Abstract
BACKGROUND: We sought to determine the prognostic relevance of aberrant serum lipid values in the myeloproliferative disorders (MPDs) of primary myelofibrosis (PMF), polycythemia vera (PV), and essential thrombocythemia (ET).
METHODS: The Mayo MPD patient institutional database was queried to identify clinical history and lipid profiles (within a year of diagnosis). Serum cholesterol (CHOL), low density lipoprotein (LDL-C), high density lipoprotein (HDL-C), and triglycerides (TRI) were assessed compared to clinical outcomes.
RESULTS: 558 patients with MPDs (PMF 28%, PV 27%, and ET 45%) (median age at diagnosis of 56 (range18–81)) were identified. A lipid profile obtained a median of 0.0 months from diagnosis (range (-8 to 12 months) from MPD patients displayed low CHOL, LDL-C, and higher HDL-C than typical for the USA. Amongst MPD disease types PMF patients had lower CHOL (p<0.001) and HDL (p<0.001) compared to ET and PV (see table).
Amongst PMF patients, although hypocholesterolemia was not a surrogate for malnutrition (p=0.13) median serum albumin 4.1 g/dL (range 2.7–4.8)), there was correlation with the presence of weight loss, hypercatabolic symptoms, and worse Mayo-CBC myelofibrosis prognostic scores (
Decreased PMF survival was also associated with traditional PMF risk factors of hemoglobin <10g/dL, leukocytes <4 or >30 × 10(9)/L, platelets <100 × 10(9)/L, and circulating blasts. In multivariate analysis (Cox-Proportional Hazard) only the Mayo-CBC score, hemoglobin <10g/dL, circulating blasts and decreased CHOL remained significant for decreased survival (p<0.001).
CONCLUSIONS: The presence of hypocholesterolemia is very common in patients with PMF and is independently associated with inferior survival.
VALUE/ NCEP CATEGORY . | PMF (N=154) . | PV (N=149) . | ET (N=255) . | NHANES (USA MEANS;95th CI) . |
---|---|---|---|---|
NCEP: National Cholesterol Education Program: NHANES (National Health and Nutrition Examination Survey (values for all races ages 65–74) | ||||
Serum Cholesterol (Median) | 149 mg/dL | 179 mg/dL | 199 mg/dL | 221 mg/dL (153–301) |
−>200mg/dl (Desirable) | 10% | 31% | 48% | |
−150–200mg/dL (Desirable) | 39% | 25% | 41% | |
−100–149mg/dL (Desirable) | 41% | 41% | 9% | |
−<100mg/dL (Low) | 10% | 3% | 2% | |
LDL Cholesterol (Median) | 33 mg/dL | 41 mg/dL | 49 mg/dL | 149 mg/dL (87–217) |
−>100mg/dL (Low to high risk) | 1% | 1% | 1% | |
−<100mg/dL (Optimal) | 99% | 99% | 99% | |
HDL Cholesterol (Median) | 79 mg/dL | 118 mg/dL | 108 mg/dL | 45.7 mg/dL (29–71) |
−>60mg/dL (Optimal) | 74% | 90% | 91% | |
−40–60mg/dL (Normal) | 16% | 10% | 8% | |
−<40mg/dL (Low) | 10% | 0% | 1% | |
Triglycerides (Median) | 151 mg/dL | 89 mg/dL | 116 mg/dL | 145 mg/dL (62–285) |
−>200mg/dL (High) | 28% | 0% | 3% | |
−150–199mg/dL (Borderline) | 23% | 6% | 14% | |
−<150mg/dL (low) | 49% | 94%% | 83% |
VALUE/ NCEP CATEGORY . | PMF (N=154) . | PV (N=149) . | ET (N=255) . | NHANES (USA MEANS;95th CI) . |
---|---|---|---|---|
NCEP: National Cholesterol Education Program: NHANES (National Health and Nutrition Examination Survey (values for all races ages 65–74) | ||||
Serum Cholesterol (Median) | 149 mg/dL | 179 mg/dL | 199 mg/dL | 221 mg/dL (153–301) |
−>200mg/dl (Desirable) | 10% | 31% | 48% | |
−150–200mg/dL (Desirable) | 39% | 25% | 41% | |
−100–149mg/dL (Desirable) | 41% | 41% | 9% | |
−<100mg/dL (Low) | 10% | 3% | 2% | |
LDL Cholesterol (Median) | 33 mg/dL | 41 mg/dL | 49 mg/dL | 149 mg/dL (87–217) |
−>100mg/dL (Low to high risk) | 1% | 1% | 1% | |
−<100mg/dL (Optimal) | 99% | 99% | 99% | |
HDL Cholesterol (Median) | 79 mg/dL | 118 mg/dL | 108 mg/dL | 45.7 mg/dL (29–71) |
−>60mg/dL (Optimal) | 74% | 90% | 91% | |
−40–60mg/dL (Normal) | 16% | 10% | 8% | |
−<40mg/dL (Low) | 10% | 0% | 1% | |
Triglycerides (Median) | 151 mg/dL | 89 mg/dL | 116 mg/dL | 145 mg/dL (62–285) |
−>200mg/dL (High) | 28% | 0% | 3% | |
−150–199mg/dL (Borderline) | 23% | 6% | 14% | |
−<150mg/dL (low) | 49% | 94%% | 83% |
Author notes
Disclosure: No relevant conflicts of interest to declare.
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