Reticulin Accumulation in Essential Thrombocythemia: Prognostic Significance and Relationship to Therapy

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Reticulin Accumulation in Essential Thrombocythemia: Prognostic Significance and Relationship to Therapy. / Campbell, PJ; Bareford, David; Erber, WN; Wilkins, BS; Wright, P; Buck, G; Wheatley, Keith; Harrison, CN; Green, AR.

In: Journal of Clinical Oncology, Vol. 27, No. 18, 01.06.2009, p. 2991-2999.

Research output: Contribution to journalArticle

Harvard

Campbell, PJ, Bareford, D, Erber, WN, Wilkins, BS, Wright, P, Buck, G, Wheatley, K, Harrison, CN & Green, AR 2009, 'Reticulin Accumulation in Essential Thrombocythemia: Prognostic Significance and Relationship to Therapy', Journal of Clinical Oncology, vol. 27, no. 18, pp. 2991-2999. https://doi.org/10.1200/JCO.2008.20.3174

APA

Campbell, PJ., Bareford, D., Erber, WN., Wilkins, BS., Wright, P., Buck, G., Wheatley, K., Harrison, CN., & Green, AR. (2009). Reticulin Accumulation in Essential Thrombocythemia: Prognostic Significance and Relationship to Therapy. Journal of Clinical Oncology, 27(18), 2991-2999. https://doi.org/10.1200/JCO.2008.20.3174

Vancouver

Author

Campbell, PJ ; Bareford, David ; Erber, WN ; Wilkins, BS ; Wright, P ; Buck, G ; Wheatley, Keith ; Harrison, CN ; Green, AR. / Reticulin Accumulation in Essential Thrombocythemia: Prognostic Significance and Relationship to Therapy. In: Journal of Clinical Oncology. 2009 ; Vol. 27, No. 18. pp. 2991-2999.

Bibtex

@article{3f035cea39e04f469f9a7fe9c3e039a6,
title = "Reticulin Accumulation in Essential Thrombocythemia: Prognostic Significance and Relationship to Therapy",
abstract = "Purpose Essential thrombocythemia (ET) manifests substantial interpatient heterogeneity in rates of thrombosis, hemorrhage, and disease transformation. Bone marrow histology reflects underlying disease activity in ET but many morphological features show poor reproducibility. Patients and Methods We evaluated the clinical significance of bone marrow reticulin, a measure previously shown to have relatively high interobserver reliability, in a large, prospectively-studied cohort of ET patients. Results Reticulin grade positively correlated with white blood cell (P = .05) and platelet counts (P = .0001) at diagnosis. Elevated reticulin levels at presentation predicted higher rates of arterial thrombosis (hazard ratio [HR], 1.8; 95% CI, 1.1 to 2.9; P = .01), major hemorrhage (HR, 2.0; 95% CI, 1.0 to 3.9; P = .05), and myelofibrotic transformation (HR, 5.5; 95% CI, 1.7 to 18.4; P = .0007) independently of known risk factors. Higher reticulin levels at diagnosis were associated with greater subsequent falls in hemoglobin levels in patients treated with anagrelide (P = .0001), but not in those receiving hydroxyurea (P = .9). Moreover, serial trephine specimens in patients randomly assigned to anagrelide showed significantly greater increases in reticulin grade compared with those allocated to hydroxyurea (P = .0003), and four patients who developed increased bone marrow reticulin on anagrelide showed regression of fibrosis when switched to hydroxyurea. These data suggest that patients receiving anagrelide therapy should undergo surveillance bone marrow biopsy every 2 to 3 years and that those who show substantially increasing reticulin levels are at risk of myelofibrotic transformation and may benefit from changing therapy before adverse clinical features develop. Conclusion Our results demonstrate that bone marrow reticulin grade at diagnosis represents an independent prognostic marker in ET, reflecting activity and/or duration of disease, with implications for the monitoring of patients receiving anagrelide. J Clin Oncol 27: 2991-2999. (C) 2009 by American Society of Clinical Oncology",
author = "PJ Campbell and David Bareford and WN Erber and BS Wilkins and P Wright and G Buck and Keith Wheatley and CN Harrison and AR Green",
year = "2009",
month = jun,
day = "1",
doi = "10.1200/JCO.2008.20.3174",
language = "English",
volume = "27",
pages = "2991--2999",
journal = "Journal of Clinical Oncology ",
issn = "0732-183X",
publisher = "American Society of Clinical Oncology",
number = "18",

}

RIS

TY - JOUR

T1 - Reticulin Accumulation in Essential Thrombocythemia: Prognostic Significance and Relationship to Therapy

AU - Campbell, PJ

AU - Bareford, David

AU - Erber, WN

AU - Wilkins, BS

AU - Wright, P

AU - Buck, G

AU - Wheatley, Keith

AU - Harrison, CN

AU - Green, AR

PY - 2009/6/1

Y1 - 2009/6/1

N2 - Purpose Essential thrombocythemia (ET) manifests substantial interpatient heterogeneity in rates of thrombosis, hemorrhage, and disease transformation. Bone marrow histology reflects underlying disease activity in ET but many morphological features show poor reproducibility. Patients and Methods We evaluated the clinical significance of bone marrow reticulin, a measure previously shown to have relatively high interobserver reliability, in a large, prospectively-studied cohort of ET patients. Results Reticulin grade positively correlated with white blood cell (P = .05) and platelet counts (P = .0001) at diagnosis. Elevated reticulin levels at presentation predicted higher rates of arterial thrombosis (hazard ratio [HR], 1.8; 95% CI, 1.1 to 2.9; P = .01), major hemorrhage (HR, 2.0; 95% CI, 1.0 to 3.9; P = .05), and myelofibrotic transformation (HR, 5.5; 95% CI, 1.7 to 18.4; P = .0007) independently of known risk factors. Higher reticulin levels at diagnosis were associated with greater subsequent falls in hemoglobin levels in patients treated with anagrelide (P = .0001), but not in those receiving hydroxyurea (P = .9). Moreover, serial trephine specimens in patients randomly assigned to anagrelide showed significantly greater increases in reticulin grade compared with those allocated to hydroxyurea (P = .0003), and four patients who developed increased bone marrow reticulin on anagrelide showed regression of fibrosis when switched to hydroxyurea. These data suggest that patients receiving anagrelide therapy should undergo surveillance bone marrow biopsy every 2 to 3 years and that those who show substantially increasing reticulin levels are at risk of myelofibrotic transformation and may benefit from changing therapy before adverse clinical features develop. Conclusion Our results demonstrate that bone marrow reticulin grade at diagnosis represents an independent prognostic marker in ET, reflecting activity and/or duration of disease, with implications for the monitoring of patients receiving anagrelide. J Clin Oncol 27: 2991-2999. (C) 2009 by American Society of Clinical Oncology

AB - Purpose Essential thrombocythemia (ET) manifests substantial interpatient heterogeneity in rates of thrombosis, hemorrhage, and disease transformation. Bone marrow histology reflects underlying disease activity in ET but many morphological features show poor reproducibility. Patients and Methods We evaluated the clinical significance of bone marrow reticulin, a measure previously shown to have relatively high interobserver reliability, in a large, prospectively-studied cohort of ET patients. Results Reticulin grade positively correlated with white blood cell (P = .05) and platelet counts (P = .0001) at diagnosis. Elevated reticulin levels at presentation predicted higher rates of arterial thrombosis (hazard ratio [HR], 1.8; 95% CI, 1.1 to 2.9; P = .01), major hemorrhage (HR, 2.0; 95% CI, 1.0 to 3.9; P = .05), and myelofibrotic transformation (HR, 5.5; 95% CI, 1.7 to 18.4; P = .0007) independently of known risk factors. Higher reticulin levels at diagnosis were associated with greater subsequent falls in hemoglobin levels in patients treated with anagrelide (P = .0001), but not in those receiving hydroxyurea (P = .9). Moreover, serial trephine specimens in patients randomly assigned to anagrelide showed significantly greater increases in reticulin grade compared with those allocated to hydroxyurea (P = .0003), and four patients who developed increased bone marrow reticulin on anagrelide showed regression of fibrosis when switched to hydroxyurea. These data suggest that patients receiving anagrelide therapy should undergo surveillance bone marrow biopsy every 2 to 3 years and that those who show substantially increasing reticulin levels are at risk of myelofibrotic transformation and may benefit from changing therapy before adverse clinical features develop. Conclusion Our results demonstrate that bone marrow reticulin grade at diagnosis represents an independent prognostic marker in ET, reflecting activity and/or duration of disease, with implications for the monitoring of patients receiving anagrelide. J Clin Oncol 27: 2991-2999. (C) 2009 by American Society of Clinical Oncology

U2 - 10.1200/JCO.2008.20.3174

DO - 10.1200/JCO.2008.20.3174

M3 - Article

C2 - 19364963

VL - 27

SP - 2991

EP - 2999

JO - Journal of Clinical Oncology

JF - Journal of Clinical Oncology

SN - 0732-183X

IS - 18

ER -