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Impact of comorbidities and body mass index on the outcome of polycythemia vera patients
Author(s) -
Benevolo Giulia,
Elli Elena M.,
Bartoletti Daniela,
Latagliata Roberto,
Tiribelli Mario,
Heidel Florian H.,
Cavazzini Francesco,
Bonifacio Massimiliano,
Crugnola Monica,
Binotto Gianni,
D'Addio Alessandra,
Tieghi Alessia,
Bergamaschi Micaela,
Caocci Giovanni,
Polverelli Nicola,
Bossi Elisa,
Auteri Giuseppe,
Carmosino Ida,
Catani Lucia,
Cuneo Antonio,
Krampera Mauro,
Lanza Francesco,
Lemoli Roberto M.,
Vianelli Nicola,
Breccia Massimo,
Palumbo Giuseppe A.,
Cavo Michele,
Palandri Francesca
Publication year - 2021
Publication title -
hematological oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 44
eISSN - 1099-1069
pISSN - 0278-0232
DOI - 10.1002/hon.2843
Subject(s) - medicine , body mass index , hazard ratio , underweight , overweight , polycythemia vera , gastroenterology , cumulative incidence , comorbidity , incidence (geometry) , surgery , cohort , confidence interval , physics , optics
Abstract In 816 patients with 2016 World Health Organization‐defined polycythemia vera (PV) enrolled in a multicenter retrospective study, we investigated the predictive value of Charlson comorbidity index (CCI) and body mass index (BMI) on thrombosis, progression to post‐PV myelofibrosis (PPV‐MF) and survival. Patients were subgrouped according to CCI = 0 (58.1%, no comorbidities) or CCI ≥ 1 (41.9%) and according to normal/underweight (BMI < 25, 54.5%) or overweight/obesity (BMI ≥ 25, 45.5%) at PV diagnosis. BMI was available for 529 patients. Patients with CCI ≥ 1 were older and more frequently presented cardiovascular risk factors compared to patients with CCI = 0 ( p < 0.001), while overweight/obese patients were more frequently males ( p < 0.001). Cumulative incidence of thromboses with death as competing risk was 13.3% at 10 years. Multivariable analysis with death as competing risk showed that previous thromboses (subdistribution hazard ratio [SHR]: 2.1, p = 0.01) and hypertension (SHR: 1.77, p = 0.04) were significantly associated with a higher thrombotic risk, while BMI ≥ 25 lost statistical significance (SHR: 1.69, p = 0.05) and CCI ≥ 1 was excluded after evaluation of goodness of fit. After a median follow‐up of 6.1 years, progression to PPV‐MF occurred in 44 patients, and 75 patients died. BMI ≥ 25 was associated with a lower probability of progression to PPV‐MF (SHR: 0.38, CI95%: 0.15–0.94, p = 0.04) and better survival (hazard ratio [HR]: 0.42, CI95%: 0.18–0.97, p = 0.04). CCI ≥ 1 did not affect progression to PPV‐MF ( p = 0.44) or survival ( p = 0.71). The evaluation of CCI and BMI may improve the prognostic definition of PV. In patients with hypertension an accurate evaluation of thrombotic risk is warranted.