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Predictors for and outcomes after bone marrow biopsy in Scandinavian patients with chronic immune thrombocytopenia
Madeleine Andersson Gotschalck1,2, Mette Nørgaard1,2, Nickolaj Risbo1,2
1Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark.
Insights
Bone marrow biopsy in chronic immune thrombocytopenia (cITP) patients indicates more severe disease. These patients face higher risks of complications, including thrombotic events, bleeding, and hematological cancers.
Area of Science:
- Hematology
- Oncology
- Clinical Medicine
Background:
- Chronic immune thrombocytopenia (cITP) is an autoimmune disorder characterized by low platelet counts.
- Bone marrow biopsy (BMB) is a diagnostic tool used in various hematological conditions.
- Understanding predictors and outcomes of BMB in cITP is crucial for patient management.
Purpose of the Study:
- To identify factors predicting the need for bone marrow biopsy (BMB) in patients with chronic immune thrombocytopenia (cITP).
- To evaluate the outcomes associated with undergoing BMB in cITP patients.
Main Methods:
- Retrospective analysis of 4471 adult patients diagnosed with cITP between 2009-2017 in Denmark, Norway, and Sweden.
- Utilized population-based healthcare databases and medical records to gather data on BMB, treatments, and clinical outcomes.
- Assessed incidence of BMB, predictors for undergoing BMB, and rates of thrombotic events, bleeding, hematological cancer, and mortality.
Main Results:
- 37.6% of cITP patients underwent BMB before diagnosis; cumulative incidence after diagnosis was 7.5% at 5 years.
- Predictors for post-diagnosis BMB included older age, male sex, low platelet count, splenectomy, and multiple cITP treatments.
- Patients with BMB showed significantly higher rates of thrombotic events, hospitalized bleeding, hematological cancer, and all-cause mortality compared to those without BMB.
Conclusions:
- Bone marrow biopsy in cITP patients identifies a subgroup with more severe disease.
- Undergoing BMB in cITP is associated with increased risks of adverse outcomes, including thrombotic events, bleeding, and hematological malignancies.
- BMB may serve as a marker for disease severity and heightened complication risk in cITP.
Objectives:
To examine predictors for bone marrow biopsy (BMB) and the outcome following BMB in patients with chronic immune thrombocytopenia (cITP).
Methods:
We identified patients diagnosed with cITP during 2009-2017 and obtained information on BMB, cITP treatment and subsequent thrombotic events, hospitalized bleeding, hematological cancer, and death using data from population-based healthcare databases and medical records in Denmark, Norway, and Sweden.
Results:
Among 4471 adults (≥18 years) with cITP, 1683 (37.6%) underwent BMB before cITP diagnosis, while cumulative BMB incidence after cITP diagnosis date was 3.1% at 1 year and 7.5% at 5 years. Predictors of having a BMB after cITP diagnosis included older age, male sex, low baseline platelet count, splenectomy, and number of cITP treatments. Compared with patients without BMB, patients with BMB had higher rates of thrombotic events (1 year adjusted hazard ratio [HR] 1.53 [95% CI, 0.92-2.54]), hospitalized bleeding episodes (1 year adjusted HR 1.72 [95% CI, 1.15-2.58]), hematological cancer (1 year adjusted HR 35.26 [95% CI 17.67-70.34]), and all-cause mortality (1 year adjusted HR 1.97 [95% CI, 1.44-2.68]).
Conclusion:
Patients who undergo BMB after cITP diagnosis represent a subset of patients with more severe disease and increased rates of complications as well as hematological malignancies.
