HOW DIAGNOSTIC AND THERAPEUTIC APPROACHE CHANGED IN THE LAST DECADES IN THE PHILADELPHIA NEGATIVE MPN PATIENTS OF THE REGISTRO ITALIANO TROMBOCITEMIE (RIT)
(Abstract release date: 05/21/15)
EHA Library. Gugliotta L. 06/12/15; 102910; PB1919
Disclosure(s): Policlinico S.Orsola-MalpighiInstitute of Hematology 'L. and A. Seragnoli'
Dr. Luigi Gugliotta
Contributions
Contributions
Abstract
Abstract: PB1919
Type: Publication Only
Background
The last decade starts for the patients with Philadelphia Neg- MPN after the JAK2 mutations discovery (2005), the Italian guidelines for Essential Thrombocythemia therapy (2004), and the WHO classification (2001)
Aims
To evaluate how the diagnostic and therapeutic approach changed in the clinical practice in the last decade.
Methods
The patients of the Registro Italiano Trombocitemie (RIT) diagnosed before and after 2005 were compared by considering demography, clinico-biological characteristics at diagnosis, and the initial treatment approach.
Results
The 2418 analyzed patients were diagnosed (PVSG or WHO criteria) before 2005 (Group I, n 1230, 51%) and after 2005 (Group II, n 1188, 49%). The patients of Group II, as compared with those of Group I, had at diagnosis older age (median 60 vs 55 y, p60 y in 50% vs 41%, p<0.001), higher rate of comorbidities (56% vs 49%, p 0.002), and lower median PLT count (748 vs 786 x109/L, p< 0.001). No significant differences were found for gender (males 38% vs 38%), prior thrombosis (20% vs 20%), prior hemorrhage (4.9% vs 5.6%), CV general risk factors (71% vs 68%), symptoms (41% vs 41%), splenomegaly (25% vs 23%), hepatomegaly (22% vs 24%), WBC count (median 8.7 vs 8.5 x109/L; >10 x109/L 28% vs 27%), and HCT level (median in males 44.8% vs 44.1%; median in females 41.5% vs 41.0%). The bone marrow biopsy in the first year was performed more frequently (76% vs 67%, p<0.001). The test for JAK2 mutation was performed in 89% of Group II patients, and, a posteriori, in 72% of Group I patients (p <0.001). The patients of Group II had a higher rate of JAK2 V617F mutation (62% vs 56%, p 0.015), and of allele burden <25% (65% vs 51%, p <0.01). Moreover, the patients of Group II had a higher rate of standard high thrombotic risk (57% vs 49%, p<0.001).During the first year after diagnosis, an antiplatelet (+ or - cytoreductive) treatment (almost always low dose aspirin) was started more frequently in the Group II (65% vs 48%, p<0.001), particularly (p<0.001) in patients at low thrombotic risk (standard and IPSET-Th). Similarly, a cytoreductive (+ or - antiplatelet) treatment was started more frequently in the Group II (57% vs 50%, p 0.002), particularly (74% vs 68%, p 0.013) in patients with high thrombotic risk (standard and IPSET-Th). In the Group II, as compared with Group I, the rate of hydroxycarbamide use was higher for patients over 60 y (71% vs 63%, p<0.01) and lower for those below 40 y (8% vs 14%, p<0.05), while the rate of anagrelide use was higher for patients below 40 y (6.4% vs 2.7%, p<0.05).
Summary
The patients of the RIT diagnosed after 2005, compared with those diagnosed before, although were older, had more frequently a bone marrow biopsy at diagnosis. They had lower platelet count, higher rate of JAK2 V617F mutation, and higher rate of high thrombotic risk. No significant differences were found for gender, prior thrombosis, CV general risk factors, symptoms, splenomegaly, WBC count. During the 1st year, they were treated more frequently with antiplatelet drugs (particularly if at low thrombotic risk), and with cytoreductive drugs (particularly if at high thrombotic risk). The hydroxycarbamide use increased in older patients, while the anagrelide use increased in younger ones. In conclusion, in the real life of the RIT centers, a significant improvement of the diagnostic and therapeutic approach was documented in the last decade.
Keyword(s): Diagnosis, Platelet, Therapy, Thrombocythemia
Session topic: Publication Only
Type: Publication Only
Background
The last decade starts for the patients with Philadelphia Neg- MPN after the JAK2 mutations discovery (2005), the Italian guidelines for Essential Thrombocythemia therapy (2004), and the WHO classification (2001)
Aims
To evaluate how the diagnostic and therapeutic approach changed in the clinical practice in the last decade.
Methods
The patients of the Registro Italiano Trombocitemie (RIT) diagnosed before and after 2005 were compared by considering demography, clinico-biological characteristics at diagnosis, and the initial treatment approach.
Results
The 2418 analyzed patients were diagnosed (PVSG or WHO criteria) before 2005 (Group I, n 1230, 51%) and after 2005 (Group II, n 1188, 49%). The patients of Group II, as compared with those of Group I, had at diagnosis older age (median 60 vs 55 y, p60 y in 50% vs 41%, p<0.001), higher rate of comorbidities (56% vs 49%, p 0.002), and lower median PLT count (748 vs 786 x109/L, p< 0.001). No significant differences were found for gender (males 38% vs 38%), prior thrombosis (20% vs 20%), prior hemorrhage (4.9% vs 5.6%), CV general risk factors (71% vs 68%), symptoms (41% vs 41%), splenomegaly (25% vs 23%), hepatomegaly (22% vs 24%), WBC count (median 8.7 vs 8.5 x109/L; >10 x109/L 28% vs 27%), and HCT level (median in males 44.8% vs 44.1%; median in females 41.5% vs 41.0%). The bone marrow biopsy in the first year was performed more frequently (76% vs 67%, p<0.001). The test for JAK2 mutation was performed in 89% of Group II patients, and, a posteriori, in 72% of Group I patients (p <0.001). The patients of Group II had a higher rate of JAK2 V617F mutation (62% vs 56%, p 0.015), and of allele burden <25% (65% vs 51%, p <0.01). Moreover, the patients of Group II had a higher rate of standard high thrombotic risk (57% vs 49%, p<0.001).During the first year after diagnosis, an antiplatelet (+ or - cytoreductive) treatment (almost always low dose aspirin) was started more frequently in the Group II (65% vs 48%, p<0.001), particularly (p<0.001) in patients at low thrombotic risk (standard and IPSET-Th). Similarly, a cytoreductive (+ or - antiplatelet) treatment was started more frequently in the Group II (57% vs 50%, p 0.002), particularly (74% vs 68%, p 0.013) in patients with high thrombotic risk (standard and IPSET-Th). In the Group II, as compared with Group I, the rate of hydroxycarbamide use was higher for patients over 60 y (71% vs 63%, p<0.01) and lower for those below 40 y (8% vs 14%, p<0.05), while the rate of anagrelide use was higher for patients below 40 y (6.4% vs 2.7%, p<0.05).
Summary
The patients of the RIT diagnosed after 2005, compared with those diagnosed before, although were older, had more frequently a bone marrow biopsy at diagnosis. They had lower platelet count, higher rate of JAK2 V617F mutation, and higher rate of high thrombotic risk. No significant differences were found for gender, prior thrombosis, CV general risk factors, symptoms, splenomegaly, WBC count. During the 1st year, they were treated more frequently with antiplatelet drugs (particularly if at low thrombotic risk), and with cytoreductive drugs (particularly if at high thrombotic risk). The hydroxycarbamide use increased in older patients, while the anagrelide use increased in younger ones. In conclusion, in the real life of the RIT centers, a significant improvement of the diagnostic and therapeutic approach was documented in the last decade.
Keyword(s): Diagnosis, Platelet, Therapy, Thrombocythemia
Session topic: Publication Only
Abstract: PB1919
Type: Publication Only
Background
The last decade starts for the patients with Philadelphia Neg- MPN after the JAK2 mutations discovery (2005), the Italian guidelines for Essential Thrombocythemia therapy (2004), and the WHO classification (2001)
Aims
To evaluate how the diagnostic and therapeutic approach changed in the clinical practice in the last decade.
Methods
The patients of the Registro Italiano Trombocitemie (RIT) diagnosed before and after 2005 were compared by considering demography, clinico-biological characteristics at diagnosis, and the initial treatment approach.
Results
The 2418 analyzed patients were diagnosed (PVSG or WHO criteria) before 2005 (Group I, n 1230, 51%) and after 2005 (Group II, n 1188, 49%). The patients of Group II, as compared with those of Group I, had at diagnosis older age (median 60 vs 55 y, p60 y in 50% vs 41%, p<0.001), higher rate of comorbidities (56% vs 49%, p 0.002), and lower median PLT count (748 vs 786 x109/L, p< 0.001). No significant differences were found for gender (males 38% vs 38%), prior thrombosis (20% vs 20%), prior hemorrhage (4.9% vs 5.6%), CV general risk factors (71% vs 68%), symptoms (41% vs 41%), splenomegaly (25% vs 23%), hepatomegaly (22% vs 24%), WBC count (median 8.7 vs 8.5 x109/L; >10 x109/L 28% vs 27%), and HCT level (median in males 44.8% vs 44.1%; median in females 41.5% vs 41.0%). The bone marrow biopsy in the first year was performed more frequently (76% vs 67%, p<0.001). The test for JAK2 mutation was performed in 89% of Group II patients, and, a posteriori, in 72% of Group I patients (p <0.001). The patients of Group II had a higher rate of JAK2 V617F mutation (62% vs 56%, p 0.015), and of allele burden <25% (65% vs 51%, p <0.01). Moreover, the patients of Group II had a higher rate of standard high thrombotic risk (57% vs 49%, p<0.001).During the first year after diagnosis, an antiplatelet (+ or - cytoreductive) treatment (almost always low dose aspirin) was started more frequently in the Group II (65% vs 48%, p<0.001), particularly (p<0.001) in patients at low thrombotic risk (standard and IPSET-Th). Similarly, a cytoreductive (+ or - antiplatelet) treatment was started more frequently in the Group II (57% vs 50%, p 0.002), particularly (74% vs 68%, p 0.013) in patients with high thrombotic risk (standard and IPSET-Th). In the Group II, as compared with Group I, the rate of hydroxycarbamide use was higher for patients over 60 y (71% vs 63%, p<0.01) and lower for those below 40 y (8% vs 14%, p<0.05), while the rate of anagrelide use was higher for patients below 40 y (6.4% vs 2.7%, p<0.05).
Summary
The patients of the RIT diagnosed after 2005, compared with those diagnosed before, although were older, had more frequently a bone marrow biopsy at diagnosis. They had lower platelet count, higher rate of JAK2 V617F mutation, and higher rate of high thrombotic risk. No significant differences were found for gender, prior thrombosis, CV general risk factors, symptoms, splenomegaly, WBC count. During the 1st year, they were treated more frequently with antiplatelet drugs (particularly if at low thrombotic risk), and with cytoreductive drugs (particularly if at high thrombotic risk). The hydroxycarbamide use increased in older patients, while the anagrelide use increased in younger ones. In conclusion, in the real life of the RIT centers, a significant improvement of the diagnostic and therapeutic approach was documented in the last decade.
Keyword(s): Diagnosis, Platelet, Therapy, Thrombocythemia
Session topic: Publication Only
Type: Publication Only
Background
The last decade starts for the patients with Philadelphia Neg- MPN after the JAK2 mutations discovery (2005), the Italian guidelines for Essential Thrombocythemia therapy (2004), and the WHO classification (2001)
Aims
To evaluate how the diagnostic and therapeutic approach changed in the clinical practice in the last decade.
Methods
The patients of the Registro Italiano Trombocitemie (RIT) diagnosed before and after 2005 were compared by considering demography, clinico-biological characteristics at diagnosis, and the initial treatment approach.
Results
The 2418 analyzed patients were diagnosed (PVSG or WHO criteria) before 2005 (Group I, n 1230, 51%) and after 2005 (Group II, n 1188, 49%). The patients of Group II, as compared with those of Group I, had at diagnosis older age (median 60 vs 55 y, p60 y in 50% vs 41%, p<0.001), higher rate of comorbidities (56% vs 49%, p 0.002), and lower median PLT count (748 vs 786 x109/L, p< 0.001). No significant differences were found for gender (males 38% vs 38%), prior thrombosis (20% vs 20%), prior hemorrhage (4.9% vs 5.6%), CV general risk factors (71% vs 68%), symptoms (41% vs 41%), splenomegaly (25% vs 23%), hepatomegaly (22% vs 24%), WBC count (median 8.7 vs 8.5 x109/L; >10 x109/L 28% vs 27%), and HCT level (median in males 44.8% vs 44.1%; median in females 41.5% vs 41.0%). The bone marrow biopsy in the first year was performed more frequently (76% vs 67%, p<0.001). The test for JAK2 mutation was performed in 89% of Group II patients, and, a posteriori, in 72% of Group I patients (p <0.001). The patients of Group II had a higher rate of JAK2 V617F mutation (62% vs 56%, p 0.015), and of allele burden <25% (65% vs 51%, p <0.01). Moreover, the patients of Group II had a higher rate of standard high thrombotic risk (57% vs 49%, p<0.001).During the first year after diagnosis, an antiplatelet (+ or - cytoreductive) treatment (almost always low dose aspirin) was started more frequently in the Group II (65% vs 48%, p<0.001), particularly (p<0.001) in patients at low thrombotic risk (standard and IPSET-Th). Similarly, a cytoreductive (+ or - antiplatelet) treatment was started more frequently in the Group II (57% vs 50%, p 0.002), particularly (74% vs 68%, p 0.013) in patients with high thrombotic risk (standard and IPSET-Th). In the Group II, as compared with Group I, the rate of hydroxycarbamide use was higher for patients over 60 y (71% vs 63%, p<0.01) and lower for those below 40 y (8% vs 14%, p<0.05), while the rate of anagrelide use was higher for patients below 40 y (6.4% vs 2.7%, p<0.05).
Summary
The patients of the RIT diagnosed after 2005, compared with those diagnosed before, although were older, had more frequently a bone marrow biopsy at diagnosis. They had lower platelet count, higher rate of JAK2 V617F mutation, and higher rate of high thrombotic risk. No significant differences were found for gender, prior thrombosis, CV general risk factors, symptoms, splenomegaly, WBC count. During the 1st year, they were treated more frequently with antiplatelet drugs (particularly if at low thrombotic risk), and with cytoreductive drugs (particularly if at high thrombotic risk). The hydroxycarbamide use increased in older patients, while the anagrelide use increased in younger ones. In conclusion, in the real life of the RIT centers, a significant improvement of the diagnostic and therapeutic approach was documented in the last decade.
Keyword(s): Diagnosis, Platelet, Therapy, Thrombocythemia
Session topic: Publication Only
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