Important new study – high WCC as risk factor for blood clots in PV

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REVEAL study

Findings from an important new study for the management of polycythemia (PV) patients have just been released.

Called the REVEAL study*, it shows that leukocytosis (a high white cell count) is a risk factor for thrombosis (blood clots) in patients with PV. The study showed thrombosis to occur in high and low-risk patients, and even in patients in whom hematocrit was adequately controlled.

To date, known risk factors for thrombosis in PV patients included advanced age, previous history of blood clots, and elevated hematocrit >.45. There was insufficient data to include elevated white blood cell (WBC) counts as a known risk factor.

However, in an analysis of 2271 PV patients, the REVEAL study found 142 blood clots in 106 patients.
Specifically. during the study period of just under 4 years, it identified:

  • Significant associations with initial blood clot occurrence for hematocrit level >45% and WBCs >11 × 109/L .
  • Elevated WBC count was significantly associated with initial thrombosis in both low and high-risk PV patients.
  • Even when hematocrit was controlled at 45% or lower, WBC count >12 × 109/L was significantly associated with thrombosis.
  • There are different risk factors for arterial and venous thrombosis, an observation that has also been reported in essential thrombocythemia. Both leukocytosis and thrombocytosis (high platelet count), poor hematocrit control, and age were associated with a higher risk of arterial thrombosis, whereas female sex, history of previous thrombosis, and leukocytosis turned out to be the main risk factors for venous thrombosis.

The study’s authors feel that, even without a large study proving that lowering leukocytosis reduces blood clots, there is sufficient evidence to ‘support the inclusion of leukocytosis in the definition of high-risk polycythemia vera’. They also suggest that two elements of clinical practice could be changed:
– ‘low-risk patients with persistent leukocytosis could be elevated to the high-risk category and, therefore, be candidates for cytoreduction’ and
– ‘normalization of leukocytes should be included as an objective of treatment in patients receiving cytoreduction.’

There are two abstracts available discussing the REVEAL study’s findings.

REVEAL puts leukocytes into risk stratification 

Association between elevated white blood cell counts and thrombotic events in polycythemia vera: analysis from REVEAL

* REVEAL is a prospective observational study that enrolled 2510 patients with PV, with median follow-up of 44.7 months (range, 2-59 months). REVEAL stands for The Prospective Observational Study of Patients with Polycythemia Vera in US Clinical Practices.

 

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New WHO guideline for diagnosis of anaemia

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The World Health Organisation has just revised its guideline for diagnosis of anaemia thanks to a team of Australian researchers from the Walter and Eliza Hall Institute in Melbourne, led by Professor Sant-Rayn Pasricha.

These Australian researchers  have already:

Whilst this WHO guideline is for diagnosis of anaemia in general populations and does not refer to anaemia in the context of myeloproliferative neoplasms, we are excited to report on the contribution made to the field by Australian researchers.

The ABC’s ‘Health Report’ interviewed Professor Sant-Rayn Pasricha to explain the new guideline and how it was arrived at.
Listen to the interview  HERE.

The guideline is titled ‘Guideline on haemoglobin cutoffs to define anaemia in individuals and populations’ and is freely available to download in PDF form HERE.

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Webinar – Creating meaning in the face of blood cancer – now available

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The Leukaemia Foundation have added another webinar to their suite of general webinars which focus on living well.

The latest webinar is now available and is about creating meaning in the face of blood cancer.
It is available HERE.

And don’t forget the wonderful webinar from Dr Ranjana Srivastava. Dr Srivastava is an oncologist with a wealth of experience.
She has fantastic tips for coping with a cancer diagnosis, ageing and living with blood cancer and we highly recommend it.
The webinar featuring Dr Srivastava is available  HERE.

 

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More research showing anti-cancer benefits of exercise

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The Cancer Council, in conjunction with the Victorian government, has just released an informative study about the importance of exercise in reducing cancer risk. Their new research estimates that more than three times as many cancers are attributable to physical inactivity than previously thought.

The cancers that were linked to physical inactivity were: breast, colon, bladder, endometrial, kidney, oesophageal adenocarcinoma, gastric, non-Hodgkin lymphoma, head and neck, myeloma, myeloid leukaemia, liver, and gallbladder.

Associate Professor Brigid Lynch, senior author of the paper, said the findings provide a contemporary understanding of the cancer burden due to physical inactivity.
“We now know being physically active reduces the risk of 13 types of cancer. This new research highlights the number of individual cancer diagnoses that could have been prevented if Australians were better supported to integrate regular physical activity into their day.”

The news article also goes onto say that “Australia is a nation proud of its health system, yet we don’t have a physical activity plan or coordinated national physical activity strategy. Combined with changes in food supply, eating behaviours, a rise in convenience and ultra-processed foods, we are living in environments that do not promote healthy lifestyles.”

The news item from the Cancer Council can be accessed HERE.

 

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QIMR Berghofer Medical Research Institute – Blood cancer treatment could be transformed by discovery

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QIMR Berghofer Medical Research Institute researchers have discovered a potential new treatment for Acute Myeloid Leukaemia and other cancers.

Watch their exciting news HERE

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Unusual site thrombosis: literature review and insights

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Exploring the Molecular Aspects of Myeloproliferative Neoplasms Associated with Unusual Site Vein Thrombosis: Review of the Literature and Latest Insights

A paper has just been released about unusual thrombosis sites in patients with myeloproliferative neoplasms.
It includes a literature review and valuable insights into these occurrences.

The abstract explains that ‘MPNs are the leading causes of unusual site thrombosis, affecting nearly 40% of individuals with conditions like Budd–Chiari syndrome or portal vein thrombosis.’ The authors state that ‘a multidisciplinary strategy is vital to accurately determine the specific subtype of MPNs, recommend additional tests, and propose the most effective treatment plan. Establishing specialized care pathways for patients with splanchnic vein thrombosis and underlying MPNs is crucial to tailor management approaches that reduce the risk of hematological outcomes and hepatic complications.’

The full paper is available HERE.

 

 

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2024 guidelines on essential thrombocythemia

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These guidelines titled ‘Essential thrombocythemia: 2024 update on diagnosis, risk stratification, and management’ have just been released. They are a collaboration between the American haematologist Professor Tefferi and Italian haematologists Professor Vannucchi and Dr Barbui.

For a direct link to these comprehensive 2024 guidelines, see HERE.

We have also put a link onto our ‘MPN guidelines and articles‘ page.

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Updated British guidelines on myelofibrosis

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The British Society for Haematology has just released (November and December 2023) new guidelines for myelofibrosis.

As these are British guidelines, not all treatment options are available in Australia and Australian practices may vary.
However the guidelines provide useful insight into diagnosis and prognosis considerations as well as the growing array of treatment options becoming available for myelofibrosis patients.

There are two parts to the guidelines:

The management guideline includes detailed advice on specific situations such as:

  • Management of myelofibrosis-associated anaemia
  • Management of thrombocytopenic patients
  • Role of splenectomy in myelofibrosis
  • Myelofibrosis in paediatric, teenage and young adult population
  • Myelofibrosis and pregnancy
  • Allogeneic stem cell transplantation for myelofibrosis
 

 

 

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