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Assessing serum albumin concentration, lymphocyte count and prognostic nutritional index might improve prognostication in patients with myelofibrosis

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Summary

Background

Primary and secondary myelofibrosis (PMF and SMF) are malignant diseases of hematopoietic stem cell characterized by the neoplastic myeloproliferation and a strong inflammatory milieu. The prognostic nutritional index (PNI) integrates information on albumin and absolute lymphocyte count (ALC) and reflects the inflammatory, nutritional and immune status of a patient. The clinical and prognostic significance of albumin, ALC and PNI in patients with myelofibrosis has not been previously investigated.

Methods

We retrospectively analyzed a cohort of 83 myelofibrosis patients treated in our institution from 2006 to 2017. Albumin, ALC and PNI were assessed in addition to other disease specific markers.

Results

The PMF and SMF patients had significantly lower ALC and PNI but similar albumin compared to controls. Lower albumin was significantly associated with older age and parameters reflecting more aggressive disease biology (e.g. anemia, lower platelet levels, higher lactate dehydrogenase (LDH), circulatory blasts, transfusion dependency, blast phase disease), inflammation (higher C reactive protein (CRP), constitutional symptoms) and higher degree of bone marrow fibrosis. Lower ALC was significantly associated with lower white blood cells (WBC) and lower circulatory blasts. Low PNI was associated with lower albumin, lower ALC, anemia, lower WBCs, lower serum iron and lower transferrin saturation. There was no difference in albumin, ALC and PNI regarding the driver mutations. In multivariate analysis adjusted for age and gender, low albumin (hazard ratio [HR] = 4.61, P = 0.001), low ALC (HR = 3.54, P = 0.004) and Dynamic International Prognostic Scoring System (DIPSS) (HR = 2.45, P = 0.001) were able to predict inferior survival independently of each other. Accordingly, low PNI (HR = 4.32, P < 0.001) predicted poor survival independently of DIPSS (HR = 3.31, P < 0.001).

Conclusion

Assessing albumin, ALC and PNI might improve prognostication in patients with myelofibrosis and could assist in recognition of patients under increased risk of death.

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Authors and Affiliations

  1. Hematology Department, University Hospital Dubrava, Av. Gojka Suska 6, 10000, Zagreb, Croatia

    Marko Lucijanic MD, PhD, Vlatko Pejsa, David Cicic & Rajko Kusec

  2. Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Ivo Veletic

  3. Endocrinology, Diabetes and Metabolic Disorders Department, University Hospital Dubrava, Zagreb, Croatia

    Dario Rahelic & Tomo Lucijanic

  4. School of Medicine, University of Zagreb, Zagreb, Croatia

    Dario Rahelic, Vlatko Pejsa & Rajko Kusec

  5. Pharmacy Department, General Hospital Sibenik, Sibenik, Croatia

    Marko Skelin

  6. Divison of Molecular Diagnosis and Genetics, Clinical Department of Laboratory Diagnostics, University Hospital Dubrava, Zagreb, Croatia

    Ana Livun, Katarina Marija Tupek & Rajko Kusec

  7. Department of Clinical Cytology and Cytometry, University Hospital Dubrava, Zagreb, Croatia

    Tajana Stoos-Veic

  8. Faculty of Medicine, University of Osijek, Osijek, Croatia

    Tajana Stoos-Veic

  9. Health Care Center Vojnic, Vojnic, Croatia

    Ana Maglicic

Authors
  1. Marko Lucijanic MD, PhD
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  2. Ivo Veletic
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Corresponding author

Correspondence to Marko Lucijanic MD, PhD.

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Conflict of interest

M. Lucijanic, I. Veletic, D. Rahelic, V. Pejsa, D. Cicic, M. Skelin, A. Livun, K.M. Tupek, T. Stoos-Veic, T. Lucijanic, A. Maglicic, and R. Kusec declare that they have no competing interests.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Review Board and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all subjects in whom molecular studies were performed.

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Lucijanic, M., Veletic, I., Rahelic, D. et al. Assessing serum albumin concentration, lymphocyte count and prognostic nutritional index might improve prognostication in patients with myelofibrosis. Wien Klin Wochenschr 130, 126–133 (2018). https://doi.org/10.1007/s00508-018-1318-z

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  • DOI: https://doi.org/10.1007/s00508-018-1318-z

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