Glycated Hemoglobin (HbA1c) and Thrombotic Risk in Polycythemia Vera and Essential Thrombocythemia

• Published in: Blood 2023-11, Vol.142 (Supplement 1), p.6416-6416
• Main Authors: Krecak, Ivan, Lekovic, Danijela, Grohovac, Dragana, Sabljic, Anica, Holik, Hrvoje, Zekanovic, Ivan, Moric Peric, Martina, Galusic, Davor, Perisa, Vlatka, Skelin, Marko, Jaksic, Ozren, Lucijanic, Marko
• Format: Article
• Language: English
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2023-174358

BACKGROUND: Essential thrombocythemia (ET) and polycythemia vera (PV) are BCR::ABL1 negative myeloproliferative neoplasms (MPNs) characterized by overproduction of one or more mature myeloid cell lineages and high thrombotic risk. Diabetes mellitus (DM) is a rare cardiovascular (CV) comorbidity in MPNs and the optimal treatment target levels of glycated hemoglobin (HbA1c) in MPNs remain unknown. OBJECTIVE&METHODS: This multicenter study was conducted in Croatia and Serbia in the period between 01/1997 and 01/23 and investigated clinical correlations of HbA1c in ET and PV patients whose diagnoses were reassessed according to 2016 WHO criteria. We retrospectively collected data regarding diabetic ET and PV patients with available HbA1c at disease diagnosis, stratified them according to HbA1c levels, and compared their clinical outcomes to a control group of 93 non-diabetic ET and PV patients. Outcomes of interest were time to thrombosis (TTT; death as a censoring event) and overall survival (OS). Survival analyses were based on Kaplan-Meier method and performed with log-rank test and the Cox-regression analysis. The study was approved by Ethics Committees from all participating centers. RESULTS: We included 109 MPN patients (33 ET and 76 PV) with DM (all type II); median age was 69 years (range 37-86), 60 (55%) were females, 81 (74.3%) were JAK2- and 10 (9.2%) CALR-positive. Ninety-two (84.4%) patients were classified as high-risk (age>60 years or prior thrombosis), 68 (62.4%) received hydroxyurea (HU), 91 (83.5%) had arterial hypertension, 44 (40.4%) hyperlipidemia, and 36 (33%) were smokers. The median follow-up time was 38 months; 16 (14.7%) thrombotic (13 arterial and 3 venous) events and 25 deaths (22.9%) occured during this time. Median HbA1c in diabetic MPN patients was 6.8% (range 4.8-16.2%). There were no associations of HbA1c with disease phenotype, age, sex, mutational status, prior thrombosis, presence of individual CV risk factors, or any of the blood cell count components (p>0.050 for all analyses). ROC curve defined the optimal HbA1c cut-off level of ≥7.2% for the best discrimination of thrombotic events in MPN patients with DM. Diabetic MPN patients with low HbA1c (