Effect of Charlson comorbidity index on vascular events and survival in Philadelphia chromosome-negative myeloproliferative neoplasms

Abstract

Background Thromboembolic events and bleeding episodes are the main complications of myeloproliferative neoplasms (MPNs). Comorbidity is a well-known independent prognostic factor for patients with cancer that affects overall survival. Aim Our aim is to detect comorbidities among patients with Philadelphia chromosome-negative MPNs and to study how comorbidities affect survival and vascular events. Patients and methods A total of 190 patients with Philadelphia chromosome-negative MPNs were diagnosed between January 2014 and December 2018 in South Valley and Assiut University Hospitals. Charlson Comorbidity Index (CCI) was applied to evaluate patients. Median age was 57.5 years (range, 20–85). Overall, 50 (26.3%) patients had no comorbidities (low), 83 (43.7%) had a CCI 1–2 (moderate), and 57 (30%) had a CCI more than 2 (severe). Results There were no significant differences between patients with CCI less than 2 and patients with CCI more than or equal to 2 regarding sex, splenomegaly, white blood cell count, platelet count, and JAK II positivity. Significantly older ages (64.7±9 vs. 50.8±9, P<0.001), lower hemoglobin (5±12.3 vs. 14.6±5, P=0.046), and higher lactate dehydrogenase (P=0.004) were detected in patients with CCI more than or equal to 2. A significant association regarding pruritus and erythromelalgia was found among patients who had CCI more than or equal to 2 compared with patients with CCI less than 2 (P=0.038 and 0.025, respectively). Thrombosis was more frequent with CCI more than or equal to 2 (P<0.001) as well as bleeding (P=0.042). Overall survival and progression-free survival differed significantly between the different CCI groups (P≤0.001 and 0.003, respectively). Conclusion In conclusion, comorbidity has a negative prognostic effect on patients with Philadelphia chromosome-negative MPNs, which might elicit to be incorporated into prognostic models, with larger prospective studies needed for validation.