Survival Patterns in United States (US) Medicare Enrollees with Non-CML Myeloproliferative Neoplasms (MPN)

Abstract

PurposeNon-CML myeloproliferative neoplasms (MPN) include essential thrombocythemia (ET), polycythemia vera (PV), and myelofibrosis (MF). Reported median overall survival (OS) ranges from a few to several years for MF, a decade or more for ET and PV. The study objective was to compare US survival rates of ET, PV, and MF patients with matched non-MPN/non-cancer controls in a nationally representative database.Patients and MethodsData were taken retrospectively from the Survey, Epidemiology, and End Results (SEER)-Medicare linked database. Medicare enrollees with a new SEER MPN diagnosis between Jan 1, 2001 and Dec 31, 2007 were eligible. First MPN diagnosis was required at or after Medicare enrollment to allow for continuous follow-up. Non-MPN/non-cancer control groups were selected from Medicare separately for each MPN subtype and demographically matched to cases at a ratio of 5∶1. Survival was determined starting from the case diagnosis date using the Kaplan-Meier method.ResultsA total of 3,364 MPN patients (n = 1,217 ET; 1,625 PV; 522 MF) met the inclusion criteria and were matched to controls. Mean age was 78.4, 76.1, and 77.4 years for ET, PV, and MF, respectively, and percent female was 63, 50, and 41. Median OS was significantly (p<0.05) lower for MPN cases vs. controls (ET: 68 vs. 101 months; PV: 65 vs. 104; MF: 24 vs. 106).ConclusionsIn the US Medicare population, survival in MF patients was worse than that of patients with ET or PV and significantly worse than matched controls. Survival of patients with ET or PV was substantially inferior to matched controls. These findings have implications for the clinical management of MPN patients and underscore the need for effective therapies in all MPN subtypes.

Incidence and patient survival of myeloproliferative neoplasms and myelodysplastic/myeloproliferative neoplasms in the United States, 2001–12

“…Our study is among the first to demonstrate the absence of gender disparity in RS among patients <60 years with PV. We confirm findings from a SEER‐Medicare study (2000–05) that older males with PV have more favourable survival than older women, and that the converse association is noted for ET (Price et al , ). We extend these results by demonstrating that the survival advantage for older males with PV and older (as well as younger) females with ET persists for at least a decade.…”

“…). While some studies have reported normal life expectancy with ET(Rozman et al, 1991;Passamonti et al, 2004Passamonti et al, , 2008Abdulkarim et al, 2010), our findings of decreased 5-year RS for ET and PV, confirm clinical and population-based reports from Europe (Gruppo Italiano StudioPolicitemia 1995, Passamonti et al, 2004Hultcrantz et al, 2012) and the US(Wolanskyj et al, 2006;Price et al, 2014).…”

“…With the exception of CML (Brunner et al , ; Pulte et al , ), population‐based studies describing survival of MPNs in the US are sparse (Rollison et al , ; Price et al , ), in contrast to reports emanating from European countries (Phekoo et al , ; Barbui et al , ; Maynadie et al , , ; Cervantes et al , ; Hultcrantz et al , ; Sant et al , ; Osca‐Gelis et al , ). This is the first US population‐based study to describe 5‐year RS of MPN and MDS/MPN by individual subtype, sex and age for cases diagnosed in the modern diagnostic and treatment era.…”

Risk of second primary malignancies in a population-based study of adult patients with essential thrombocythemia

“…Prior studies have used a similar approach in identifying patients with ET from the SEER database [20,21] . Cases with unknown age or survival time and those dia gnosed at autopsy and by death certificate only were excluded.…”

Historical Views, Conventional Approaches, and Evolving Management Strategies for Myeloproliferative Neoplasms

“…Then, nearly 55 years after Dameshek's treatise, the JAK2 V617F mutation was discovered, representing a watershed moment that renewed research interests in MPN. 5 In addition, more clarity now exists regarding the impact of the MPN symptom burden, attributed partly to cytokine excess, splenomegaly, hyperviscosity (PV), thrombotic complications, and cytopenias (MF). 4 These data showed the numbers of persons with ET, PV, and MF living in the United States in 2010 to be approximately 134,000, 148,000, and 13,000, respectively.…”