TY - JOUR
T1 - Impact of comorbidities and body mass index on the outcome of polycythemia vera patients
AU - Benevolo, Giulia
AU - Elli, Elena M.
AU - Bartoletti, Daniela
AU - Latagliata, Roberto
AU - Tiribelli, Mario
AU - Heidel, Florian H.
AU - Cavazzini, Francesco
AU - Bonifacio, Massimiliano
AU - Crugnola, Monica
AU - Binotto, Gianni
AU - D'Addio, Alessandra
AU - Tieghi, Alessia
AU - Bergamaschi, Micaela
AU - Caocci, Giovanni
AU - Polverelli, Nicola
AU - Bossi, Elisa
AU - Auteri, Giuseppe
AU - Carmosino, Ida
AU - Catani, Lucia
AU - Cuneo, Antonio
AU - Krampera, Mauro
AU - Lanza, Francesco
AU - Lemoli, Roberto M.
AU - Vianelli, Nicola
AU - Breccia, Massimo
AU - Palumbo, Giuseppe A.
AU - Cavo, Michele
AU - Palandri, Francesca
N1 - Publisher Copyright:
© 2021 John Wiley & Sons Ltd.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021
Y1 - 2021
N2 - In 816 patients with 2016 World Health Organization-defined polycythemia vera (PV) enrolled in a multicenter retrospective study, we investigated the predictive value of Charlson comorbidity index (CCI) and body mass index (BMI) on thrombosis, progression to post-PV myelofibrosis (PPV-MF) and survival. Patients were subgrouped according to CCI = 0 (58.1%, no comorbidities) or CCI ≥ 1 (41.9%) and according to normal/underweight (BMI < 25, 54.5%) or overweight/obesity (BMI ≥ 25, 45.5%) at PV diagnosis. BMI was available for 529 patients. Patients with CCI ≥ 1 were older and more frequently presented cardiovascular risk factors compared to patients with CCI = 0 (p < 0.001), while overweight/obese patients were more frequently males (p < 0.001). Cumulative incidence of thromboses with death as competing risk was 13.3% at 10 years. Multivariable analysis with death as competing risk showed that previous thromboses (subdistribution hazard ratio [SHR]: 2.1, p = 0.01) and hypertension (SHR: 1.77, p = 0.04) were significantly associated with a higher thrombotic risk, while BMI ≥ 25 lost statistical significance (SHR: 1.69, p = 0.05) and CCI ≥ 1 was excluded after evaluation of goodness of fit. After a median follow-up of 6.1 years, progression to PPV-MF occurred in 44 patients, and 75 patients died. BMI ≥ 25 was associated with a lower probability of progression to PPV-MF (SHR: 0.38, CI95%: 0.15–0.94, p = 0.04) and better survival (hazard ratio [HR]: 0.42, CI95%: 0.18–0.97, p = 0.04). CCI ≥ 1 did not affect progression to PPV-MF (p = 0.44) or survival (p = 0.71). The evaluation of CCI and BMI may improve the prognostic definition of PV. In patients with hypertension an accurate evaluation of thrombotic risk is warranted.
AB - In 816 patients with 2016 World Health Organization-defined polycythemia vera (PV) enrolled in a multicenter retrospective study, we investigated the predictive value of Charlson comorbidity index (CCI) and body mass index (BMI) on thrombosis, progression to post-PV myelofibrosis (PPV-MF) and survival. Patients were subgrouped according to CCI = 0 (58.1%, no comorbidities) or CCI ≥ 1 (41.9%) and according to normal/underweight (BMI < 25, 54.5%) or overweight/obesity (BMI ≥ 25, 45.5%) at PV diagnosis. BMI was available for 529 patients. Patients with CCI ≥ 1 were older and more frequently presented cardiovascular risk factors compared to patients with CCI = 0 (p < 0.001), while overweight/obese patients were more frequently males (p < 0.001). Cumulative incidence of thromboses with death as competing risk was 13.3% at 10 years. Multivariable analysis with death as competing risk showed that previous thromboses (subdistribution hazard ratio [SHR]: 2.1, p = 0.01) and hypertension (SHR: 1.77, p = 0.04) were significantly associated with a higher thrombotic risk, while BMI ≥ 25 lost statistical significance (SHR: 1.69, p = 0.05) and CCI ≥ 1 was excluded after evaluation of goodness of fit. After a median follow-up of 6.1 years, progression to PPV-MF occurred in 44 patients, and 75 patients died. BMI ≥ 25 was associated with a lower probability of progression to PPV-MF (SHR: 0.38, CI95%: 0.15–0.94, p = 0.04) and better survival (hazard ratio [HR]: 0.42, CI95%: 0.18–0.97, p = 0.04). CCI ≥ 1 did not affect progression to PPV-MF (p = 0.44) or survival (p = 0.71). The evaluation of CCI and BMI may improve the prognostic definition of PV. In patients with hypertension an accurate evaluation of thrombotic risk is warranted.
KW - body mass index
KW - cancer
KW - Charlson comorbidity index
KW - outcome
KW - polycythemia vera
KW - thrombotic risk
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U2 - 10.1002/hon.2843
DO - 10.1002/hon.2843
M3 - Article
C2 - 33590502
AN - SCOPUS:85102305555
VL - 39
SP - 409
EP - 418
JO - Hematological Oncology
JF - Hematological Oncology
SN - 0278-0232
IS - 3
ER -