Title: MPN-207: Is the Absence of JAK2V617F Mutation a Risk Factor for Bleeding in Philadelphia Chromosome-Negative Myeloproliferative Neoplasms?
Abstract: Thromboembolic events and bleeding episodes are the main complications of myeloproliferative neoplasms (MPNs). JAK2V617Fmutation is a known thrombotic risk factor in MPNs, while few data correlate JAK2V617F with bleeding risk. Therefore, the thrombosis/hemorrhage risk reassessment in MPN patients should be reappraised. The aim of our study is to evaluate the impact of JAK2V617V mutation positivity on bleeding complications in MPNs. A cross-sectional study was performed at two tertiary centers in upper Egypt, Assiut and Qena University Hospitals, from January 2019 to December 2020. Newly diagnosed MPN patients underwent history taking, physical examination, basic laboratory work, and molecular assessment of both the JAK2V617Vmutation and Philadelphia chromosome. The cohort included 78 Philadelphia-negative MPN patients, 55% of whom were female, and the median age was 57 (range 40–85). Half of the patients were polycythemia rubra vera (PRV; n=40, 51%), while one-third were primary myelofibrosis (PMF; n=28, 36%), and only 13% were essential thrombocytosis (ET; n=10). The median total leukocytic count (TLC) was 9.6 (range: 0.3–190) × 109/L, median hemoglobin level (HB) was 15 (range: 4–21) g/dl, and median platelet count was 359 (range: 3–2960) × 109/L. Almost half of the patients (n=35; 45%) harbor JAK2V617F. Regarding patients’ clinical criteria based on JAK2V617V mutation, there was no significant difference in itching (6% for JAK2V617F-positive group vs 9% JAK2V617F-negative group, P=0.6) and splenomegaly (71% vs 67%, P=0.8). Erythema was significantly higher in the JAK2V617F-positive group (34% vs 14%; P=0.0008). The main observation was that thrombosis occurred significantly more often in the JAK2V617V-positive group (49% vs 16%; P=0.0003). On the contrary, there was no significant difference in bleeding between the JAK2V617F-positive (23%) and JAK2V617F-negative groups (28%; P=0.6). A multivariate model was performed to identify the significant independent variables that lead to bleeding, which showed that only platelets (odds ratio=1) and splenomegaly (odds ratio=8.5) had significant effects. In conclusion, the data confirmed that JAK2V617V mutation is associated with an increased risk of thrombosis in MPNs, but it does not have a role in increased bleeding risk in MPNs. Large prospective studies are needed to confirm the role of JAK2V617V in bleeding during the course of MPNs and its relation to different lines of treatment. Thromboembolic events and bleeding episodes are the main complications of myeloproliferative neoplasms (MPNs). JAK2V617Fmutation is a known thrombotic risk factor in MPNs, while few data correlate JAK2V617F with bleeding risk. Therefore, the thrombosis/hemorrhage risk reassessment in MPN patients should be reappraised. The aim of our study is to evaluate the impact of JAK2V617V mutation positivity on bleeding complications in MPNs. A cross-sectional study was performed at two tertiary centers in upper Egypt, Assiut and Qena University Hospitals, from January 2019 to December 2020. Newly diagnosed MPN patients underwent history taking, physical examination, basic laboratory work, and molecular assessment of both the JAK2V617Vmutation and Philadelphia chromosome. The cohort included 78 Philadelphia-negative MPN patients, 55% of whom were female, and the median age was 57 (range 40–85). Half of the patients were polycythemia rubra vera (PRV; n=40, 51%), while one-third were primary myelofibrosis (PMF; n=28, 36%), and only 13% were essential thrombocytosis (ET; n=10). The median total leukocytic count (TLC) was 9.6 (range: 0.3–190) × 109/L, median hemoglobin level (HB) was 15 (range: 4–21) g/dl, and median platelet count was 359 (range: 3–2960) × 109/L. Almost half of the patients (n=35; 45%) harbor JAK2V617F. Regarding patients’ clinical criteria based on JAK2V617V mutation, there was no significant difference in itching (6% for JAK2V617F-positive group vs 9% JAK2V617F-negative group, P=0.6) and splenomegaly (71% vs 67%, P=0.8). Erythema was significantly higher in the JAK2V617F-positive group (34% vs 14%; P=0.0008). The main observation was that thrombosis occurred significantly more often in the JAK2V617V-positive group (49% vs 16%; P=0.0003). On the contrary, there was no significant difference in bleeding between the JAK2V617F-positive (23%) and JAK2V617F-negative groups (28%; P=0.6). A multivariate model was performed to identify the significant independent variables that lead to bleeding, which showed that only platelets (odds ratio=1) and splenomegaly (odds ratio=8.5) had significant effects. In conclusion, the data confirmed that JAK2V617V mutation is associated with an increased risk of thrombosis in MPNs, but it does not have a role in increased bleeding risk in MPNs. Large prospective studies are needed to confirm the role of JAK2V617V in bleeding during the course of MPNs and its relation to different lines of treatment.
Publication Year: 2021
Publication Date: 2021-08-30
Language: en
Type: article
Indexed In: ['crossref']
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