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Impact of comorbidities and body mass index in patients with myelofibrosis treated with ruxolitinib

  • Massimo Breccia
  • Daniela Bartoletti
  • Massimiliano Bonifacio
  • Giuseppe A. Palumbo
  • Nicola Polverelli
  • Elisabetta Abruzzese
  • Micaela Bergamaschi
  • Alessia Tieghi
  • Mario Tiribelli
  • Alessandra Iurlo
  • Francesco Cavazzini
  • Nicola Sgherza
  • Gianni Binotto
  • Alessandro Isidori
  • Mariella D’Adda
  • Monica Crugnola
  • Costanza Bosi
  • Florian Heidel
  • Matteo Molica
  • Luigi Scaffidi
  • Daniele Cattaneo
  • Roberto Latagliata
  • Giuseppe Auteri
  • Roberto M. Lemoli
  • Renato Fanin
  • Domenico Russo
  • Franco Aversa
  • Antonio Cuneo
  • Gianpietro Semenzato
  • Lucia Catani
  • Michele Cavo
  • Nicola Vianelli
  • Robin Foà
  • Francesca Palandri
Original Article
  • 32 Downloads

Abstract

Comorbidities defined by the Charlson comorbidity index (CCI) and body mass index (BMI) are significantly associated with outcome in patients who receive continuous treatment with tyrosine kinase inhibitors. We evaluated the impact of CCI and BMI on responses, drug-related toxicities, and outcome in a cohort of 402 patients with myelofibrosis (MF) treated with ruxolitinib in 23 European Hematology Centers. Comorbidities were evaluable in all 402 patients. A higher (≥ 3) CCI did not correlate with a lower spleen reduction at any time (p = 0.68) or symptoms’ response (p = 0.11), but influenced the onset of anemia during the first 3 months of treatment and later (p = 0.02 and p = 0.03, respectively) in patients without anemia baseline. BMI was evaluable in 380 patients and did not correlate with differences in spleen and symptoms response (p = 0.57 and p = 0.49, respectively). A higher CCI and a lower BMI correlated also with a reduced overall survival (p < 0.001 and p = 0.02, respectively). The achievement of a spleen response at 6 months could counterbalance the negative impact of comorbidities, while patients who were underweight when starting ruxolitinib and did not achieve a spleen response at 6 months were projected to the worse outcome. In MF patients treated with ruxolitinib, BMI and comorbidities did not influence the achievement of spleen/symptom responses, but they contributed to the early identification of patients who deserve a strict monitoring during treatment.

Keywords

Myelofibrosis Ruxolitinib BMI CCI Comorbidities 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards statement

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

Statement of informed consent

Informed consent was obtained from all patients for being included in the study.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Massimo Breccia
    • 1
  • Daniela Bartoletti
    • 2
  • Massimiliano Bonifacio
    • 3
  • Giuseppe A. Palumbo
    • 4
  • Nicola Polverelli
    • 5
  • Elisabetta Abruzzese
    • 6
  • Micaela Bergamaschi
    • 7
  • Alessia Tieghi
    • 8
  • Mario Tiribelli
    • 9
  • Alessandra Iurlo
    • 10
  • Francesco Cavazzini
    • 11
  • Nicola Sgherza
    • 12
  • Gianni Binotto
    • 13
  • Alessandro Isidori
    • 14
  • Mariella D’Adda
    • 15
  • Monica Crugnola
    • 16
  • Costanza Bosi
    • 17
  • Florian Heidel
    • 18
  • Matteo Molica
    • 1
  • Luigi Scaffidi
    • 3
  • Daniele Cattaneo
    • 10
  • Roberto Latagliata
    • 1
  • Giuseppe Auteri
    • 2
  • Roberto M. Lemoli
    • 7
  • Renato Fanin
    • 9
  • Domenico Russo
    • 5
  • Franco Aversa
    • 16
  • Antonio Cuneo
    • 11
  • Gianpietro Semenzato
    • 13
  • Lucia Catani
    • 2
  • Michele Cavo
    • 2
  • Nicola Vianelli
    • 2
  • Robin Foà
    • 1
  • Francesca Palandri
    • 2
  1. 1.Division of Cellular Biotechnologies and HematologyUniversity SapienzaRomeItaly
  2. 2.Institute of Hematology “L. and A. Seràgnoli”Sant’Orsola-Malpighi University HospitalBolognaItaly
  3. 3.Department of HematologyUniversity of VeronaVeronaItaly
  4. 4.Division of Hematology, AOU “Policlinico-V. Emanuele”University of CataniaCataniaItaly
  5. 5.Unit of Blood Diseases and Stem Cells Transplantation, Department of Clinical and Experimental SciencesUniversity of Brescia, ASST Spedali Civili of BresciaBresciaItaly
  6. 6.Division of HematologyOspedale S. EugenioRomeItaly
  7. 7.Clinic of Hematology, Department of Internal Medicine (DiMI)IRCCS AOU San Martino-ISTGenoaItaly
  8. 8.Division of HematologyAzienda Ospedaliera-IRCSS Arcispedale Santa Maria NuovaReggio EmiliaItaly
  9. 9.Division of Hematology and BMT, Department of Medical AreaUniversity of UdineUdineItaly
  10. 10.Hematology Division, IRCCS Ca’ Granda - Maggiore Policlinico Hospital FoundationUniversity of MilanMilanItaly
  11. 11.Division of HematologyUniversity of FerraraFerraraItaly
  12. 12.Division of HematologyCasa Sollievo SofferenzaSan Giovanni RotondoItaly
  13. 13.Unit of Hematology and Clinical ImmunologyUniversity of PadovaPaduaItaly
  14. 14.Hematology and Stem Cell Transplant CenterAORMN HospitalPesaroItaly
  15. 15.Division of Hematology, ASST Spedali Civili di BresciaBresciaItaly
  16. 16.Division of Hematology, Azienda Ospedaliero-Universitaria di ParmaParmaItaly
  17. 17.Division of HematologyPiacenzaItaly
  18. 18.Internal Medicine II, Hematology and OncologyFriedrich-Schiller-University Medical CenterJenaGermany

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