1
|
Sant'Antonio E, Guglielmelli P, Pieri L, Primignani M, Randi ML, Santarossa C, Rumi E, Cervantes F, Delaini F, Carobbio A, Betti S, Rossi E, Lavi N, Harrison CN, Curto‐Garcia N, Gisslinger H, Gisslinger B, Specchia G, Ricco A, Vianelli N, Polverelli N, Koren‐Michowitz M, Ruggeri M, Girodon F, Ellis M, Iurlo A, Mannelli F, Mannelli L, Sordi B, Loscocco GG, Cazzola M, De Stefano V, Barbui T, Tefferi A, Vannucchi AM. Splanchnic vein thromboses associated with myeloproliferative neoplasms: An international, retrospective study on 518 cases. Am J Hematol 2020; 95:156-166. [PMID: 31721282 DOI: 10.1002/ajh.25677] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 11/01/2019] [Accepted: 11/05/2019] [Indexed: 12/22/2022]
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.
Collapse
Affiliation(s)
- Emanuela Sant'Antonio
- CRIMM, Centro di Ricerca e Innovazione per le Malattie MieloproliferativeAzienda Ospedaliera Universitaria Careggi Florence Italy
- Dipartimento di Medicina Sperimentale e ClinicaUniversità degli Studi, Firenze, DENOTHE Excellence Center Florence Italy
- Medical Genetics, University of Siena Siena Italy
| | - Paola Guglielmelli
- CRIMM, Centro di Ricerca e Innovazione per le Malattie MieloproliferativeAzienda Ospedaliera Universitaria Careggi Florence Italy
- Dipartimento di Medicina Sperimentale e ClinicaUniversità degli Studi, Firenze, DENOTHE Excellence Center Florence Italy
| | - Lisa Pieri
- CRIMM, Centro di Ricerca e Innovazione per le Malattie MieloproliferativeAzienda Ospedaliera Universitaria Careggi Florence Italy
- Dipartimento di Medicina Sperimentale e ClinicaUniversità degli Studi, Firenze, DENOTHE Excellence Center Florence Italy
| | - Massimo Primignani
- CRC "A. M. e A. Migliavacca" Center for Liver Disease, Division of Gastroenterology and Hepatology, Foundation IRCCS Cà Granda Maggiore Policlinico Hospital, University of Milan Milan Italy
| | - Maria Luigia Randi
- Department of Medicine – DIMEDUniversity of Padova Medical School Padova Italy
| | - Claudia Santarossa
- Department of Medicine – DIMEDUniversity of Padova Medical School Padova Italy
| | - Elisa Rumi
- Department of Hematology OncologyIRCCS Policlinico S. Matteo Foundation and University of Pavia Pavia Italy
| | | | - Federica Delaini
- Hematology and Bone Marrow Transplant UnitAzienda Ospedaliera Papa Giovanni XXIII Bergamo Italy
| | - Alessandra Carobbio
- Hematology and Bone Marrow Transplant UnitAzienda Ospedaliera Papa Giovanni XXIII Bergamo Italy
| | - Silvia Betti
- Institute of HematologyCatholic University, Fondazione Policlinico A. Gemelli IRCCS Rome Italy
| | - Elena Rossi
- Institute of HematologyCatholic University, Fondazione Policlinico A. Gemelli IRCCS Rome Italy
| | - Noa Lavi
- Department of Hematology and Bone Marrow TransplantationRambam Health Care Campus Haifa Israel
| | - Claire N. Harrison
- Department of HaematologyGuy's and St. Thomas NHS Foundation Trust London UK
| | | | - Heinz Gisslinger
- Department of Internal Medicine I, Division of Hematology and Blood CoagulationMedical University of Vienna Vienna Austria
| | - Bettina Gisslinger
- Department of Internal Medicine I, Division of Hematology and Blood CoagulationMedical University of Vienna Vienna Austria
| | - Giorgina Specchia
- Department of Emergency and Organ TransplantationSection of Hematology with Transplantation, Medical School, University of Bari Bari Italy
| | - Alessandra Ricco
- Department of Emergency and Organ TransplantationSection of Hematology with Transplantation, Medical School, University of Bari Bari Italy
| | - Nicola Vianelli
- Department of Hematology and Clinical Oncology “L. and A. Seràgnoli” S. Orsola‐Malpighi Hospital Bologna Italy
| | - Nicola Polverelli
- Department of Hematology and Clinical Oncology “L. and A. Seràgnoli” S. Orsola‐Malpighi Hospital Bologna Italy
| | - Maya Koren‐Michowitz
- Department of HematologyShamir Medical Center (Assaf Harofeh), Zerifin, Israel and Sackler school of Medicine, Tel Aviv University Tel Aviv Israel
| | | | | | - Martin Ellis
- The Hematology Institute and Blood Bank and Translational Hemato‐Oncology, Meir Hospital Kfar‐Saba Israel
| | - Alessandra Iurlo
- Hematology Division, Foundation IRCCS Ca' Granda‐Ospedale Maggiore Policlinico Milan Italy
| | - Francesco Mannelli
- CRIMM, Centro di Ricerca e Innovazione per le Malattie MieloproliferativeAzienda Ospedaliera Universitaria Careggi Florence Italy
- Dipartimento di Medicina Sperimentale e ClinicaUniversità degli Studi, Firenze, DENOTHE Excellence Center Florence Italy
| | - Lara Mannelli
- CRIMM, Centro di Ricerca e Innovazione per le Malattie MieloproliferativeAzienda Ospedaliera Universitaria Careggi Florence Italy
- Dipartimento di Medicina Sperimentale e ClinicaUniversità degli Studi, Firenze, DENOTHE Excellence Center Florence Italy
- Medical Genetics, University of Siena Siena Italy
| | - Benedetta Sordi
- CRIMM, Centro di Ricerca e Innovazione per le Malattie MieloproliferativeAzienda Ospedaliera Universitaria Careggi Florence Italy
- Dipartimento di Medicina Sperimentale e ClinicaUniversità degli Studi, Firenze, DENOTHE Excellence Center Florence Italy
| | - Giuseppe Gaetano Loscocco
- CRIMM, Centro di Ricerca e Innovazione per le Malattie MieloproliferativeAzienda Ospedaliera Universitaria Careggi Florence Italy
- Dipartimento di Medicina Sperimentale e ClinicaUniversità degli Studi, Firenze, DENOTHE Excellence Center Florence Italy
| | - Mario Cazzola
- Department of Hematology OncologyIRCCS Policlinico S. Matteo Foundation and University of Pavia Pavia Italy
| | - Valerio De Stefano
- Institute of HematologyCatholic University, Fondazione Policlinico A. Gemelli IRCCS Rome Italy
| | - Tiziano Barbui
- Research Foundation, Azienda Ospedaliera Papa Giovanni XXIII Bergamo Italy
| | | | - Alessandro Maria Vannucchi
- CRIMM, Centro di Ricerca e Innovazione per le Malattie MieloproliferativeAzienda Ospedaliera Universitaria Careggi Florence Italy
- Dipartimento di Medicina Sperimentale e ClinicaUniversità degli Studi, Firenze, DENOTHE Excellence Center Florence Italy
| |
Collapse
|