engleski

The Degree of Anisocytosis Predicts Survival in Patients with Primary Myelofibrosis

Background: Red cell distribution width (RDW) provides a quantitative measure of anisocytosis and it is associated with the presence of subclinical systemic inflammation and a poor outcome in a variety of diseases when elevated. Anisocytosis is a feature of primary myelofibrosis (PMF) but it’s prognostic role in PMF has not yet been evaluated. Aims: To determine whether anisocytosis bears prognostic significance in patients with PMF and its relation to disease features. Methods: 33 newly-diagnosed patients with PMF were analyzed in this study. Baseline RDW values were obtained in addition to other routine blood analyses (CRP, LDH, complete blood count and iron metabolism parameters) and JAK2 V617F mutational status. Patients were staged according to IPSS prognostic scoring system, liver and spleen size were assessed by palpation. The Mann Whitney U test, the Pearson correlation and the Χ2 test/ the Fisher test were used where appropriate. Survival analyses were performed using methods of Kaplan and Meier, the log-rank test and the Cox regression analysis. All statistical tests were two- sided and P values <0.05 were considered significant. Results: Median RDW was 19.0% (15.2% - 22.5%). RDW correlated significantly with hemoglobin (p=0.005), CRP (p=0.031), spleen size (p=0.036) and IPSS score (p=0.003). Patients with more pronounced anisocytosis had an inferior overall survival (OS) – very-high RDW (≥19.0%) vs. high RDW (15.1% - 18.9%) subgroup, HR 5.37, p=0.002. RDW remained significantly associated with OS (p=0.002) in a multivariate model including IPSS score, hemoglobin level and CRP. Summary/Conclusion: PMF pathogenesis surpasses inflammation as only cause of anisocytosis. A higher degree of anisocytosis is associated with more advanced disease features and a decreased overall survival. RDW encompasses standard prognostic score and may help in the rapid detection of patients with an unfavorable prognosis.

RDW ; anisocytosis ; survival ; primary myelofibrosis ; inflammation ; spleen

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