<p>Vascular Diseases In Patients With Chronic Myeloproliferative Neoplasms – Impact Of Comorbidity</p>

Abstract

BackgroundPatients with chronic myeloproliferative neoplasms (MPNs), including essential thrombocythemia (ET), polycythemia vera (PV), and primary myelofibrosis (PMF), are at high risk of vascular complications. However, the magnitude of this is risk not well known and the possible effect of comorbidity is poorly understood.AimOur aim was to compare the risk of vascular diseases in patients with MPNs and matched comparisons from the general population and to study the effect modification of comorbidity.MethodsWe followed 3087 patients with ET, 6076 with PV, 3719 with PMF or unspecified MPN, and age- and sex-matched general population comparisons to estimate the risks of cardiovascular diseases such as myocardial infarction and stroke. We computed 5-year cumulative incidences (risks) for vascular disease in patients with MPNs and comparisons as well as 1-year and 5-year risks, risk differences, and hazard ratios (HRs) for vascular diseases comparing rates in each group of patients with their comparison cohort by level of comorbidity based on the Charlson Comorbidity Index (CCI) [score of 0 (low comorbidity), of 1–2 (moderate comorbidity), and of >2 (severe comorbidity)], as well as other comorbid conditions.ResultsThe overall 5-year risk of vascular disease ranged from 0.5% to 7.7% in patients with MPNs, which was higher than the risk in the general population. In the same period, the adjusted HRs for vascular disease were 1.3 to 3.7 folds higher in patients with MPNs compared to the general population. An increase in CCI score was associated with an equally increased rate of most types of vascular diseases during the first 5 years of follow-up in both MPN and comparisons.ConclusionPatients with MPNs have a higher risk of vascular diseases during the first 5 years than that of the general population; however, comorbidity modifies the rates similarly in MPN and in the general population.

Treatment of Essential Thrombocythemia with Anagrelide Is Associated with an Increased Risk of Worsened Kidney Function

“…Similar relationships had been found with respect to Cr level [9]. Since in patients with myelo-proliferative neoplasms the risk of vascular disease is 1.3to 3.7-fold higher than that in the general population [10], administration of drugs affecting kidney function may be particularly harmful. The present study is aimed at evaluating the effects of the most frequently used methods of cytoreductive ET treatment (i.e., HU and ANA) on renal function, taking into account the risk factors of renal disease progression and coexisting genetic mutations.…”

Risks of Solid and Lymphoid Malignancies in Patients with Myeloproliferative Neoplasms: Clinical Implications

“…Myeloproliferative neoplasms (MPNs) encompassing essential thrombocythemia (ET), polycythemia vera (PV), primary myelofibrosis (PMF), chronic myeloid leukemia (CML), and unspecified MPNs are chronic stem cell cancers of the bone marrow [ 1 ]. Although MPNs are considered to be relatively indolent hematological cancers, patients suffer a reduced quality of life, increased risks of vascular complications, MPN progression, leukemic transformation, and consequently reduced life expectancy [ 2 , 3 , 4 , 5 , 6 , 7 , 8 ]. Patients with MPNs therefore often remain in life-long clinical follow up to monitor and treat the disease and to avoid or manage complications.…”

Low-Risk Essential Thrombocythemia: A Comprehensive Review

“… 33 In contrast to other MPNs, ET is more common in females. 33 , 34 It is primarily a disease of older age with a usual age of onset of 50-60 years, although there is also a substantial cohort of younger patients diagnosed with ET. 35 Overall survival is only mildly reduced when compared with the general population 30 , 36 and prognosis is more favorable in ET than in PV or PMF, regardless of molecular subtype.…”