Konference: 2015 57th ASH Annual Meeting - účast ČR
Kategorie: Myeloproliferativní nemoci
Téma: 634. Myeloproliferative Syndromes: Clinical: Poster I
Číslo abstraktu: 1602
Autoři: Dr. Alberto Alvarez-Larrán; MD Paola Guglielmelli; Eduardo Arellano-Rodrigo; MD Martin Griesshammer, Ph.D.; Chiara Paoli; Ana Kerguelen; Francisca Ferrer-Marin; Juan Carlos Hernández-Boluda; doc. MUDr. Bjorn Andreasson; MUDr. Jiří Schwarz, CSc.; Valentín García-Gutierrez; MD Rosa Ayala, Ph.D.; MD Pere Barba; María Teresa Gómez-Casares; MD Radek C. Skoda; Dr. Carmen Burgaleta; Stefanie Slot; MD Jan Samuelsson, Ph.D.; Alimam Samah; Yan Beauverd; Claire N. Harrison; MD Francisco Cervantes; MD Alessandro M. Vannucchi; MD Carlos Besses
The aim of the present study was to assess the effect of antiplatelet therapy in the primary prevention of thrombosis in patients with CALR-positive ET without indication of cytoreductive therapy. For such purpose, 240 patients (107 males, 133 females) diagnosed with ET at a median age of 42 years (range 13-59) were included in a multicenter retrospective study. Initial treatment consisted of antiplatelet therapy (n=109) or careful observation (n=108), whereas 23 patients received cytoreduction since diagnosis and were excluded. During a median follow up of 8 years, 137 patients were started on cytoreductive therapy because of the following indications: age > 60 years (n=10), thrombosis (n=10), bleeding (n=2), microvascular symptoms (n=18), extreme thrombocytosis (n=89), and others (n=8). Median time free of cytoreductive therapy was 3.2 years. Thrombosis-free survival restricted to the time of cytoreductive therapy abstention was calculated using the Kaplan-Meier method. Variables attaining a significant level at the univariate analysis were included in a Cox proportional hazard model.
During the period of abstention of cytoreductive therapy, a total of 10 thrombotic events and 8 major bleeding episodes were registered. The probability of thrombosis at 3 years was 5% in patients managed with careful observation and 1% in those receiving antiplatelet therapy (p = 0.2). At multivariate analysis, antiplatelet therapy did not result in a lower risk of thrombosis after correction for age, sex and presence of cardiovascular risk factors. Interaction studies did not identify any subgroup of patients that benefited from antiplatelet therapy in thrombosis prevention. Regarding major bleeding, patients receiving antiplatelet therapy experienced a higher rate than those managed on observation (3-year probability of major bleeding, 5.5% and 0%, respectively, p=0.05). At multivariate analysis, antiplatelet therapy was associated with a tendency towards and increased risk of major bleeding (HR: 7.7, 95%CI: 0.9-66.2, p=0.06) independently of platelet count at diagnosis, age and gender.
In conclusion, CALR-mutated low-risk ET patients under cytoreductive therapy abstention may not obtain a clear benefit from antiplatelet therapy since the increase in the rate of bleeding may offset the reduction in the rate of thrombosis
Disclosures: García-Gutierrez: Pfizer: Consultancy , Membership on an entity’s Board of Directors or advisory committees , Research Funding ; BMS: Consultancy , Membership on an entity’s Board of Directors or advisory committees , Research Funding ; Ariad: Consultancy , Membership on an entity’s Board of Directors or advisory committees , Research Funding ; Novartis: Consultancy , Membership on an entity’s Board of Directors or advisory committees , Research Funding . Harrison: Sanofi: Honoraria , Speakers Bureau ; Gilead: Honoraria ; Shire:Speakers Bureau ; CTI Biopharma: Consultancy , Honoraria , Speakers Bureau ; Novartis: Honoraria , Research Funding , Speakers Bureau . Cervantes: Sanofi-Aventis: Consultancy ; Novartis: Consultancy , Speakers Bureau ;CTI-Baxter: Consultancy , Speakers Bureau . Vannucchi: Shire: Speakers Bureau ; Baxalta: Membership on an entity’s Board of Directors or advisory committees ; Novartis Pharmaceuticals Corporation: Membership on an entity’s Board of Directors or advisory committees , Research Funding , Speakers Bureau .
Datum přednesení příspěvku: 5. 12. 2015