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Blood, 15 October 2008, Vol. 112, No. 8, pp. 3526-3527. This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Barbui, T. Articles by Finazzi, G. Search for Related Content PubMed Articles by Barbui, T. Articles by Finazzi, G. Related Collections Related Articles in Blood Online Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  CORRESPONDENCE Response: Thrombocytosis in low-risk ET patients Response We thank Dr Tefferi for the comment to our work and are glad to answer his questions. First, the threshold of platelet count recommended for starting a cytoreductive treatment in otherwise "low-risk" essential thrombocythemia (ET) patients is a controversial issue, so that experts' opinions and clinical practice have changed over time. The Italian guidelines1 reflect the consensus of experts based on the limited information available in 2004, when it was decided to follow a precautionary principle to treat patients with high platelet count, particularly if they had associated cardiovascular risk factors. However, the lack of controlled study and further published data on this topic, including Tefferi et al's letter in Blood,2 addressed the clinical practice of many Centers, including ours, to limit or even avoid treating ET patients on the basis of high platelet count. As a matter of fact, only 20 patients (2%) included in our analysis were "low-risk" patients given short-term cytoreduction because of platelet count more than 1500 x 109/L. Second, we did not include in our paper a separate analysis restricted to "low-risk" untreated patients because we had only 58 incidents of thrombotic events in this subgroup and, therefore, the risk estimates were not as accurate as needed. We performed a multivariable analysis (adjusted for center, sex, hemoglobin, leukocyte count, and low-dose aspirin) exploring the relationship between major thrombosis and platelet number in this untreated group. Results have shown a hazard ratio (HR) of 0.65 (95% confidence interval [CI] 0.31-1.25; P = .15) for patients with a platelet count more than 1000 x 109/L. Thus, a clear, albeit not significant, trend toward "more platelets, less thrombosis" can be observed also in these patients. Overall, we are happy to share with Dr Tefferi the belief that thrombocytosis, per se, should not be taken as a good reason to give cytotoxic chemotherapy to otherwise low-risk ET patients.    Authorship Top Authorship References   Conflict-of-interest disclosure: The authors declare no competing financial interests. Correspondence: Tiziano Barbui, Divisione di Ematologia, Ospedali Riuniti, Largo Barozzi 1, 24100 Bergamo, Italy; e-mail: tbarbui{at}ospedaliriuniti.bergamo.it. Tiziano Barbui, Alessandra Carobbio, and Guido Finazzi    References Top Authorship References   Barbui T, Barosi G, Grossi A, et al. Practice guidelines for the therapy of essential thrombocythemia. A statement from the Italian Society of Hematology, the Italian Society of Experimental Hematology and the Italian Group for Bone Marrow Transplantation. Haematologica. 2004;89:215–232.[Abstract/Free Full Text] Tefferi A, Gangat N, Wolanskyj AP. Management of extreme thrombocytosis in otherwise low-risk essential thrombocythemia; does number matter? [letter]. Blood. 2006;108:2493–2494.[Free Full Text] CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? Related Articles in Blood Online: Platelet count in essential thrombocythemia: the more the better? Ayalew Tefferi Blood 2008 112: 3526. [Full Text] [PDF] Thrombocytosis and leukocytosis interaction in vascular complications of essential thrombocythemia Alessandra Carobbio, Guido Finazzi, Elisabetta Antonioli, Paola Guglielmelli, Alessandro M. Vannucchi, Federica Delaini, Vittoria Guerini, Marco Ruggeri, Francesco Rodeghiero, Alessandro Rambaldi, and Tiziano Barbui Blood 2008 112: 3135-3137. [Abstract] [Full Text] [PDF] This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Barbui, T. Articles by Finazzi, G. Search for Related Content PubMed Articles by Barbui, T. Articles by Finazzi, G. Related Collections Related Articles in Blood Online Social Bookmarking                   What's this?

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