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Ann Hematol. 2019 Apr;98(4):889-896. doi: 10.1007/s00277-018-3569-1. Epub 2018 Dec 4.

Impact of comorbidities and body mass index in patients with myelofibrosis treated with ruxolitinib.

Author information

1
Division of Cellular Biotechnologies and Hematology, University Sapienza, Via Benevento 6, 00161, Rome, Italy. breccia@bce.uniroma1.it.
2
Institute of Hematology "L. and A. Seràgnoli", Sant'Orsola-Malpighi University Hospital, Bologna, Italy.
3
Department of Hematology, University of Verona, Verona, Italy.
4
Division of Hematology, AOU "Policlinico-V. Emanuele", University of Catania, Catania, Italy.
5
Unit of Blood Diseases and Stem Cells Transplantation, Department of Clinical and Experimental Sciences, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy.
6
Division of Hematology, Ospedale S. Eugenio, Rome, Italy.
7
Clinic of Hematology, Department of Internal Medicine (DiMI), IRCCS AOU San Martino-IST, Genoa, Italy.
8
Division of Hematology, Azienda Ospedaliera-IRCSS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
9
Division of Hematology and BMT, Department of Medical Area, University of Udine, Udine, Italy.
10
Hematology Division, IRCCS Ca' Granda - Maggiore Policlinico Hospital Foundation, University of Milan, Milan, Italy.
11
Division of Hematology, University of Ferrara, Ferrara, Italy.
12
Division of Hematology, Casa Sollievo Sofferenza, San Giovanni Rotondo, Italy.
13
Unit of Hematology and Clinical Immunology, University of Padova, Padua, Italy.
14
Hematology and Stem Cell Transplant Center, AORMN Hospital, Pesaro, Italy.
15
Division of Hematology, ASST Spedali Civili di Brescia, Brescia, Italy.
16
Division of Hematology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
17
Division of Hematology, Piacenza, Italy.
18
Internal Medicine II, Hematology and Oncology, Friedrich-Schiller-University Medical Center, Jena, Germany.
19
Division of Cellular Biotechnologies and Hematology, University Sapienza, Via Benevento 6, 00161, Rome, Italy.

Abstract

Comorbidities defined by the Charlson comorbidity index (CCI) and body mass index (BMI) are significantly associated with outcome in patients who receive continuous treatment with tyrosine kinase inhibitors. We evaluated the impact of CCI and BMI on responses, drug-related toxicities, and outcome in a cohort of 402 patients with myelofibrosis (MF) treated with ruxolitinib in 23 European Hematology Centers. Comorbidities were evaluable in all 402 patients. A higher (≥ 3) CCI did not correlate with a lower spleen reduction at any time (p = 0.68) or symptoms' response (p = 0.11), but influenced the onset of anemia during the first 3 months of treatment and later (p = 0.02 and p = 0.03, respectively) in patients without anemia baseline. BMI was evaluable in 380 patients and did not correlate with differences in spleen and symptoms response (p = 0.57 and p = 0.49, respectively). A higher CCI and a lower BMI correlated also with a reduced overall survival (p < 0.001 and p = 0.02, respectively). The achievement of a spleen response at 6 months could counterbalance the negative impact of comorbidities, while patients who were underweight when starting ruxolitinib and did not achieve a spleen response at 6 months were projected to the worse outcome. In MF patients treated with ruxolitinib, BMI and comorbidities did not influence the achievement of spleen/symptom responses, but they contributed to the early identification of patients who deserve a strict monitoring during treatment.

KEYWORDS:

BMI; CCI; Comorbidities; Myelofibrosis; Ruxolitinib

PMID:
30515542
DOI:
10.1007/s00277-018-3569-1
[Indexed for MEDLINE]

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