Splenic Infarction in Patients with Philadelphia-negative Myeloproliferative Neoplasms

Abstract

Objective We retrospectively analyzed the prevalence and clinical features of splenic infarctions in patients with Philadelphia chromosome-negative myeloproliferative neoplasms (Ph -MPNs). Patients Patients diagnosed with essential thrombocythemia (ET), polycythemia vera (PV), prefibrotic/early primary myelofibrosis (pre-PMF), or PMF from January 1996 to October 2020 in Chungnam National University Hospital, Daejeon, Korea, were reviewed. Results A total of 347 patients (143 ET, 129 PV, 44 pre-PMF, and 31 PMF patients; 201 men and 146 women) with a median age of 64 (range 15-91) years old were followed up for a median of 4.7 (range 0.1-26.5) years. Fifteen (4.3%) patients exhibited splenic infarctions at the diagnosis. These were most common in PMF patients (12.9%), followed by pre-PMF (9.1%) and PV (5.4%) patients. Multifocal infarcts (60.0%) were most common, followed by solitary (33.3%) and extensive infarcts (6.7%). The cumulative incidence of thrombosis in patients with splenic infarctions tended to be higher than in those lacking infarctions (10-year incidence 46.7% vs. 21.0% in PV; p=0.215; 33.3% vs. 17.9% in pre-PMF; p=0.473) patients, but statistical significance was lacking. Palpable splenomegaly (hazard ratio 14.89; 95% confidence interval 4.00-55.35; p< 0.001) was the only independent risk factor for splenic infarction. During follow-up, 5 (1.4%) patients developed splenic infarctions. Conservative treatment adequately controlled the symptoms; no serious complications were noted in any patient. Conclusion Splenic infarctions occurred most frequently in patients with PMF; it was rare in patients with ET. The clinical courses were generally mild.

Abdominal aortic calcification in patients newly diagnosed with essential thrombocythemia

“…Abdominal CT is not routinely performed during the initial evaluation of ET patients [ 32 ]. The clinical relevance of volumetric splenomegaly and splenic infarction detected using abdominal CT performed at the time of diagnosis of Ph - MPN has been previously evaluated [ 23 , 33 , 34 ]. Furthermore, in a small proportion of patients, abdominal CT has been used to detected asymptomatic malignancies at the time of diagnosis of Ph - MPN.…”

Incidental abdominal computed tomography findings in patients newly diagnosed with Philadelphia-negative myeloproliferative neoplasm

“…PV patients with volumetric splenomegaly at diagnosis had a poorer prognosis than those without; however, the prognosis is better than that of patients with palpable splenomegaly [ 8 ]. In addition, abdominal CT performed at the time of MPN diagnosis revealed asymptomatic splenic infarction [ 9 ] and abdominal aortic calcification, indicative of a poor prognosis (submitted for publication). Several cancers are more common in Ph - MPN patients than in the general population [ 2 , 10 ].…”

“…Despite these limitations, we found that a small population of Ph - MPN patients had asymptomatic splanchnic thrombosis and malignant tumors at the time of MPN diagnosis. As mentioned earlier, we previously reported that volumetric splenomegaly and asymptomatic splenic infarction detected by abdominal CT performed at the time of diagnosis are clinically useful for determining the diagnosis and prognosis [ 7 - 9 ]. The advantages of performing abdominal CT may offset the risks associated with radiation exposure and medical costs.…”