Post-Diagnosis Hemorrhagic Events Are Strongly Associated With Poor Survival in Patients With Essential Thrombocythemia.

OBJECTIVES

The present study investigated the effects of thrombosis, hemorrhagic events, disease progression, and secondary malignancies on patient survival after the diagnosis of essential thrombocythemia (ET).

METHODS

We analyzed data from 1152 patients enrolled in the JSH-MPN-18 study using time-dependent Cox regression and multistate Markov models to estimate transition hazards and state occupation probabilities.

RESULTS

Hemorrhagic events (hazard ratio = 2.92, 95% confidence interval = 1.78-4.78, < 0.001) was associated with a poor prognosis. In multistate model, hazards from the hemorrhagic event to death were higher among cumulative transition hazards, and the probability of remaining in the hemorrhagic state was lower than the probability of remaining in the other states of thrombosis, disease progression, and secondary malignancy in state occupancy probabilities.

CONCLUSIONS

The present results demonstrated that hemorrhagic events following the diagnosis of ET are a serious risk factor and are directly related to early death. Baseline characteristics and post-diagnosis events (intermediate status) may both have a significant impact on survival, and treatment strategies that take into account the prevention of an intermediate status need to be incorporated into clinical practice.

TRIAL REGISTRATION

The authors have confirmed clinical trial registration is not needed for this submission.