Please use this identifier to cite or link to this item:http://hdl.handle.net/20.500.12105/20479
Title
Risk of thrombosis according to need of phlebotomies in patients with polycythemia vera treated with hydroxyurea
Author(s)
Alvarez-Larran, Alberto | Perez-Encinas, Manuel | Ferrer-Marin, Francisca | Carlos Hernandez-Boluda, Juan | Jose Ramirez, Maria | Martinez-Lopez, Joaquin CNIO | Magro, Elena | Cruz, Yasmina | Isabel Mata, Maria | Pilar Aragues, Mata | Laura Fox, Maria | Cuevas, Beatriz | Montesdeoca, Sara | Hernández-Rivas, José Ángel | Garcia-Gutierrez, Valentin | Teresa Gomez-Casares, Maria | Luis Steegmann, Juan | Duran Pastor, Maria Antonia | Gomez, Montse | Kerguelen, Ana | Barez, Abelardo | Carmen Garcia, Mari | Boque, Concepcion | Maria Raya, Jose | Martinez, Clara | Albors, Manuel | Garcia, Francesc | Burgaleta, Carmen | Besses, Carlos | Grp Espanol Neoplasias
Date issued
2017-01
Citation
Alvarez-Larran A, Perez-Encinas M, Ferrer-Marin F, Hernandez-Boluda JC, Ramirez MJ, Martinez-Lopez J, et al. Risk of thrombosis according to need of phlebotomies in patients with polycythemia vera treated with hydroxyurea. Haematologica. 2017 Jan;102(1):103-9. Epub 2016 Sep 29.
Language
Inglés
Document type
research article
Abstract
Hematocrit control below 45% is associated with a lower rate of thrombosis in polycythemia vera. In patients receiving hydroxyurea, this target can be achieved with hydroxyurea alone or with the combination of hydroxyurea plus phlebotomies. However, the clinical implications of phlebotomy requirement under hydroxyurea therapy are unknown. The aim of this study was to evaluate the need for additional phlebotomies during the first five years of hydroxyurea therapy in 533 patients with polycythemia vera. Patients requiring 3 or more phlebotomies per year (n=85, 16%) showed a worse hematocrit control than those requiring 2 or less phlebotomies per year (n=448, 84%). There were no significant differences between the two study groups regarding leukocyte and platelet counts. Patients requiring 3 or more phlebotomies per year received significantly higher doses of hydroxyurea than the remaining patients. A significant higher rate of thrombosis was found in patients treated with hydroxyurea plus 3 or more phlebotomies per year compared to hydroxyurea with 0-2 phlebotomies per year (20.5% vs. 5.3% at 3 years; P<0.0001). In multivariate analysis, independent risk factors for thrombosis were phlebotomy dependency (HR: 3.3, 95% CI: 1.5-6.9; P=0.002) and thrombosis at diagnosis (HR: 4.7, 95% CI: 2.3-9.8; P<0.0001). The proportion of patients fulfilling the European LeukemiaNet criteria of resistance/intolerance to hydroxyurea was significantly higher in the group requiring 3 or more phlebotomies per year (18.7% vs. 7.1%; P=0.001) mainly due to extra-hematologic toxicity. In conclusion, phlebotomy requirement under hydroxyurea therapy identifies a subset of patients with increased proliferation of polycythemia vera and higher risk of thrombosis.
MESH
Hydroxyurea | Aged, 80 and over | Aged | Young Adult | Spain | Adult | Humans | Thrombosis | Adolescent | Combined Modality Therapy | Hematocrit | Middle Aged | Blood Cell Count | Phenotype | Drug Resistance | Male | Multivariate Analysis | Time Factors | Female | Risk | Treatment Outcome | Polycythemia Vera | Registries | Phlebotomy
DECS
Resultado del Tratamiento | Flebotomía | Factores de Tiempo | Femenino | Análisis Multivariante | Resistencia a Medicamentos | Terapia Combinada | Adolescente | Masculino | Trombosis | Hematócrito | Riesgo | Recuento de Células Sanguíneas | Humanos | Persona de Mediana Edad | Adulto Joven | Anciano | Fenotipo | Anciano de 80 o más Años | Adulto | Policitemia Vera | Hidroxiurea | España | Sistema de Registros
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