Splanchnic vein thromboses associated with myeloproliferative neoplasms: An international, retrospective study on 518 cases: American Journal of Hematology

E. Sant'Antonio, P. Guglielmelli, L. Pieri, M. Primignani, M.L. Randi, C. Santarossa, E. Rumi, F. Cervantes, F. Delaini, A. Carobbio, S. Betti, E. Rossi, N. Lavi, C.N. Harrison, N. Curto-Garcia, H. Gisslinger, B. Gisslinger, G. Specchia, A. Ricco, N. VianelliN. Polverelli, M. Koren-Michowitz, M. Ruggeri, F. Girodon, M. Ellis, A. Iurlo, F. Mannelli, L. Mannelli, B. Sordi, G.G. Loscocco, M. Cazzola, V. De Stefano, T. Barbui, A. Tefferi, A.M. Vannucchi

Research output: Contribution to journalArticlepeer-review

Abstract

Myeloproliferative Neoplasms (MPN) course can be complicated by thrombosis involving unusual sites as the splanchnic veins (SVT). Their management is challenging, given their composite vascular risk. We performed a retrospective, cohort study in the framework of the International Working Group for MPN Research and Treatment (IWG-MRT), and AIRC-Gruppo Italiano Malattie Mieloproliferative (AGIMM). A total of 518 MPN-SVT cases were collected and compared with 1628 unselected, control MPN population, matched for disease subtype. Those with MPN-SVT were younger (median 44 years) and enriched in females compared to controls; PV (37.1%) and ET (34.4%) were the most frequent diagnoses. JAK2V617F mutation was highly prevalent (90.2%), and 38.6% of cases had an additional hypercoagulable disorder. SVT recurrence rate was 1.6 per 100 patient-years. Vitamin K-antagonists (VKA) halved the incidence of recurrence (OR 0.48), unlike cytoreduction (OR 0.96), and were not associated with overall or gastrointestinal bleeding in multivariable analysis. Esophageal varices were the only independent predictor for major bleeding (OR 17.4). Among MPN-SVT, risk of subsequent vascular events was skewed towards venous thromboses compared to controls. However, MPN-SVT clinical course was overall benign: SVT were enriched in PMF with lower IPSS, resulting in significantly longer survival than controls; survival was not affected in PV and slightly reduced in ET. MPN-U with SVT (n = 55) showed a particularly indolent phenotype, with no signs of disease evolution. In the to-date largest, contemporary cohort of MPN-SVT, VKA were confirmed effective in preventing recurrence, unlike cytoreduction, and safe; the major risk factor for bleeding was esophageal varices that therefore represent a major therapeutic target.

Original languageEnglish
Pages (from-to)156-166
Number of pages11
JournalAm. J. Hematol.
Volume95
Issue number2
DOIs
Publication statusPublished - 2020

Keywords

  • antivitamin K
  • anticoagulant agent
  • adolescent
  • adult
  • age
  • aged
  • Article
  • child
  • cohort analysis
  • controlled study
  • cytoreductive surgery
  • disease association
  • disease course
  • esophagus varices
  • female
  • gastrointestinal hemorrhage
  • gender
  • gene
  • gene mutation
  • human
  • hypercoagulability
  • incidence
  • JAK2V617F gene
  • major clinical study
  • male
  • myeloproliferative neoplasm
  • polycythemia vera
  • priority journal
  • prognosis
  • recurrent disease
  • retrospective study
  • splanchnic vein thrombosis
  • survival
  • thrombocythemia
  • vein thrombosis
  • very elderly
  • clinical trial
  • hematologic disease
  • middle aged
  • multicenter study
  • myeloproliferative disorder
  • prevalence
  • risk factor
  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Anticoagulants
  • Female
  • Gastrointestinal Hemorrhage
  • Hematologic Neoplasms
  • Humans
  • Male
  • Middle Aged
  • Myeloproliferative Disorders
  • Prevalence
  • Risk Factors
  • Venous Thrombosis

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