Duminuco Andrea, Vaghela Raj, Virdee Sukhraj, Woodley Claire, Asirvatham Susan, Curto-Garcia Natalia, Sriskandarajah Priya, O'Sullivan Jennifer, de Lavallade Hugues, Radia Deepti, Kordasti Shahram, Palumbo Giuseppe A, Harrison Claire, Harrington Patrick
Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Department of Medical, Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Catania, Italy.
Leukemia. 2025 Jul 24. doi: 10.1038/s41375-025-02681-9.
Thromboembolic events (TE) represent the commonest cause of morbidity and mortality in polycythemia vera (PV) and essential thrombocythaemia (ET). The QRISK3 model is a tool for predicting TE in the general population, with 7.5% recognised as a threshold to identify high-risk patients. We analyzed data of 937 patients (490 ET and 447 PV) with a median follow-up of 85 and 95 months, reporting an occurrence of 52 and 73 TE, respectively. Median QRISK3 scores at diagnosis were higher in conventional high-risk patients in both cohorts (ET; 4.2 in high-risk vs. 2.4 in low-risk, PV; 8.8 vs. 2.8, p < 0.001). During follow-up, a QRISK3 score greater than 7.5%, demonstrated potential to further stratify individuals at high risk of TE, outperforming standard risk assessments in both low and high-risk patients. Using cytoreductive treatment instead of active surveillance in patients with QRISK3 ≥ 7.5% conferred a reduced risk of thrombosis in both cohorts. Of this group, 79.7% with ET and 86.9% with PV, on cytoreductive therapy, remained thrombosis free, compared with 64.1% and 57.1% of those not receiving cytoreductive therapy (p = 0.018/0.034). QRISK3 identifies patients in whom cytoreductive therapies may be indicated, and provides a tool that allows patients to assess, monitor and reduce their cardiovascular risk.
血栓栓塞事件（TE）是真性红细胞增多症（PV）和原发性血小板增多症（ET）中发病率和死亡率的最常见原因。QRISK3模型是一种用于预测普通人群中TE的工具，7.5%被认为是识别高危患者的阈值。我们分析了937例患者（490例ET和447例PV）的数据，中位随访时间分别为85个月和95个月，分别报告了52例和73例TE事件。在两个队列中，传统高危患者诊断时的QRISK3评分中位数均较高（ET：高危组为4.2，低危组为2.4；PV：高危组为8.8，低危组为2.8，p<0.001）。在随访期间，QRISK3评分大于7.5%显示出进一步分层TE高危个体的潜力，在低危和高危患者中均优于标准风险评估。在QRISK3≥7.5%的患者中使用细胞减灭性治疗而非主动监测，在两个队列中均降低了血栓形成风险。在这组患者中，接受细胞减灭性治疗的ET患者中有79.7%、PV患者中有86.9%未发生血栓，而未接受细胞减灭性治疗的患者中这一比例分别为64.1%和57.1%（p=0.018/0.034）。QRISK3可识别可能需要进行细胞减灭性治疗的患者，并提供一种工具，使患者能够评估、监测和降低其心血管风险。
