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Blood, 1 September 2002, Vol. 100, No. 5, pp. 1596-1601
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Predictive values of X-chromosome inactivation patterns and
clinicohematologic parameters for vascular complications in female
patients with essential thrombocythemia
Lee-Yung Shih,
Tung-Liang Lin,
Chang-Liang Lai,
Po Dunn,
Jin-Hou Wu,
Po-Nan Wang,
Ming-Chung Kuo, and
Lai-Chu Lee
From the Division of Hematology-Oncology, Department of
Internal Medicine, Chang Gung Memorial Hospital, and the Biostatistics
Consulting Center, College of Medicine, Chang Gung University, Taiwan.
Essential thrombocythemia (ET) is a heterogeneous disorder in which
the clonality of hematopoiesis varies. The clinical significance of clonality status in ET remains to be determined. We used the human androgen receptor gene (HUMARA)-polymerase chain
reaction assay to investigate X-chromosome inactivation patterns
(XCIPs) and their value in predicting vascular complications in 89 female patients with ET. Fifty-four (68.4%) patients had a clonal
pattern of XCIP, and 15 (19.0%) had a polyclonal pattern. The
remaining 20 patients had either an ambiguous or a homozygous pattern
of XCIP and were therefore excluded from further analysis. Patients with clonal XCIPs were older (P = .029) and were at
greater risk for thrombosis (P = .007) than were those
with polyclonal XCIPs. We did not find a correlation between the
occurrence of hemorrhage and XCIP (P = .492). Advanced
age was predictive of thrombosis and hemorrhage. Platelet count did not
influence the risk for vascular complications. Hypertension was
significantly correlated with thrombotic events
(P = .002), whereas diabetes mellitus and hypercholesterolemia were of no predictive value. In a multivariate analysis, age was the significant predictor of thrombosis
(P = .030); however, XCIPs (P = .083) and
hypertension (P = .073) tended to predict thrombosis. Our
results suggest that older patients who have clonal XCIPs or
hypertension are at increased risk for thrombosis and should be
monitored closely for this complication.
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