Survival and disease progression in essential thrombocythemia are significantly influenced by accurate morphologic diagnosis: A international study

Tiziano Barbui, Juergen Thiele, Francesco Passamonti, Elisa Rumi, Emanuela Boveri, Marco Ruggeri, Francesco Rodeghiero, Emanuele S.G. D'Amore, Maria Luigia Randi, Irene Bertozzi, Filippo Marino, Alessandro M. Vannucchi, Elisabetta Antonioli, Valentina Carrai, Heinz Gisslinger, Veronika Buxhofer-Ausch, Leonhard Mul̈lauer, Alessandra Carobbio, Andrea Gianatti, Naseema GangatCurtis A. Hanson, Ayalew Tefferi

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315 Scopus citations


Purpose: The WHO diagnostic criteria underscore the role of bone marrow (BM) morphology in distinguishing essential thrombocythemia (ET) from early/prefibrotic primary myelofibrosis (PMF). This study examined the clinical relevance of such a distinction. Methods: Representatives from seven international centers of excellence for myeloproliferative neoplasms convened to create a clinicopathologic database of patients previously diagnosed as having ET (N = 1,104). Study eligibility criteria included availability of treatment-naive BM specimens obtained within 1 year of diagnosis. All bone marrows subsequently underwent a central re-review. Results: Diagnosis was confirmed as ET in 891 patients (81%) and was revised to early/prefibrotic PMF in 180 (16%); 33 patients were not evaluable. In early/prefibrotic PMF compared with ET, the 10-year survival rates (76% and 89%, respectively) and 15-year survival rates (59% and 80%, respectively), leukemic transformation rates at 10 years (5.8% and 0.7%, respectively) and 15 years (11.7% and 2.1%, respectively), and rates of progression to overt myelofibrosis at 10 years (12.3% and 0.8%, respectively) and 15 years (16.9% and 9.3%) were significantly worse. The respective death, leukemia, and overt myelofibrosis incidence rates per 100 patient-years for early/prefibrotic PMF compared with ET were 2.7% and 1.3% (relative risk [RR], 2.1; P < .001), 0.6% and 0.1% (RR, 5.2; P = .001), and 1% and 0.5% (RR, 2.0; P = .04). Multivariable analysis confirmed these findings and also identified age older than 60 years (hazard ratio [HR], 6.7), leukocyte count greater than 11 × 109/L (HR, 2.01), anemia (HR, 2.95), and thrombosis history (HR, 2.81) as additional risk factors for survival. Thrombosis and JAK2V617F incidence rates were similar between the two groups. Survival in ET was similar to the sex- and age-standardized European population. Conclusion: This study validates the clinical relevance of strict adherence to WHO criteria in the diagnosis of ET and provides important information on survival, disease complication rates, and prognostic factors in strictly WHO-defined ET and early/prefibrotic PMF.

Original languageEnglish (US)
Pages (from-to)3179-3184
Number of pages6
JournalJournal of Clinical Oncology
Issue number23
StatePublished - Aug 10 2011

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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