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ASH 2024 | Revised ELN criteria in PV identify an increased risk phenotype for thrombotic events
Francesca Palandri, MD, PhD, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy, comments on a multicenter cooperative study which highlighted that the revised European Leukemia Network (ELN) criteria for polycythemia vera (PV) can be used to identify patients with an increased risk phenotype for thrombotic events beyond conventional risk stratification. Specifically, progressive splenomegaly, uncontrolled cardiovascular risk factors, and inadequate hematocrit control are key drivers of thrombotic risk in patients with PV and hold the potential to inform and personalize the management of patients with PV. This interview took place at the 66th ASH Annual Meeting and Exposition, held in San Diego, CA.
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Transcript
This year at ASH, we presented in an oral presentation our cooperative work on the revised ELN criteria in polycythemia vera, and we describe how they can identify an increased risk phenotype for thrombotic events that goes beyond conventional risk stratification. It is known that currently the thrombotic risk stratification in polycythemia is based on age and thrombosis history...
This year at ASH, we presented in an oral presentation our cooperative work on the revised ELN criteria in polycythemia vera, and we describe how they can identify an increased risk phenotype for thrombotic events that goes beyond conventional risk stratification. It is known that currently the thrombotic risk stratification in polycythemia is based on age and thrombosis history. And these two factors guide the decision to start cytoreductive therapy. However, these factors are sometimes perceived as suboptimal for a proper management of polycythemia vera. And recently, the European Leukemia Network has proposed some clinical signs and symptoms that should or could trigger cytoreduction also in conventionally defined low-risk patients. Specifically, these factors include persistent or progressive hyperleukocytosis, extreme thrombocytosis, progressive splenomegaly, inadequate hematocrit control or phlebotomy intolerance, uncontrolled cardiovascular risk factors, and severe itching.
In a large cooperative study of PV patients treated with hydroxyurea in the front line, we investigated the impact of these clinical signs and symptoms on thrombotic risk. And our results indicate that clinical signs and symptoms can identify within each conventionally defined risk category a sub-cohort of patients at increased thrombotic risk. This broad predictive value suggests that clinical symptoms may be able to capture significant aspects of the thrombotic potential, even in the patients who are traditionally considered low-risk based on age and thrombotic history alone.
For clinicians, the integration of clinical symptoms into a routine assessment could help personalize care and identify patients who potentially need an earlier intervention, even if at low risk, or maybe an intensification of cytoreduction or of the antithrombotic therapy.
In a subsequent analysis, we also identified specific clinical signs and symptoms as the most significant predictors for thrombosis. These particular signs, which include progressive splenomegaly, uncontrolled cardiovascular risk factors and inadequate hematocrit control, are critical drivers of thrombotic risk and can be actionable markers that can inform more aggressive and also more personalized management of polycythemia vera patients.
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Disclosures
Speakers Bureau: Novartis, BMS, AOP, Incyte, Telios, Sierra Oncology, Abbvie, Constellation-Morphosys, Sobi; Membership on an entity’s Board of Directors or advisory committees: Novartis, BMS, AOP, Incyte, Telios, Sierra Oncology, Abbvie, Constellation-Morphosys, Sobi.
