Department of Hematology, The Second Hospital of Tianjin Medical University, Tianjin, China.
State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, National Clinical Research Center for Blood Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China.
Cancer Med. 2020 Mar;9(6):2096-2105. doi: 10.1002/cam4.2886. Epub 2020 Jan 28.
To explore the risk factors of thrombosis in patients with JAK2 -mutated myeloproliferative neoplasms (MPNs), a cohort of 1537 Chinese patients with JAK2 -mutated MPN was retrospectively analyzed. The Kaplan-Meier method and multivariate Cox analysis were used to study the risk factors of thrombosis in patients with JAK2 -mutated MPN. Among the 1537 MPN patients, 931, 468, and 138 had polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF), respectively. The median follow-up time was 7 years (range 1-47), and 12.8% of patients (197/1537) died during this period. A total of 16.8% (259/1399) of PV and ET patients had secondary myelofibrosis, and 2.5% (38/1537) of patients developed acute myeloid leukemia (AML). Thrombotic events occurred in 43.9% (675/1537) of patients, among which 91.4% (617/675) were arterial thrombosis and 16.6% (112/675) were venous thrombosis. The number of thrombotic events in PV, ET, and PMF patients was 439 (47.2%), 197 (42.1%) and 39 (28.2%), respectively. The multivariate analysis indicated that age ≥60 years old, HCT ≥48%, at least one cardiovascular risk factor, a history of thrombosis, and JAK2 allele burden (V617F%) ≥50% are risk factors for thrombosis in JAK2 -mutated MPN. According to the results of the multivariate analysis, a risk model of thrombosis was established and comprised low-risk (0 points), intermediate-risk (1 points) and high-risk (≥2 points) groups, among which the incidence of thrombosis was 9.1%, 33.7% and 72.9%. For elderly patients with JAK2 -mutated MPN and a history of thrombosis, reducing the V617F%, controlling HCT and preventing cardiovascular risk factors are necessary measures to prevent thrombosis.
为了探究 JAK2 突变骨髓增殖性肿瘤（MPN）患者发生血栓的风险因素，回顾性分析了 1537 例中国 JAK2 突变 MPN 患者。采用 Kaplan-Meier 法和多因素 Cox 分析研究 JAK2 突变 MPN 患者血栓形成的风险因素。在 1537 例 MPN 患者中，分别有 931 例、468 例和 138 例患有真性红细胞增多症（PV）、原发性血小板增多症（ET）和原发性骨髓纤维化（PMF）。中位随访时间为 7 年（1~47 年），在此期间 12.8%（197/1537）的患者死亡。259/1399（16.8%）的 PV 和 ET 患者发生继发性骨髓纤维化，38/1537（2.5%）的患者发生急性髓系白血病（AML）。1537 例患者中有 43.9%（675/1537）发生血栓事件，其中 91.4%（617/675）为动脉血栓形成，16.6%（112/675）为静脉血栓形成。PV、ET 和 PMF 患者的血栓事件数分别为 439（47.2%）、197（42.1%）和 39（28.2%）。多因素分析表明，年龄≥60 岁、HCT≥48%、至少有一个心血管危险因素、有血栓史和 JAK2 等位基因负荷（V617F%）≥50%是 JAK2 突变 MPN 发生血栓的危险因素。根据多因素分析结果，建立了一个血栓形成风险模型，包括低危（0 分）、中危（1 分）和高危（≥2 分）组，其中血栓形成发生率分别为 9.1%、33.7%和 72.9%。对于老年 JAK2 突变 MPN 合并血栓史的患者，降低 V617F%、控制 HCT 和预防心血管危险因素是预防血栓形成的必要措施。
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