Persistent leukocytosis in polycythemia vera is associated with disease evolution but not thrombosis
Top Cited Papers
Open Access
- 7 May 2020
- journal article
- research article
- Published by American Society of Hematology in Blood
- Vol. 135 (19), 1696-1703
- https://doi.org/10.1182/blood.2019003347
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 use 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 laboratory data at similar to 3-month intervals (or as available) for all patients for duration of follow-up, we used group-based trajectory modeling to identify latent clusters of patients who follow distinct trajectories with regard to their leukocyte, hematocrit, and platelet counts over time. We then tested the association between trajectory membership and hazard of 2 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 the hazard of a thrombotic event (P=.4163), but were significantly associated with increased hazard of disease evolution in an ascending stepwise manner (overall P = .0002). In addition, we found that neither hematocrit nor platelet count was significantly associated with the hazard of thrombosis or disease evolution.This publication has 25 references indexed in Scilit:
- Revised response criteria for polycythemia vera and essential thrombocythemia: an ELN and IWG-MRT consensus projectBlood, 2013
- Survival and prognosis among 1545 patients with contemporary polycythemia vera: an international studyLeukemia, 2013
- Group-Based Trajectory Modeling in Clinical ResearchAnnual Review of Clinical Psychology, 2010
- Postpolycythaemic myelofibrosis: frequency and risk factors for this complication in 116 patientsBritish Journal of Haematology, 2009
- Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics supportJournal of Biomedical Informatics, 2008
- Leucocytosis in polycythaemia vera predicts both inferior survival and leukaemic transformationBritish Journal of Haematology, 2007
- Leukocytosis is a risk factor for thrombosis in essential thrombocythemia: interaction with treatment, standard risk factors, and Jak2 mutation statusBlood, 2006
- Inflammation, Atherosclerosis, and Coronary Artery DiseaseThe New England Journal of Medicine, 2005
- Polycythemia vera: myths, mechanisms, and managementBlood, 2002
- A SAS Procedure Based on Mixture Models for Estimating Developmental TrajectoriesSociological Methods & Research, 2001