A practical tool for predicting outcomes in essential thrombocythemia: Triple A risk model and beyond

Area of Science:

• Hematology
• Oncology
• Clinical Risk Stratification

Background:

• Essential thrombocythemia (ET) management requires accurate risk stratification.
• Existing risk scores for ET may lack sufficient prognostic value.
• Novel, easily applicable risk scores are needed to improve patient outcomes.

Purpose of the Study:

• To evaluate the predictive performance of the Triple A risk score in an independent cohort of ET patients.
• To refine the Triple A score by incorporating absolute monocyte count and neutrophil-to-lymphocyte ratio (NLR).
• To assess the prognostic value of monocytosis and NLR in ET.

Main Methods:

• Retrospective collection of demographic, clinical, and laboratory data from 565 ET patients.
• Classification of patients into risk groups based on the Triple A score (age, absolute neutrophil count, absolute lymphocyte count).
• Analysis of survival, thrombosis, bleeding, myelofibrosis, and mortality rates over a median follow-up of 6 years.

Main Results:

• Significant differences in overall survival and thrombosis-free survival were observed across Triple A risk groups.
• Monocytosis (>0.8 × 10^9/L) was associated with increased mortality and correlated with higher Triple A scores.
• Elevated NLR independently predicted higher mortality risk and contributed to a novel NLR-monocyte-age risk score with significant prognostic value.

Conclusions:

• The Triple A score is a reliable and user-friendly tool for predicting survival and thrombosis in ET.
• Incorporating monocytosis into the Triple A score (AAA+A model) may enhance its prognostic accuracy.
• NLR shows prognostic value in ET, both independently and within a combined risk model, supporting its use in risk stratification.