Splanchnic vein thrombosis in myeloproliferative neoplasms: Risk factors for recurrences in a cohort of 181 patients

Valerio De Stefano, Alessandro M. Vannucchi, Marco Ruggeri, Francisco Cervantes, Alberto Alvarez-Larrán, Alessandra Iurlo, M. L. Randi, Lisa Pieri, E. Rossi, Paola Guglielmelli, Silvia Betti, Elena Elli, Mariachiara Finazzi, Guido Finazzi, E. Zetterberg, Nicola Vianelli, Gianluca Gaidano, Ilaria Nichele, Daniele Cattaneo, M. PalovaM. H. Ellis, Emma Cacciola, Alessia Tieghi, Juan Carlos Hernández-Boluda, Esther Pungolino, Giorgina Specchia, Davide Rapezzi, A. Forcina, Caterina Musolino, Alessandra Carobbio, M. Griesshammer, Tiziano Barbui

Research output: Contribution to journalArticle

Abstract

We retrospectively studied 181 patients with polycythaemia vera (n=67), essential thrombocythaemia (n=67) or primary myelofibrosis (n=47), who presented a first episode of splanchnic vein thrombosis (SVT). Budd-Chiari syndrome (BCS) and portal vein thrombosis were diagnosed in 31 (17.1%) and 109 (60.3%) patients, respectively; isolated thrombosis of the mesenteric or splenic veins was detected in 18 and 23 cases, respectively. After this index event, the patients were followed for 735 patient years (pt-years) and experienced 31 recurrences corresponding to an incidence rate of 4.2 per 100 pt-years. Factors associated with a significantly higher risk of recurrence were BCS (hazard ratio (HR): 3.03), history of previous thrombosis (HR: 3.62), splenomegaly (HR: 2.66) and leukocytosis (HR: 2.8). Vitamin K-antagonists (VKA) were prescribed in 85% of patients and the recurrence rate was 3.9 per 100 pt-years, whereas in the small fraction (15%) not receiving VKA more recurrences (7.2 per 100 pt-years) were reported. Intracranial and extracranial major bleeding was recorded mainly in patients on VKA and the corresponding rate was 2.0 per 100 pt-years. In conclusion, despite anticoagulation treatment, the recurrence rate after SVT in myeloproliferative neoplasms is high and suggests the exploration of new avenues of secondary prophylaxis with new antithrombotic drugs and JAK-2 inhibitors.

Original languageEnglish
Article numbere493
JournalBlood Cancer Journal
Volume6
Issue number11
DOIs
Publication statusPublished - Nov 4 2016

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Viscera
Veins
Thrombosis
Recurrence
Neoplasms
Vitamin K
Budd-Chiari Syndrome
Splenic Vein
Essential Thrombocythemia
Mesenteric Veins
Polycythemia Vera
Primary Myelofibrosis
Splenomegaly
Leukocytosis
Portal Vein
Hemorrhage

ASJC Scopus subject areas

  • Hematology
  • Oncology

Cite this

De Stefano, V., Vannucchi, A. M., Ruggeri, M., Cervantes, F., Alvarez-Larrán, A., Iurlo, A., ... Barbui, T. (2016). Splanchnic vein thrombosis in myeloproliferative neoplasms: Risk factors for recurrences in a cohort of 181 patients. Blood Cancer Journal, 6(11), [e493]. https://doi.org/10.1038/bcj.2016.103

Splanchnic vein thrombosis in myeloproliferative neoplasms : Risk factors for recurrences in a cohort of 181 patients. / De Stefano, Valerio; Vannucchi, Alessandro M.; Ruggeri, Marco; Cervantes, Francisco; Alvarez-Larrán, Alberto; Iurlo, Alessandra; Randi, M. L.; Pieri, Lisa; Rossi, E.; Guglielmelli, Paola; Betti, Silvia; Elli, Elena; Finazzi, Mariachiara; Finazzi, Guido; Zetterberg, E.; Vianelli, Nicola; Gaidano, Gianluca; Nichele, Ilaria; Cattaneo, Daniele; Palova, M.; Ellis, M. H.; Cacciola, Emma; Tieghi, Alessia; Hernández-Boluda, Juan Carlos; Pungolino, Esther; Specchia, Giorgina; Rapezzi, Davide; Forcina, A.; Musolino, Caterina; Carobbio, Alessandra; Griesshammer, M.; Barbui, Tiziano.

In: Blood Cancer Journal, Vol. 6, No. 11, e493, 04.11.2016.

Research output: Contribution to journalArticle

De Stefano, V, Vannucchi, AM, Ruggeri, M, Cervantes, F, Alvarez-Larrán, A, Iurlo, A, Randi, ML, Pieri, L, Rossi, E, Guglielmelli, P, Betti, S, Elli, E, Finazzi, M, Finazzi, G, Zetterberg, E, Vianelli, N, Gaidano, G, Nichele, I, Cattaneo, D, Palova, M, Ellis, MH, Cacciola, E, Tieghi, A, Hernández-Boluda, JC, Pungolino, E, Specchia, G, Rapezzi, D, Forcina, A, Musolino, C, Carobbio, A, Griesshammer, M & Barbui, T 2016, 'Splanchnic vein thrombosis in myeloproliferative neoplasms: Risk factors for recurrences in a cohort of 181 patients', Blood Cancer Journal, vol. 6, no. 11, e493. https://doi.org/10.1038/bcj.2016.103
De Stefano, Valerio ; Vannucchi, Alessandro M. ; Ruggeri, Marco ; Cervantes, Francisco ; Alvarez-Larrán, Alberto ; Iurlo, Alessandra ; Randi, M. L. ; Pieri, Lisa ; Rossi, E. ; Guglielmelli, Paola ; Betti, Silvia ; Elli, Elena ; Finazzi, Mariachiara ; Finazzi, Guido ; Zetterberg, E. ; Vianelli, Nicola ; Gaidano, Gianluca ; Nichele, Ilaria ; Cattaneo, Daniele ; Palova, M. ; Ellis, M. H. ; Cacciola, Emma ; Tieghi, Alessia ; Hernández-Boluda, Juan Carlos ; Pungolino, Esther ; Specchia, Giorgina ; Rapezzi, Davide ; Forcina, A. ; Musolino, Caterina ; Carobbio, Alessandra ; Griesshammer, M. ; Barbui, Tiziano. / Splanchnic vein thrombosis in myeloproliferative neoplasms : Risk factors for recurrences in a cohort of 181 patients. In: Blood Cancer Journal. 2016 ; Vol. 6, No. 11.
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abstract = "We retrospectively studied 181 patients with polycythaemia vera (n=67), essential thrombocythaemia (n=67) or primary myelofibrosis (n=47), who presented a first episode of splanchnic vein thrombosis (SVT). Budd-Chiari syndrome (BCS) and portal vein thrombosis were diagnosed in 31 (17.1{\%}) and 109 (60.3{\%}) patients, respectively; isolated thrombosis of the mesenteric or splenic veins was detected in 18 and 23 cases, respectively. After this index event, the patients were followed for 735 patient years (pt-years) and experienced 31 recurrences corresponding to an incidence rate of 4.2 per 100 pt-years. Factors associated with a significantly higher risk of recurrence were BCS (hazard ratio (HR): 3.03), history of previous thrombosis (HR: 3.62), splenomegaly (HR: 2.66) and leukocytosis (HR: 2.8). Vitamin K-antagonists (VKA) were prescribed in 85{\%} of patients and the recurrence rate was 3.9 per 100 pt-years, whereas in the small fraction (15{\%}) not receiving VKA more recurrences (7.2 per 100 pt-years) were reported. Intracranial and extracranial major bleeding was recorded mainly in patients on VKA and the corresponding rate was 2.0 per 100 pt-years. In conclusion, despite anticoagulation treatment, the recurrence rate after SVT in myeloproliferative neoplasms is high and suggests the exploration of new avenues of secondary prophylaxis with new antithrombotic drugs and JAK-2 inhibitors.",
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T2 - Risk factors for recurrences in a cohort of 181 patients

AU - De Stefano, Valerio

AU - Vannucchi, Alessandro M.

AU - Ruggeri, Marco

AU - Cervantes, Francisco

AU - Alvarez-Larrán, Alberto

AU - Iurlo, Alessandra

AU - Randi, M. L.

AU - Pieri, Lisa

AU - Rossi, E.

AU - Guglielmelli, Paola

AU - Betti, Silvia

AU - Elli, Elena

AU - Finazzi, Mariachiara

AU - Finazzi, Guido

AU - Zetterberg, E.

AU - Vianelli, Nicola

AU - Gaidano, Gianluca

AU - Nichele, Ilaria

AU - Cattaneo, Daniele

AU - Palova, M.

AU - Ellis, M. H.

AU - Cacciola, Emma

AU - Tieghi, Alessia

AU - Hernández-Boluda, Juan Carlos

AU - Pungolino, Esther

AU - Specchia, Giorgina

AU - Rapezzi, Davide

AU - Forcina, A.

AU - Musolino, Caterina

AU - Carobbio, Alessandra

AU - Griesshammer, M.

AU - Barbui, Tiziano

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