Chronic kidney disease (CKD) is a well-known risk factor for venous thromboembolism and cardiovascular (CV) disease development in the general population, but its role in thrombotic risk in essential ...thrombocythemia (ET) and polycythemia vera (PV) remains poorly understood. This retrospective multicenter study analyzed clinical correlations and the potential impact of CKD on thrombosis development in ET and PV patients. We included 167 patients (76 ET and 91 PV); 25.7% had CKD at diagnosis, defined as estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m
2
for ≥ 3 months. Lower eGFR correlated with advanced age, female sex, higher granulocytes, higher serum C-reactive protein, history of thrombosis, CV risk factors, and the presence of palpable splenomegaly. CKD was univariately associated with inferior thrombosis-free survival in the entire cohort, as well as in both ET and PV patients. These results remained significant in the multivariate Cox regression models when adjusted to disease-specific risk models. Therefore, CKD could be a risk factor for thrombosis in ET and PV patients. Additional studies on a larger number of patients are needed to confirm our findings and to elucidate whether the addition of CKD to the current risk stratification models might improve prognostication in ET and PV patients.
Obinutuzumab (G) has become part of front‐line treatment of follicular lymphoma (FL) based on results of a large randomized study. Data on patients treated outside of clinical trials are lacking. We ...have retrospectively investigated efficacy and safety of G‐based immunochemotherapy regimens in 114 patients treated in a real‐life setting during a period of 2 years, largely coinciding with the COVID‐19 pandemic. The response rate was 93.8%; 18‐months overall (OS) and progression‐free survival (PFS) were 88% and 84%, respectively. Patients treated with G‐cyclophosphamide, vincristine and glucocorticoid + doxorubicine (CHOP) had statistically significantly superior OS and PFS compared to patients treated with G‐bendamustine (G‐B) (P = 0.002 and P = 0.006, respectively) due to an increase in lethal infections, most notably COVID‐19, in the latter group. A total of 12 patients died during follow‐up; 9 of 61 treated with G‐B, 1 of 49 treated with G‐CHOP and 2 of 4 treated with G‐cyclophosphamide, vincristine and glucocorticoid (CVP). SARS‐CoV‐2 infection was diagnosed in 20 (17.5%) patients. All of the 7 treated with G‐CHOP recovered, while 4 of 12 treated with G‐B died. Immunoglobulin levels and severity of neutropenia were similar between the groups. In multivariate analysis, G‐B in comparison to G‐CHOP was an independent prognostic factor (P = 0.044, hazard ratio = 9.81) after adjustment for age, sex and Follicular Lymphoma International Prognostic Index (FLIPI). Based on our experience G has excellent antilymphoma activity in patients receiving front‐line treatment for FL in real‐life setting, but during the COVID‐19 pandemic, it should be preferentially combined with CHOP, at least in patients younger than 65.
Author Affiliation: (1) Department of Internal Medicine, General Hospital of Sibenik-Knin County, Stjepana Radica 83, 22000, Sibenik, Croatia (2) Department of Internal Medicine, "Dr. Josip Bencevic" ...General Hospital, Slavonski Brod, Croatia (3) Department of Internal Medicine, General Hospital Zadar, Zadar, Croatia (4) Department of Psychiatry, General Hospital of Sibenik-Knin County, Sibenik, Croatia (5) University Hospital Dubrava, Zagreb, Croatia (6) School of Medicine, University of Zagreb, Zagreb, Croatia (a) krecak.ivan@gmail.com Article History: Registration Date: 01/14/2021 Received Date: 01/11/2021 Accepted Date: 01/14/2021 Online Date: 01/20/2021 Byline:
Summary
Discriminating polycythemia vera (PV) from secondary polycythemia (SP) is crucial due to the inherent risk of thrombosis in PV and different treatment approaches. The majority of PV patients ...have subnormal serum erythropoietin levels and harbor Janus kinase 2 (JAK2) mutations; however, serum erythropoietin levels may be normal in approximately one third of PV patients and mutational analysis is costly and requires access to specialized laboratories. Recently, neutrophil-to-lymphocyte (NLR) and platelet-to-lymphocyte ratios (PLR) emerged as rapidly available biomarkers to identify PV patients under an increased risk of thrombosis and death. This multicenter retrospective study investigated whether these two biomarkers may also be used to differentiate PV from SP. A total of 207 subjects were included (103 PV and 104 SP) with both baseline NLR (median 4.33 vs. 1.89) and PLR (median 259.12 vs. 81.11) being significantly higher in PV than in SP (
p
< 0.001 for both analyses). According to the receiver operating curve analysis, PLR (area under the curve, AUC 0.936, the optimal cut-off value of > 138.1 had 82.5% sensitivity and 91.67% specificity for the detection of PV) outperformed other tested variables (NLR, total leukocytes, neutrophils, lymphocytes and platelets) and its cut-off values with 100% specificity and sensitivity were able to confirm (PLR > 224.56; 31% patients) and to exclude (PLR < 68.8; 13% patients) the highest proportions of PV patients. Therefore, PLR may represent a cheap and a rapidly available biomarker with valuable diagnostic and prognostic properties. This information may be particularly useful in resource-limited settings; however, our results need validation on larger datasets.
