retrospective study on 226 polycythemia vera patients: impact of median hematocrit value on clinical outcomes and survival improvement with anti-thrombotic prophylaxis and non-alkylating drugs
The clinical impact of polycythemia vera (PV) diagnostic and therapeutic guidelines is still undetermined. In particular, the recommended target of hematocrit (Hct)
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| Veröffentlicht in: | Annals of hematology 2010-07, Vol.89 (7), p.691-699 |
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| container_title | Annals of hematology |
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| creator | Crisà, Elena Venturino, Ermanno Passera, Roberto Prina, Marco Schinco, Piercarla Borchiellini, Alessandra Giai, Valentina Ciocca Vasino, Maria Ausilia Bazzan, Mario Vaccarino, Antonella Boccadoro, Mario Ferrero, Dario |
| description | The clinical impact of polycythemia vera (PV) diagnostic and therapeutic guidelines is still undetermined. In particular, the recommended target of hematocrit (Hct) |
| doi_str_mv | 10.1007/s00277-009-0899-z |
| format | Article |
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In particular, the recommended target of hematocrit (Hct) <0.45 has been recently questioned and alkylating drugs are still used for elderly patients. We revised, according to WHO criteria, 300 PV diagnosis and evaluated the impact on clinical outcome of median Hct and of the strategy to administer anti-thrombotic prophylaxis and to avoid alkylating chemotherapy in almost all patients. Of 226 patients with WHO-confirmed diagnosis (median age 66), 91.3% survived at the median follow-up of 5.84 years and 77.5% are projected alive at 13 years. Eighteen percent had major thrombosis and 2.7% acute myeloid leukemia. Twenty-two percent of patients maintained an Hct <0.45: their overall and thrombosis-free survival are similar to those of patients with a 0.45-0.48 value. Conversely, an Hct >0.48 and a “high thrombotic risk” according to ECLAP criteria were both significantly associated to shorter survival and higher thrombosis risk. Chemotherapy reduced thrombotic events without affecting survival. Our study revealed suboptimal compliance to published guidelines. However, in our casistic characterized by wide use of anti-platelet- and avoidance of alkylating drugs, patients' survival, although analyzed retrospectively, seemed to have improved compared to old literature data. The optimal Hct target was not clearly defined, although a value <0.48 looks highly advisable.</description><identifier>ISSN: 0939-5555</identifier><identifier>EISSN: 1432-0584</identifier><identifier>DOI: 10.1007/s00277-009-0899-z</identifier><identifier>PMID: 20146064</identifier><language>eng</language><publisher>Berlin/Heidelberg: Berlin/Heidelberg : Springer-Verlag</publisher><subject>Acute myeloid leukemia ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; chemotherapy ; Disease-Free Survival ; Female ; Follow-Up Studies ; Hematocrit ; Hematology ; Humans ; Leukemia, Myeloid, Acute - blood ; Leukemia, Myeloid, Acute - complications ; Leukemia, Myeloid, Acute - drug therapy ; Leukemia, Myeloid, Acute - mortality ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Oncology ; Original Article ; Platelet Aggregation Inhibitors ; Polycythemia vera ; Polycythemia Vera - blood ; Polycythemia Vera - complications ; Polycythemia Vera - drug therapy ; Polycythemia Vera - mortality ; Practice Guidelines as Topic ; Retrospective Studies ; Survival Rate ; Thrombosis - blood ; Thrombosis - complications ; Thrombosis - drug therapy ; Thrombosis - mortality ; Thrombotic events</subject><ispartof>Annals of hematology, 2010-07, Vol.89 (7), p.691-699</ispartof><rights>Springer-Verlag 2010</rights><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c471t-6b4c82d298d92aff9f1712b09e4225854a24358f75e9ff162cf025f4c07ac6fd3</citedby><cites>FETCH-LOGICAL-c471t-6b4c82d298d92aff9f1712b09e4225854a24358f75e9ff162cf025f4c07ac6fd3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00277-009-0899-z$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00277-009-0899-z$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>230,314,780,784,885,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20146064$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://hal.science/hal-00535121$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Crisà, Elena</creatorcontrib><creatorcontrib>Venturino, Ermanno</creatorcontrib><creatorcontrib>Passera, Roberto</creatorcontrib><creatorcontrib>Prina, Marco</creatorcontrib><creatorcontrib>Schinco, Piercarla</creatorcontrib><creatorcontrib>Borchiellini, Alessandra</creatorcontrib><creatorcontrib>Giai, Valentina</creatorcontrib><creatorcontrib>Ciocca Vasino, Maria Ausilia</creatorcontrib><creatorcontrib>Bazzan, Mario</creatorcontrib><creatorcontrib>Vaccarino, Antonella</creatorcontrib><creatorcontrib>Boccadoro, Mario</creatorcontrib><creatorcontrib>Ferrero, Dario</creatorcontrib><title>retrospective study on 226 polycythemia vera patients: impact of median hematocrit value on clinical outcomes and survival improvement with anti-thrombotic prophylaxis and non-alkylating drugs</title><title>Annals of hematology</title><addtitle>Ann Hematol</addtitle><addtitle>Ann Hematol</addtitle><description>The clinical impact of polycythemia vera (PV) diagnostic and therapeutic guidelines is still undetermined. In particular, the recommended target of hematocrit (Hct) <0.45 has been recently questioned and alkylating drugs are still used for elderly patients. We revised, according to WHO criteria, 300 PV diagnosis and evaluated the impact on clinical outcome of median Hct and of the strategy to administer anti-thrombotic prophylaxis and to avoid alkylating chemotherapy in almost all patients. Of 226 patients with WHO-confirmed diagnosis (median age 66), 91.3% survived at the median follow-up of 5.84 years and 77.5% are projected alive at 13 years. Eighteen percent had major thrombosis and 2.7% acute myeloid leukemia. Twenty-two percent of patients maintained an Hct <0.45: their overall and thrombosis-free survival are similar to those of patients with a 0.45-0.48 value. Conversely, an Hct >0.48 and a “high thrombotic risk” according to ECLAP criteria were both significantly associated to shorter survival and higher thrombosis risk. Chemotherapy reduced thrombotic events without affecting survival. Our study revealed suboptimal compliance to published guidelines. However, in our casistic characterized by wide use of anti-platelet- and avoidance of alkylating drugs, patients' survival, although analyzed retrospectively, seemed to have improved compared to old literature data. The optimal Hct target was not clearly defined, although a value <0.48 looks highly advisable.</description><subject>Acute myeloid leukemia</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>chemotherapy</subject><subject>Disease-Free Survival</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Hematocrit</subject><subject>Hematology</subject><subject>Humans</subject><subject>Leukemia, Myeloid, Acute - blood</subject><subject>Leukemia, Myeloid, Acute - complications</subject><subject>Leukemia, Myeloid, Acute - drug therapy</subject><subject>Leukemia, Myeloid, Acute - mortality</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Oncology</subject><subject>Original Article</subject><subject>Platelet Aggregation Inhibitors</subject><subject>Polycythemia vera</subject><subject>Polycythemia Vera - blood</subject><subject>Polycythemia Vera - complications</subject><subject>Polycythemia Vera - drug therapy</subject><subject>Polycythemia Vera - mortality</subject><subject>Practice Guidelines as Topic</subject><subject>Retrospective Studies</subject><subject>Survival Rate</subject><subject>Thrombosis - blood</subject><subject>Thrombosis - complications</subject><subject>Thrombosis - drug therapy</subject><subject>Thrombosis - mortality</subject><subject>Thrombotic events</subject><issn>0939-5555</issn><issn>1432-0584</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9ksFu1DAQhi0EosvCA3ABiwviEBg7dhL3VlVAkVbiAD1bXsfedUniYDuB7dPxaDhKKRIHfLE08_3_zGgGoecE3hKA-l0EoHVdAIgCGiGK2wdoQ1hJC-ANe4g2IEpR8PzO0JMYbwAIbRh9jM4oEFZBxTboVzAp-DgandxscExTe8J-wJRWePTdSZ_S0fRO4dkEhUeVnBlSPMeuH5VO2Fvcm9apAWdKJa-DS3hW3WQWE925wWnVYT8l7XsTsRpaHKcwu8wsHsHPps-O-IdLx5xNrkjH4Pu9T07jnB6Pp079dKty8EOhum85ktxwwG2YDvEpemRVF82zu3-Lrj-8_3p5Vew-f_x0ebErNKtJKqo90w1tqWhaQZW1wpKa0D0IwyjlDWeKspI3tuZGWEsqqi1QbpmGWunKtuUWvVl9j6qTY3C9CifplZNXFzu5xAB4yQklM8ns65XNA3yfTEyyd1GbrlOD8VOUdVmSkgHnmXz1D3njpzDkQSQlglbVQm4RWSGdNxWDsff1CcjlEOR6CLkFIZdDkLdZ8-LOeNrnDd0r_mw-A3QFYk4NBxP-Vv6f68tVZJWX6hBclNdfsmUJpGGcM17-BryIzAc</recordid><startdate>20100701</startdate><enddate>20100701</enddate><creator>Crisà, Elena</creator><creator>Venturino, Ermanno</creator><creator>Passera, Roberto</creator><creator>Prina, Marco</creator><creator>Schinco, Piercarla</creator><creator>Borchiellini, Alessandra</creator><creator>Giai, Valentina</creator><creator>Ciocca Vasino, Maria Ausilia</creator><creator>Bazzan, Mario</creator><creator>Vaccarino, Antonella</creator><creator>Boccadoro, Mario</creator><creator>Ferrero, Dario</creator><general>Berlin/Heidelberg : Springer-Verlag</general><general>Springer-Verlag</general><general>Springer Nature B.V</general><general>Springer Verlag</general><scope>FBQ</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>1XC</scope><scope>VOOES</scope></search><sort><creationdate>20100701</creationdate><title>retrospective study on 226 polycythemia vera patients: impact of median hematocrit value on clinical outcomes and survival improvement with anti-thrombotic prophylaxis and non-alkylating drugs</title><author>Crisà, Elena ; Venturino, Ermanno ; Passera, Roberto ; Prina, Marco ; Schinco, Piercarla ; Borchiellini, Alessandra ; Giai, Valentina ; Ciocca Vasino, Maria Ausilia ; Bazzan, Mario ; Vaccarino, Antonella ; Boccadoro, Mario ; Ferrero, Dario</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c471t-6b4c82d298d92aff9f1712b09e4225854a24358f75e9ff162cf025f4c07ac6fd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Acute myeloid leukemia</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>chemotherapy</topic><topic>Disease-Free Survival</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Hematocrit</topic><topic>Hematology</topic><topic>Humans</topic><topic>Leukemia, Myeloid, Acute - 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Academic</collection><collection>Hyper Article en Ligne (HAL)</collection><collection>Hyper Article en Ligne (HAL) (Open Access)</collection><jtitle>Annals of hematology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Crisà, Elena</au><au>Venturino, Ermanno</au><au>Passera, Roberto</au><au>Prina, Marco</au><au>Schinco, Piercarla</au><au>Borchiellini, Alessandra</au><au>Giai, Valentina</au><au>Ciocca Vasino, Maria Ausilia</au><au>Bazzan, Mario</au><au>Vaccarino, Antonella</au><au>Boccadoro, Mario</au><au>Ferrero, Dario</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>retrospective study on 226 polycythemia vera patients: impact of median hematocrit value on clinical outcomes and survival improvement with anti-thrombotic prophylaxis and non-alkylating drugs</atitle><jtitle>Annals of hematology</jtitle><stitle>Ann Hematol</stitle><addtitle>Ann Hematol</addtitle><date>2010-07-01</date><risdate>2010</risdate><volume>89</volume><issue>7</issue><spage>691</spage><epage>699</epage><pages>691-699</pages><issn>0939-5555</issn><eissn>1432-0584</eissn><abstract>The clinical impact of polycythemia vera (PV) diagnostic and therapeutic guidelines is still undetermined. In particular, the recommended target of hematocrit (Hct) <0.45 has been recently questioned and alkylating drugs are still used for elderly patients. We revised, according to WHO criteria, 300 PV diagnosis and evaluated the impact on clinical outcome of median Hct and of the strategy to administer anti-thrombotic prophylaxis and to avoid alkylating chemotherapy in almost all patients. Of 226 patients with WHO-confirmed diagnosis (median age 66), 91.3% survived at the median follow-up of 5.84 years and 77.5% are projected alive at 13 years. Eighteen percent had major thrombosis and 2.7% acute myeloid leukemia. Twenty-two percent of patients maintained an Hct <0.45: their overall and thrombosis-free survival are similar to those of patients with a 0.45-0.48 value. Conversely, an Hct >0.48 and a “high thrombotic risk” according to ECLAP criteria were both significantly associated to shorter survival and higher thrombosis risk. Chemotherapy reduced thrombotic events without affecting survival. Our study revealed suboptimal compliance to published guidelines. However, in our casistic characterized by wide use of anti-platelet- and avoidance of alkylating drugs, patients' survival, although analyzed retrospectively, seemed to have improved compared to old literature data. The optimal Hct target was not clearly defined, although a value <0.48 looks highly advisable.</abstract><cop>Berlin/Heidelberg</cop><pub>Berlin/Heidelberg : Springer-Verlag</pub><pmid>20146064</pmid><doi>10.1007/s00277-009-0899-z</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Annals of hematology, 2010-07, Vol.89 (7), p.691-699 |
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| subjects | Acute myeloid leukemia Adolescent Adult Aged Aged, 80 and over chemotherapy Disease-Free Survival Female Follow-Up Studies Hematocrit Hematology Humans Leukemia, Myeloid, Acute - blood Leukemia, Myeloid, Acute - complications Leukemia, Myeloid, Acute - drug therapy Leukemia, Myeloid, Acute - mortality Male Medicine Medicine & Public Health Middle Aged Oncology Original Article Platelet Aggregation Inhibitors Polycythemia vera Polycythemia Vera - blood Polycythemia Vera - complications Polycythemia Vera - drug therapy Polycythemia Vera - mortality Practice Guidelines as Topic Retrospective Studies Survival Rate Thrombosis - blood Thrombosis - complications Thrombosis - drug therapy Thrombosis - mortality Thrombotic events |
| title | retrospective study on 226 polycythemia vera patients: impact of median hematocrit value on clinical outcomes and survival improvement with anti-thrombotic prophylaxis and non-alkylating drugs |
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