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EHA 2025 | The prognostic impact of peripheral blasts in polycythemia vera
Lucia Masarova, MD, The University of Texas MD Anderson Cancer Center, Houston, TX, discusses the prognostic impact of peripheral blasts in polycythemia vera. Dr Masarova highlights that even a small percentage of peripheral blasts is associated with a significantly reduced survival time, emphasizing the importance of closer follow-up for patients with this high-risk profile. This interview took place at the 30th Congress of the European Hematology Association (EHA) in Milan, Italy.
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Transcript
So it was an interesting study and idea where we have multiple prognostic models for polycythemia vera patients where we have the standard risks that were conventional just considering age and patients with thrombosis and then a couple other factors that came over the years with increased white cells, patients with monocytosis, adverse mutations and so on. So we look at our database of patients that came to our institution since 2000, which was over 580 patients with polycythemia vera, with a median time to presentation of about two months...
So it was an interesting study and idea where we have multiple prognostic models for polycythemia vera patients where we have the standard risks that were conventional just considering age and patients with thrombosis and then a couple other factors that came over the years with increased white cells, patients with monocytosis, adverse mutations and so on. So we look at our database of patients that came to our institution since 2000, which was over 580 patients with polycythemia vera, with a median time to presentation of about two months. And then we analyze the impact of the outcome, looking at survival, bus score events, progression rates, the most important outcomes that are always measured for patients with polycythemia vera. And except for all the standard that we already reported, so we just confirmed the already known knowledge. We noticed that patients that had increased peripheral blasts which was a minority of this patient only 2.2% so 30 patients of this large cohort had blasts 1% or above. Here I want to just emphasize that actually almost all had 1% very few had 2% and one patient had 6% so these were not increased blasts in these patients that came very significant for outcome. So the median survival of these patients of the entire cohort was almost 200 months. For patients with even 1% blasts, it was only 40 months. So we have seen a population of patients, super rare, but there that had 40 months of outcome of survival. And then we looked at different groups. So patients that would have, for example, higher age or lower age, presence or absence of monocytosis as currently established, patients with different LDH levels, fibrosis degrees, anemias and so on. And in every single of these subgroups, the relevance of having 1% peripheral blast was strikingly significant and persistent, where none of these groups, patients lived longer than 40 months. So that’s something that we have to actually consider. If we see these patients, of course, there was a significant correlation with other factors, but it is a significant risk that this patient might need more closer follow-up. And hopefully, once we reach an era where we have more significant targeted therapies, even earlier interventions. So looks kind of exciting looking into it. So we discover more and more high-risk patients for these populations.
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