19, 95% CI: 1.80-14.95, p = 0.002). Medications for treating or preventing thrombosis and cytoreductive agents such as aspirin, persantin, antiplatelet, hydroxyurea or anagrelide demonstrated no elevated risk of hemorrhage of statistical significance. Multivariate analysis showed that WBC ≥ 16 x 10^9/ L was the only significant risk factor of hemorrhage in PV patients (OR: 3.51, 95% CI: 1.16-10.58, p = 0.026) and splenomegaly the only risk factor in ET patients (OR: 3.54, 95% CI: 1.25-10.00, p = 0.017). The risk factors of WBC ≥ 16 x10^9/L and splenomegaly also predicted worse HFS for PV and ET patients, respectively (p = 0.041 for PV and 0.009 for ET, respectively).

Conclusion

Although the pathogenic mechanism(s) of hemorrhage behind leukocytosis in PV and splenomegaly in ET remains elusive, the clinical implication warrants further investigation.

Disclosure

All authors have declared no conflicts of interest.