Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Myeloproliferative Syndromes Unit, Via Francesco Sforza 35, Milan, 20122, Italy.
Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.
Ann Hematol. 2024 Aug;103(8):2787-2795. doi: 10.1007/s00277-024-05801-0. Epub 2024 Jun 12.
We evaluated RDW in a single-center series of 61 consecutive patients with primary and secondary MF at diagnosis and during treatment with ruxolitinib (RUX) and examined any possible prognostic impact. Elevated RDW values were present in all but 4 patients at diagnosis with a median RDW of 18.9%. RDW was higher in subjects with palpable splenomegaly (p = 0.02), higher ferritin, as well as among those cases who did not receive any cytoreduction before RUX (p = 0.04). Interestingly, higher RDW at diagnosis also correlated with a shorter time from MF diagnosis to RUX start (-4.1 months per one RDW unit; p = 0.03). We observed a modest increase (< 1%) in RDW during the first 6 months of RUX treatment. In a multivariable random-intercept model that considered all time points and contained the covariates time and RUX dose, we also observed a clear decrease in RDW with increasing hemoglobin (Hb) during RUX (slope: -0.4% per g/dL of Hb; p < 0.001). The median RDW at diagnosis of 18.9% was used as a cut-off to identify two subgroups of patients [Group 1: RDW 19.0-25.7%; Group 2: RDW 13.1-18.7%], showing a difference in mortality [Group 1 vs. 2: crude HR 2.88; p = 0.01]. Using continuous RDW at diagnosis, the crude HR was 1.21 per RDW unit (p = 0.002). In a Cox model adjusted for gender, age and Hb at diagnosis, the HR was 1.13 per RDW unit (p = 0.07). RDW may have prognostic significance at MF diagnosis and during RUX, helping in the rapid detection of patients with poor prognosis.
我们评估了 61 例原发性和继发性骨髓纤维化患者在诊断时和接受芦可替尼（RUX）治疗期间的 RDW，并检查了任何可能的预后影响。所有患者除 4 例外，RDW 在诊断时均升高，中位数为 18.9%。RDW 在有可触及脾肿大的患者中更高（p=0.02），铁蛋白更高，以及在那些在接受 RUX 治疗前未接受任何细胞减少治疗的病例中更高（p=0.04）。有趣的是，诊断时的 RDW 更高也与从 MF 诊断到 RUX 开始的时间较短有关（每增加一个 RDW 单位，时间减少 4.1 个月；p=0.03）。我们观察到在 RUX 治疗的前 6 个月期间，RDW 有适度增加（<1%）。在考虑所有时间点并包含时间和 RUX 剂量的多变量随机截距模型中，我们还观察到在 RUX 期间，随着血红蛋白（Hb）的增加，RDW 明显下降（斜率：每增加 1g/dL Hb，RDW 降低 0.4%；p<0.001）。诊断时的 RDW 中位数为 18.9%，用作识别两个患者亚组的截止值[组 1：RDW 19.0-25.7%；组 2：RDW 13.1-18.7%]，死亡率存在差异[组 1 与组 2：粗 HR 2.88；p=0.01]。使用诊断时的连续 RDW，每增加一个 RDW 单位，粗 HR 为 1.21（p=0.002）。在调整性别、年龄和诊断时 Hb 的 Cox 模型中，HR 为每增加一个 RDW 单位 1.13（p=0.07）。RDW 在 MF 诊断时和 RUX 期间可能具有预后意义，有助于快速检测预后不良的患者。
