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Red cell distribution width and prognosis in myelofibrosis patients treated with ruxolitinib

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Abstract

We evaluated RDW in a single-center series of 61 consecutive patients with primary and secondary MF at diagnosis and during treatment with ruxolitinib (RUX) and examined any possible prognostic impact. Elevated RDW values were present in all but 4 patients at diagnosis with a median RDW of 18.9%. RDW was higher in subjects with palpable splenomegaly (p = 0.02), higher ferritin, as well as among those cases who did not receive any cytoreduction before RUX (p = 0.04). Interestingly, higher RDW at diagnosis also correlated with a shorter time from MF diagnosis to RUX start (-4.1 months per one RDW unit; p = 0.03). We observed a modest increase (< 1%) in RDW during the first 6 months of RUX treatment. In a multivariable random-intercept model that considered all time points and contained the covariates time and RUX dose, we also observed a clear decrease in RDW with increasing hemoglobin (Hb) during RUX (slope: -0.4% per g/dL of Hb; p < 0.001). The median RDW at diagnosis of 18.9% was used as a cut-off to identify two subgroups of patients [Group 1: RDW 19.0-25.7%; Group 2: RDW 13.1-18.7%], showing a difference in mortality [Group 1 vs. 2: crude HR 2.88; p = 0.01]. Using continuous RDW at diagnosis, the crude HR was 1.21 per RDW unit (p = 0.002). In a Cox model adjusted for gender, age and Hb at diagnosis, the HR was 1.13 per RDW unit (p = 0.07). RDW may have prognostic significance at MF diagnosis and during RUX, hel** in the rapid detection of patients with poor prognosis.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

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Funding

This study was partially funded by Italian Ministry of Health - Current research IRCCS.

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Authors and Affiliations

  1. Hematology Division, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Myeloproliferative Syndromes Unit, Via Francesco Sforza 35, Milan, 20122, Italy

    Daniele Cattaneo, Nicole Galli, Cristina Bucelli, Cecilia Anna Fidanza, Valentina Bellani, Silvia Artuso, Paola Bianchi, Francesco Passamonti & Alessandra Iurlo

  2. Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy

    Daniele Cattaneo, Nicole Galli, Cecilia Anna Fidanza & Francesco Passamonti

  3. Epidemiology Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

    Dario Consonni

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Contributions

D.Ca. and A.I. were responsible for study concept and design and wrote the paper. D.Co. was responsible for statistical analyses. D.Ca., N.G., C.B., C.A.F., V.B., S.A., P.B., and A.I. followed the patients and collected data. F.P. critically reviewed the manuscript. All authors approved the final version of the manuscript.

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Correspondence to Alessandra Iurlo.

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Cattaneo, D., Galli, N., Bucelli, C. et al. Red cell distribution width and prognosis in myelofibrosis patients treated with ruxolitinib. Ann Hematol (2024). https://doi.org/10.1007/s00277-024-05801-0

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