Impact of comorbidities and body mass index on the outcome of polycythemia vera patients

Giulia Benevolo, Elena M. Elli, Daniela Bartoletti, Roberto Latagliata, Mario Tiribelli, Florian H. Heidel, Francesco Cavazzini, Massimiliano Bonifacio, Monica Crugnola, Gianni Binotto, Alessandra D'Addio, Alessia Tieghi, Micaela Bergamaschi, Giovanni Caocci, Nicola Polverelli, Elisa Bossi, Giuseppe Auteri, Ida Carmosino, Lucia Catani, Antonio CuneoMauro Krampera, Francesco Lanza, Roberto M. Lemoli, Nicola Vianelli, Massimo Breccia, Giuseppe A. Palumbo, Michele Cavo, Francesca Palandri

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
JournalHematological Oncology
DOIs
Publication statusAccepted/In press - 2021

Keywords

  • body mass index
  • cancer
  • Charlson comorbidity index
  • outcome
  • polycythemia vera
  • thrombotic risk

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

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