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Chronic Myeloproliferative Neoplasias

Incidence and risk factors for bleeding in 1104 patients with essential thrombocythemia or prefibrotic myelofibrosis diagnosed according to the 2008 WHO criteria

Leukemia volume 26, pages 716–719 (2012)Cite this article

Abstract

In an international study of 1104 patients with essential thrombocythemia (ET), a histological review according to the 2008 World Health Organization (WHO) criteria confirmed ET in 891 patients (WHO-ET, 81%), and revised the diagnosis to prefibrotic primary myelofibrosis (PMF) in 180 patients (PMF, 16%). Major bleeding during follow-up occurred in 55 (6%) WHO-ET and 21 (12%) PMF patients (P=0.009), at a rate of 0.79 and 1.39% patients per year, respectively, (P=0.039). In a multivariable analysis, predictors of bleeding included diagnosis of PMF (P=0.05; hazard ratio (HR) 1.74), leukocytosis (P=0.04; HR 1.74), previous hemorrhage (P=0.025; HR 2.35) and aspirin therapy (P=0.001; HR 3.16). The analysis restricted to patients with WHO-ET confirmed previous hemorrhage (P=0.043; HR 1.92) and aspirin (P=0.027; HR 2.24) as independent risk factors. The current study reveals that major bleeding associated with thrombocytosis might be relatively specific to PMF, as opposed to WHO-defined ET. Furthermore, it shows that low-dose aspirin exacerbates these hemorrhagic events of PMF. In contrast, thrombocytosis per se was not a risk factor for bleeding; however, low-dose aspirin had a synergistic hemorrhagic effect unmasking the bleeding tendency of patients with extreme thrombocytosis. These observations carry significant therapeutic implications in these two WHO entities.

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Acknowledgements

Alessandro M Vanucchi at the University of Florence and investigators at the University of Pavia and at the Ospedali Riuniti di Bergamo were supported by a grant from Associazione Italiana per la Ricerca sul Cancro (AIRC, Milano) ‘Special Program Molecular Clinical Oncology 5 × 1000’ to AGIMM (AIRC-Gruppo Italiano Malattie Mieloproliferative).

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Authors and Affiliations

  1. Division of Hematology, Research Foundation, Ospedali Riuniti di Bergamo, Bergamo, Italy

    G Finazzi, A Carobbio, A Rambaldi & T Barbui

  2. Institute of Pathology, University of Cologne, Cologne, Germany

    J Thiele

  3. Division of Hematology, Ospedale di Varese, Varese, Italy

    F Passamonti

  4. Department of Hematology Oncology, University of Pavia, IRCCS Policlinico San Matteo, Pavia, Italy

    E Rumi

  5. Division of Hematology S Bortolo Hospital, Vicenza, Italy

    M Ruggeri & F Rodeghiero

  6. Department of Medical and Surgical Sciences, University of Padua, Padua, Italy

    M L Randi & I Bertozzi

  7. Division of Hematology, University of Florence, Florence, Italy

    A M Vannucchi & E Antonioli

  8. Division of Hematology and Blood Coagulation, Medical University of Vienna, Vienna, Austria

    H Gisslinger & V Buxhofer-Ausch

  9. Division of Hematology, Mayo Clinic, Rochester, MN, USA

    N Gangat & A Tefferi

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  1. G Finazzi
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  2. A Carobbio
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  15. A Rambaldi
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  16. A Tefferi
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  17. T Barbui
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Correspondence to T Barbui.

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Finazzi, G., Carobbio, A., Thiele, J. et al. Incidence and risk factors for bleeding in 1104 patients with essential thrombocythemia or prefibrotic myelofibrosis diagnosed according to the 2008 WHO criteria. Leukemia 26, 716–719 (2012). https://doi.org/10.1038/leu.2011.258

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