Patients with essential thrombocythaemia (ET) frequently have thrombosis and hemorrhage. Patients were divided into 4 risk categories according to the 2016 revision of the International Prognostic Score for Thrombosis in Essential Thrombocythaemia-Thrombosis (r-IPSET-t) score: very-low-risk (VLR), low-risk (LR), intermediate-risk (IR), and high-risk (HR).
The r-IPSET-t score was verified in the largest group of ET patients to date (n = 1,381), and researchers discovered that it provided a better match than the original IPSET-t score. After diagnosis, there were 0.578 thrombotic events per person per year and 0.286 bleeding events per person per year, with an average follow-up of 87.7 months. The r-IPSET-t LR & VLR groups had 10-year thrombosis-free survival rates of 88% and 99%, respectively (P<0.001). Younger patients (<60 years, hazard ratio 9.49, P=0.026; aged ≥60 years, hazard ratio 1.04, P=0.93) had cytoreduction as a thrombotic risk factor.
Anti-aggregation after diagnosis was shown to be protective against thrombosis (hazard ratio 0.31, P=0.005) but risky for serious bleeding (hazard ratio 10.56, P=0.021) in a multivariate Cox regression analysis. 132/780 and 249/301, respectively, of the IPSET-t HR and LR groups, were reclassified as LR and VLR (P<0.001). Although aspirin was not advised for VLR patients by the European LeukemiaNET (ELN), 83.1% of VLR patients got it in the real-life investigation.
The findings supported the r-IPSET-t score as being more thrombosis-predictive than the ELN-recommended IPSET-t and indicated issues with needless cytoreductive and anti-aggregative treatment.
Reference: onlinelibrary.wiley.com/doi/10.1111/bjh.18387
