Hypocholesterolemia Is Independently Associated with Decreased Survival in Patients with Primary Myelofibrosis: An Analysis of Lipid Profiles in 558 Myeloproliferative Patients.

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 (Cancer 2006; 106:623; p<0.01). Amongst the study group PMF patients had the poorest survival (followed by PV then ET; p<0.001). Decreased cholesterol (CHOL <150mg/dL, or HDL <60 mg/dL) was associated with decreased survival (P<0.001), but only in PMF patients (see figure).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. [Display omitted] Lipid Distributions in 558 MPD patientsVALUE/ NCEP CATEGORYPMF (N=154)PV (N=149)ET (N=255)NHANES (USA MEANS;95th CI)Serum Cholesterol (Median)149 mg/dL179 mg/dL199 mg/dL221 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/dL41 mg/dL49 mg/dL149 mg/dL (87–217)−>100mg/dL (Low to high risk)1%1%1%−<100mg/dL (Optimal)99%99%99%HDL Cholesterol (Median)79 mg/dL118 mg/dL108 mg/dL45.7 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/dL89 mg/dL116 mg/dL145 mg/dL (62–285)−>200mg/dL (High)28%0%3%−150–199mg/dL (Borderline)23%6%14%−<150mg/dL (low)49%94%%83%NCEP: National Cholesterol Education Program: NHANES (National Health and Nutrition Examination Survey (values for all races ages 65–74)