Very elderly patients with essential thrombocythaemia: are they a separate category? A monocentric study on 118 patients older than 75 years

Palandri, Francesca; Polverelli, Nicola; Catani, Lucia; Ottaviani, Emanuela; Baccarani, Michele; Vianelli, Nicola

doi:10.1111/j.1365-2141.2011.08903.x

Cited by 7 publications

(5 citation statements)

References 8 publications

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“…The reason for first switch from HC or anagrelide was more often because of intolerance than loss of efficacy. Similar proportions of patients switched from HC because of lack of efficacy in our study and that of Palandri et al [19]. Elderly patients have more frequent cardiac abnormalities than younger patients, which may make them more prone to switch treatment if they experience tachycardia or palpitations while receiving anagrelide.…”

Section: Discussionsupporting

confidence: 73%

“…Sparse data are available on the treatment of very elderly patients with ET. Notably, Palandri et al reported data on 118 patients with ET aged >75 years, who they classified as very elderly [19]. They retrospectively analysed 326 consecutive patients with ET diagnosed at >60 years, although no patients aged >75 years received anagrelide and, perhaps because of this, only 5.3 % discontinued HC because of adverse effects.…”

Section: Discussionmentioning

confidence: 99%

“…The very elderly patients in the study by Palandri et al also experienced a greater thrombotic risk than those aged <75 years. [19] Although data on the incidence of angina in a non-MPN population are available [27], uncertainties concerning diagnostic definitions and data collection principles make comparisons with the EXELS population unreliable.…”

Section: Discussionmentioning

confidence: 99%

“…Elderly patients are known to have greater thrombotic risk than younger patients in the general population [18] and this risk is already increased in patients with ET. To date, there has been limited information reported regarding treatment practice in very elderly patients with ET [19]. …”

Section: Introductionmentioning

confidence: 99%

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Efficacy and Safety of Cytoreductive Therapies in Patients with Essential Thrombocythaemia Aged >80 Years: An Interim Analysis of the EXELS Study

Kiladjian

Besses²,

Grießhammer

et al. 2012

Clinical Drug Investigation

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BackgroundThe median age of patients diagnosed with essential thrombocythaemia (ET) is 65–70 years but the management of very elderly patients (aged >80 years) with ET has not been well characterized.ObjectiveThis study aimed to document the treatment patterns of very elderly patients with ET in a multinational, real-world setting.Study DesignEXELS (Evaluation of Xagrid Efficacy and Long-term Safety) is a phase IV observational study, designed to monitor the efficacy and safety of cytoreductive therapies in clinical practice. In total, 3,598 high-risk patients with ET were recruited from May 2005 to April 2009, in 13 European countries. Data were collected at registration and every 6 months thereafter for 5 years. This analysis was performed on a data-cut taken approximately 2 years after the last patient was registered.PatientsIn total, 395 patients aged >80 years at registration into EXELS were included in the analysis; of these, 42.2 % had experienced a previous thrombohaemorrhagic event.ResultsAt registration, the most frequently prescribed cytoreductive therapy for patients aged >80 years was hydroxycarbamide (HC), which accounted for 82.8 % of patients whereas anagrelide use was less frequent (8.6 %). Very elderly patients were more likely to be switched from anagrelide than from HC (47.1 vs. 17.4 %; 95 % confidence interval for difference in proportion 12.4–46.9; Chi-squared test p < 0.001). Median platelet count during treatment was ~430 × 109/L. In patients aged >80 years, the main reason for switch was intolerance/side effects (34.1 %); 0/16 patients reported treatment with anagrelide was non-efficacious compared with 8/57 (14 %) patients receiving HC, and 7/16 (43.8 %) anagrelide patients switched because of intolerance versus 18/57 (31.6 %) patients receiving HC. At least one predefined clinical event (PDE) was experienced by 27.3 % of patients aged >80 years. The most common PDEs reported in the very elderly age group were death (non-PDE related; 11.1 %), other cardiovascular symptoms (5.8 %), haematological transformation (3.8 %), congestive heart failure (3.3 %), myocardial infarction and angina (2.8 %), and thromboembolic events (6.3 %).ConclusionWell-tolerated and effective cytoreductive therapy has been achieved in patients aged >80 years by following individual treatment modalities that appear in agreement with the recent European LeukemiaNet (ELN) guidelines.Clinical Trial RegistrationRegistered as ClinicalTrials.gov identifier NCT00567502; Protocol No: SPD422-401.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Efficacy and Safety of Cytoreductive Therapies in Patients with Essential Thrombocythaemia Aged >80 Years: An Interim Analysis of the EXELS Study

Kiladjian

Besses²,

Grießhammer

et al. 2012

Clinical Drug Investigation

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“…Similarly, in the aforementioned recent large study of ET patients, multivariate analysis found that age and previous thrombosis were independent risk factors for arterial events, but it is of note that statistical significance was not reached for venous events . In a single‐center retrospective study of 118 ET patients aged > 75 years, the 10‐year cumulative risk of thrombosis was higher than in patients aged between 60 and 74 years (30% vs. 21.9%) . The role of these risk factors in PMF is less well established .…”

Section: Thrombotic Risk Factors In Mpnsmentioning

confidence: 94%

Thrombotic complications of myeloproliferative neoplasms: risk assessment and risk‐guided management

Casini

Fontana

Lecompte

2013

Journal of Thrombosis and Haemostasis

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Summary Philadelphia‐negative myeloproliferative neoplasms are considered to be acquired thrombophilic states. Thromboses, both arterial and venous (not rarely in unusual sites), are often the initial events leading to the diagnosis. After diagnosis, the yearly incidence of thrombotic events is highly variable, and ranges from approximately 1% to 10%. The identification of patients at risk who may benefit from antithrombotic therapy remains a challenge, and it is currently based on age and history of thrombotic events. However, the predictive value of these clinical characteristics is rather limited. Few prospective studies and even fewer interventional randomized studies are available, and there are no studies designed to formally validate the use of risk stratification. The implementation of laboratory parameters such as leukocytosis and/or the JAK2 V617F mutation into a scoring system may be of interest. The mechanisms at work leading to thrombosis remain largely speculative, but are likely to be complex and multifactorial, with a prominent role of cell–cell interactions, mostly owing to qualitative changes. The long‐term treatment options to prevent thrombosis are, schematically, aspirin alone as primary prevention for the low‐risk patients, and cytoreduction combined with aspirin for the other patients. In very low‐risk young essential thrombocythemia patients, abstention can even be considered. The optimal duration of anticoagulation after a thrombotic event is not established. All antithrombotic therapies should be balanced with the hemorrhagic risk, which can also be increased in these patients.

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Prophylaxis and management of venous thromboembolism in patients with myeloproliferative neoplasms: consensus statement of the Haemostasis Working Party of the German Society of Hematology and Oncology (DGHO), the Austrian Society of Hematology and Oncology (ÖGHO) and Society of Thrombosis and Haemostasis Research (GTH e.V.)

et al. 2014

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Patients with Philadelphia chromosome-negative myeloproliferative neoplasms (MPN) like polycythemia vera and essential thrombocythemia are at increased risk of arterial and venous thrombosis. Strategies of prevention may consist of platelet aggregation inhibitors and/or cytoreductive agents depending on the underlying disease and the individual risk. Clinical evidence for management of acute venous thromboembolic events in MPN patients is limited. Modality and duration of therapeutic anticoagulation after venous thrombosis has to be evaluated critically with special regard to the increased risk for spontaneous bleeding events associated with the underlying diseases. Both for therapy of the acute event and for secondary prophylaxis, low-molecular-weight heparins should preferentially be used. A prolongation of the therapeutic anticoagulation beyond the usual 3 to 6 months can only be recommended in high-risk settings and after careful evaluation of potential risks and benefits for the individual patient. New direct oral anticoagulants (NOAC) should not preferentially be used due to lack of clinical experience in patients with MPN and potential drug interactions (e.g. with JAK inhibitors). Consequent treatment of the underlying myeloproliferative disease and periodical evaluation of the response to therapy is crucial for optimal secondary prophylaxis of thromboembolic events in those patients.

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Very elderly patients with essential thrombocythaemia: are they a separate category? A monocentric study on 118 patients older than 75 years

Cited by 7 publications

References 8 publications

Efficacy and Safety of Cytoreductive Therapies in Patients with Essential Thrombocythaemia Aged >80 Years: An Interim Analysis of the EXELS Study

Efficacy and Safety of Cytoreductive Therapies in Patients with Essential Thrombocythaemia Aged >80 Years: An Interim Analysis of the EXELS Study

Thrombotic complications of myeloproliferative neoplasms: risk assessment and risk‐guided management

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