A PRESENTING NEUTROPHIL COUNT MORE THAN 75% IS A PREDICTOR OF THROMBOSIS AT DIAGNOSIS BUT IS ASSOCIATED WITH LESS THROMBOSIS SUBSEQUENTLY IN PATIENTS WITH POLYCYTHAEMIA VERA
(Abstract release date: 05/21/15)
EHA Library. Kam G. 06/12/15; 102707; PB1906
Disclosure(s): Singapore General HospitalDepartment of Haematology
Dr. Grace Kam
Contributions
Contributions
Abstract
Abstract: PB1906
Type: Publication Only
Background
Polycythaemia vera (PV) is a myeloproliferative neoplasm (MPN) characterised by elevated haemoglobin and thrombotic tendency. Leukocytosis has been demonstrated to be a risk factor for thrombosis in PV. However, the white cell subtype implicated in thrombosis in PV has not been evaluated.
Aims
In this study we examined the role of presenting neutrophil levels in PV patients with thrombosis.
Methods
We retrospectively reviewed the case records of 163 patients with PV for thrombotic events in our institution’s MPN registry. This is an institutional review board approved registry that utilises REDCap, an electronic data capture tool for research studies. Thrombotic events considered were ischaemic heart disease, cerebrovascular accident, peripheral arterial disease, retinal artery occlusion, thrombosis of the splanchnic circulation and venous thromboembolism.
Results
Median age of diagnosis was 58years; 58.3% were male. 32 patients presented with a thrombotic event at diagnosis of PV. 12.5% of events were venous. Patients with a thrombosis at diagnosis were more likely to have risk factors for atherosclerotic disease (31.3% vs. 8.4%, p=0.012), have a higher presenting white cell count (15.2 x 109/L vs. 13.6 x 109/L, p=0.04) and to be treated with cytoreduction (90.6% vs. 71.8%, p=0.026). Patients with a thrombosis at diagnosis had a higher presenting neutrophil percentage of 82% (vs. 76.4%, p=0.002) and median absolute neutrophil count (ANC) (12.1 x 109/L vs. 10.1 x 109/L, p=0.017) than patients who did not. Based on receiver operating characteristic (ROC) analysis, a cut-off neutrophil percentage of 75% was derived for further analysis. 80.6% of patients who presented with thrombosis at diagnosis had a neutrophil count ≥ 75%, whereas 57.3% of those who did not, had a presenting neutrophil count ≥ 75% (p=0.016). On logistic regression, adjusting for gender, age ≥ 60 at diagnosis, prior thrombosis and presence of atherosclerotic disease risk factors, a presenting neutrophil percentage ≥ 75% (Odds ratio (OR) 3.36, 95% CI 1.25-9.03, p=0.016) and presence of atherosclerotic disease risk factors (OR 4.43, 95% CI 1.21-16.18, p=0.024) were predictors for thrombosis at diagnosis. Over a 5.4year median follow up, 31 thrombotic events occurred in 28 patients. Six patients who presented with thrombosis had subsequent events. Paradoxically, less patients who had a thrombotic event on follow up had a presenting neutrophil percentage ≥ 75% than patients who did not have thrombosis on follow up (34.6% vs 67.4%, p =0.002). Of patients who had a thrombosis after diagnosis, 57.1% were on cytoreduction compared to 74.8% of those who did not develop thrombosis (p=0.059). 10 and 20year thrombosis-free survivals were better in patients with presenting neutrophil percentage ≥ 75% than those with lower presenting neutrophil counts: 91.4% vs. 47.6% and 64.9% vs. 35.7% (p=0.001) respectively. On multivariate analysis, in a model including gender, age ≥ 60 at diagnosis, atherosclerotic disease risk factors, prior thrombosis, use of cytoreduction, thrombosis at diagnosis and presenting neutrophil ≥ 75%, a presenting neutrophil level ≥ 75% was significant (Hazard ratio 0.25, 95% CI 0.11-0.6, p=0.002).
Summary
More patients who presented with a thrombotic complication at diagnosis had a presenting neutrophil count ≥ 75%. A presenting neutrophil count ≥ 75% and presence of risk factors for atherosclerotic disease were predictors of thrombosis occurring at diagnosis. However, for follow up thrombotic events, a presenting neutrophil ≥ 75% was associated with less thrombosis.
Keyword(s): Neutrophil, Polycythemia vera, Thrombosis
Type: Publication Only
Background
Polycythaemia vera (PV) is a myeloproliferative neoplasm (MPN) characterised by elevated haemoglobin and thrombotic tendency. Leukocytosis has been demonstrated to be a risk factor for thrombosis in PV. However, the white cell subtype implicated in thrombosis in PV has not been evaluated.
Aims
In this study we examined the role of presenting neutrophil levels in PV patients with thrombosis.
Methods
We retrospectively reviewed the case records of 163 patients with PV for thrombotic events in our institution’s MPN registry. This is an institutional review board approved registry that utilises REDCap, an electronic data capture tool for research studies. Thrombotic events considered were ischaemic heart disease, cerebrovascular accident, peripheral arterial disease, retinal artery occlusion, thrombosis of the splanchnic circulation and venous thromboembolism.
Results
Median age of diagnosis was 58years; 58.3% were male. 32 patients presented with a thrombotic event at diagnosis of PV. 12.5% of events were venous. Patients with a thrombosis at diagnosis were more likely to have risk factors for atherosclerotic disease (31.3% vs. 8.4%, p=0.012), have a higher presenting white cell count (15.2 x 109/L vs. 13.6 x 109/L, p=0.04) and to be treated with cytoreduction (90.6% vs. 71.8%, p=0.026). Patients with a thrombosis at diagnosis had a higher presenting neutrophil percentage of 82% (vs. 76.4%, p=0.002) and median absolute neutrophil count (ANC) (12.1 x 109/L vs. 10.1 x 109/L, p=0.017) than patients who did not. Based on receiver operating characteristic (ROC) analysis, a cut-off neutrophil percentage of 75% was derived for further analysis. 80.6% of patients who presented with thrombosis at diagnosis had a neutrophil count ≥ 75%, whereas 57.3% of those who did not, had a presenting neutrophil count ≥ 75% (p=0.016). On logistic regression, adjusting for gender, age ≥ 60 at diagnosis, prior thrombosis and presence of atherosclerotic disease risk factors, a presenting neutrophil percentage ≥ 75% (Odds ratio (OR) 3.36, 95% CI 1.25-9.03, p=0.016) and presence of atherosclerotic disease risk factors (OR 4.43, 95% CI 1.21-16.18, p=0.024) were predictors for thrombosis at diagnosis. Over a 5.4year median follow up, 31 thrombotic events occurred in 28 patients. Six patients who presented with thrombosis had subsequent events. Paradoxically, less patients who had a thrombotic event on follow up had a presenting neutrophil percentage ≥ 75% than patients who did not have thrombosis on follow up (34.6% vs 67.4%, p =0.002). Of patients who had a thrombosis after diagnosis, 57.1% were on cytoreduction compared to 74.8% of those who did not develop thrombosis (p=0.059). 10 and 20year thrombosis-free survivals were better in patients with presenting neutrophil percentage ≥ 75% than those with lower presenting neutrophil counts: 91.4% vs. 47.6% and 64.9% vs. 35.7% (p=0.001) respectively. On multivariate analysis, in a model including gender, age ≥ 60 at diagnosis, atherosclerotic disease risk factors, prior thrombosis, use of cytoreduction, thrombosis at diagnosis and presenting neutrophil ≥ 75%, a presenting neutrophil level ≥ 75% was significant (Hazard ratio 0.25, 95% CI 0.11-0.6, p=0.002).
Summary
More patients who presented with a thrombotic complication at diagnosis had a presenting neutrophil count ≥ 75%. A presenting neutrophil count ≥ 75% and presence of risk factors for atherosclerotic disease were predictors of thrombosis occurring at diagnosis. However, for follow up thrombotic events, a presenting neutrophil ≥ 75% was associated with less thrombosis.
Keyword(s): Neutrophil, Polycythemia vera, Thrombosis
Abstract: PB1906
Type: Publication Only
Background
Polycythaemia vera (PV) is a myeloproliferative neoplasm (MPN) characterised by elevated haemoglobin and thrombotic tendency. Leukocytosis has been demonstrated to be a risk factor for thrombosis in PV. However, the white cell subtype implicated in thrombosis in PV has not been evaluated.
Aims
In this study we examined the role of presenting neutrophil levels in PV patients with thrombosis.
Methods
We retrospectively reviewed the case records of 163 patients with PV for thrombotic events in our institution’s MPN registry. This is an institutional review board approved registry that utilises REDCap, an electronic data capture tool for research studies. Thrombotic events considered were ischaemic heart disease, cerebrovascular accident, peripheral arterial disease, retinal artery occlusion, thrombosis of the splanchnic circulation and venous thromboembolism.
Results
Median age of diagnosis was 58years; 58.3% were male. 32 patients presented with a thrombotic event at diagnosis of PV. 12.5% of events were venous. Patients with a thrombosis at diagnosis were more likely to have risk factors for atherosclerotic disease (31.3% vs. 8.4%, p=0.012), have a higher presenting white cell count (15.2 x 109/L vs. 13.6 x 109/L, p=0.04) and to be treated with cytoreduction (90.6% vs. 71.8%, p=0.026). Patients with a thrombosis at diagnosis had a higher presenting neutrophil percentage of 82% (vs. 76.4%, p=0.002) and median absolute neutrophil count (ANC) (12.1 x 109/L vs. 10.1 x 109/L, p=0.017) than patients who did not. Based on receiver operating characteristic (ROC) analysis, a cut-off neutrophil percentage of 75% was derived for further analysis. 80.6% of patients who presented with thrombosis at diagnosis had a neutrophil count ≥ 75%, whereas 57.3% of those who did not, had a presenting neutrophil count ≥ 75% (p=0.016). On logistic regression, adjusting for gender, age ≥ 60 at diagnosis, prior thrombosis and presence of atherosclerotic disease risk factors, a presenting neutrophil percentage ≥ 75% (Odds ratio (OR) 3.36, 95% CI 1.25-9.03, p=0.016) and presence of atherosclerotic disease risk factors (OR 4.43, 95% CI 1.21-16.18, p=0.024) were predictors for thrombosis at diagnosis. Over a 5.4year median follow up, 31 thrombotic events occurred in 28 patients. Six patients who presented with thrombosis had subsequent events. Paradoxically, less patients who had a thrombotic event on follow up had a presenting neutrophil percentage ≥ 75% than patients who did not have thrombosis on follow up (34.6% vs 67.4%, p =0.002). Of patients who had a thrombosis after diagnosis, 57.1% were on cytoreduction compared to 74.8% of those who did not develop thrombosis (p=0.059). 10 and 20year thrombosis-free survivals were better in patients with presenting neutrophil percentage ≥ 75% than those with lower presenting neutrophil counts: 91.4% vs. 47.6% and 64.9% vs. 35.7% (p=0.001) respectively. On multivariate analysis, in a model including gender, age ≥ 60 at diagnosis, atherosclerotic disease risk factors, prior thrombosis, use of cytoreduction, thrombosis at diagnosis and presenting neutrophil ≥ 75%, a presenting neutrophil level ≥ 75% was significant (Hazard ratio 0.25, 95% CI 0.11-0.6, p=0.002).
Summary
More patients who presented with a thrombotic complication at diagnosis had a presenting neutrophil count ≥ 75%. A presenting neutrophil count ≥ 75% and presence of risk factors for atherosclerotic disease were predictors of thrombosis occurring at diagnosis. However, for follow up thrombotic events, a presenting neutrophil ≥ 75% was associated with less thrombosis.
Keyword(s): Neutrophil, Polycythemia vera, Thrombosis
Type: Publication Only
Background
Polycythaemia vera (PV) is a myeloproliferative neoplasm (MPN) characterised by elevated haemoglobin and thrombotic tendency. Leukocytosis has been demonstrated to be a risk factor for thrombosis in PV. However, the white cell subtype implicated in thrombosis in PV has not been evaluated.
Aims
In this study we examined the role of presenting neutrophil levels in PV patients with thrombosis.
Methods
We retrospectively reviewed the case records of 163 patients with PV for thrombotic events in our institution’s MPN registry. This is an institutional review board approved registry that utilises REDCap, an electronic data capture tool for research studies. Thrombotic events considered were ischaemic heart disease, cerebrovascular accident, peripheral arterial disease, retinal artery occlusion, thrombosis of the splanchnic circulation and venous thromboembolism.
Results
Median age of diagnosis was 58years; 58.3% were male. 32 patients presented with a thrombotic event at diagnosis of PV. 12.5% of events were venous. Patients with a thrombosis at diagnosis were more likely to have risk factors for atherosclerotic disease (31.3% vs. 8.4%, p=0.012), have a higher presenting white cell count (15.2 x 109/L vs. 13.6 x 109/L, p=0.04) and to be treated with cytoreduction (90.6% vs. 71.8%, p=0.026). Patients with a thrombosis at diagnosis had a higher presenting neutrophil percentage of 82% (vs. 76.4%, p=0.002) and median absolute neutrophil count (ANC) (12.1 x 109/L vs. 10.1 x 109/L, p=0.017) than patients who did not. Based on receiver operating characteristic (ROC) analysis, a cut-off neutrophil percentage of 75% was derived for further analysis. 80.6% of patients who presented with thrombosis at diagnosis had a neutrophil count ≥ 75%, whereas 57.3% of those who did not, had a presenting neutrophil count ≥ 75% (p=0.016). On logistic regression, adjusting for gender, age ≥ 60 at diagnosis, prior thrombosis and presence of atherosclerotic disease risk factors, a presenting neutrophil percentage ≥ 75% (Odds ratio (OR) 3.36, 95% CI 1.25-9.03, p=0.016) and presence of atherosclerotic disease risk factors (OR 4.43, 95% CI 1.21-16.18, p=0.024) were predictors for thrombosis at diagnosis. Over a 5.4year median follow up, 31 thrombotic events occurred in 28 patients. Six patients who presented with thrombosis had subsequent events. Paradoxically, less patients who had a thrombotic event on follow up had a presenting neutrophil percentage ≥ 75% than patients who did not have thrombosis on follow up (34.6% vs 67.4%, p =0.002). Of patients who had a thrombosis after diagnosis, 57.1% were on cytoreduction compared to 74.8% of those who did not develop thrombosis (p=0.059). 10 and 20year thrombosis-free survivals were better in patients with presenting neutrophil percentage ≥ 75% than those with lower presenting neutrophil counts: 91.4% vs. 47.6% and 64.9% vs. 35.7% (p=0.001) respectively. On multivariate analysis, in a model including gender, age ≥ 60 at diagnosis, atherosclerotic disease risk factors, prior thrombosis, use of cytoreduction, thrombosis at diagnosis and presenting neutrophil ≥ 75%, a presenting neutrophil level ≥ 75% was significant (Hazard ratio 0.25, 95% CI 0.11-0.6, p=0.002).
Summary
More patients who presented with a thrombotic complication at diagnosis had a presenting neutrophil count ≥ 75%. A presenting neutrophil count ≥ 75% and presence of risk factors for atherosclerotic disease were predictors of thrombosis occurring at diagnosis. However, for follow up thrombotic events, a presenting neutrophil ≥ 75% was associated with less thrombosis.
Keyword(s): Neutrophil, Polycythemia vera, Thrombosis
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