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Blood. 2020 Feb 27. pii: blood.2019003347. doi: 10.1182/blood.2019003347. [Epub ahead of print]

Persistent leukocytosis in polycythemia vera is associated with disease evolution but not thrombosis.

Author information

1
Icahn School of Medicine At Mount Sinai, New York, New York, United States.
2
Yale University, New Haven, Connecticut, United States.
3
Stanford Cancer Institute, Stanford, California, United States.
4
Columbia University Medical Center, New York, New York, United States.
5
H. Lee Moffitt Cancer Center, Tampa, Florida, United States.
6
University of Southern California, Los Angeles, California, United States.
7
Rush University, Chicago, Illinois, United States.
8
University of California, Irvine, Irvine, California, United States.
9
Mays Cancer Center UT Health San Antonio, San Antonio, Texas, United States.
10
UT Health San Antonio Cancer Center, San Antonio, Texas, United States.
11
The University of Kansas Cancer Center, Kansas City, Kansas, United States.
12
Stanford Cancer Institute, Palo Alto, California, United States.
13
Yale School of Public Health, New Haven, Connecticut, United States.
14
Yale Cancer Center, New Haven, Connecticut, United States.
15
Icahn School of Medicine at Mount Sinai, New York, New York, United States.
16
Rush University Medical Center, Chicago, Illinois, United States.
17
Mount Sinai Medical Center, New York, New York, United States.
18
Icahn School of Medicine, New York, New York, United States.

Abstract

There are unresolved questions regarding the association between persistent leukocytosis and risk of thrombosis and disease evolution in polycythemia vera (PV), as much of the published literature on the topic does not appropriately utilize repeated measures data or time-dependent modeling to answer these questions. To address this knowledge gap, we analyzed a retrospective database of 520 PV patients seen at 10 academic institutions across the United States. Taking hematologic lab data at approximate 3-month intervals (or as available) for all patients for duration of follow-up, we used group-based trajectory modeling (GBTM) to identify latent clusters of patients who follow distinct trajectories with regards to their leukocyte, hematocrit, and platelet counts over time. We then tested the association between trajectory membership and hazard of two major outcomes: thrombosis and disease evolution to myelofibrosis, myelodysplastic syndrome, or acute myeloid leukemia. Controlling for relevant covariates, we found that persistently elevated leukocyte trajectories were not associated with hazard of thrombotic event (p = 0.4163), but were significantly associated with increased hazard of disease evolution in an ascending stepwise manner (overall p = 0.0002). Additionally, we found that neither hematocrit nor platelet count were significantly associated with hazard of thrombosis or disease evolution.

PMID:
32107559
DOI:
10.1182/blood.2019003347

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