Hypocholesterolemia Is Independently Associated with Decreased Survival in Patients with Primary Myelofibrosis: An Analysis of Lipid Profiles in 558 Myeloproliferative Patients.
Authors: Mesa Ruben A. , Huang Jocelin , Schwager Susan , Pardanani Animesh , Hussein Kebede , Dingli David , Jensen Michael , Haglind Elizabeth , Tefferi Ayalew 
Published: April 2020

Abstract
BACKGROUND: We sought to determine the prognostic relevance of aberrant serum lipid values in the myeloproliferative disorders (MPDs) of primary myelofibrosis (PMF), polycythemia vera (PV), and essential thrombocythemia (ET).
METHODS: The Mayo MPD patient institutional database was queried to identify clinical history and lipid profiles (within a year of diagnosis). Serum cholesterol (CHOL), low density lipoprotein (LDL-C), high density lipoprotein (HDL-C), and triglycerides (TRI) were assessed compared to clinical outcomes.
RESULTS: 558 patients with MPDs (PMF 28%, PV 27%, and ET 45%) (median age at diagnosis of 56 (range18–81)) were identified. A lipid profile obtained a median of 0.0 months from diagnosis (range (-8 to 12 months) from MPD patients displayed low CHOL, LDL-C, and higher HDL-C than typical for the USA. Amongst MPD disease types PMF patients had lower CHOL (p&lt;0.001) and HDL (p&lt;0.001) compared to ET and PV (see table).
Amongst PMF patients, although hypocholesterolemia was not a surrogate for malnutrition (p=0.13) median serum albumin 4.1 g/dL (range 2.7–4.8)), there was correlation with the presence of weight loss, hypercatabolic symptoms, and worse Mayo-CBC myelofibrosis prognostic scores (Cancer2006;106:623; p&lt;0.01). Amongst the study group PMF patients had the poorest survival (followed by PV then ET; p&lt;0.001). Decreased cholesterol (CHOL &lt;150mg/dL, or HDL &lt;60 mg/dL) was associated with decreased survival (P&lt;0.001), but only in PMF patients (see figure).
Decreased PMF survival was also associated with traditional PMF risk factors of hemoglobin &lt;10g/dL, leukocytes &lt;4 or &gt;30 × 10(9)/L, platelets &lt;100 × 10(9)/L, and circulating blasts. In multivariate analysis (Cox-Proportional Hazard) only the Mayo-CBC score, hemoglobin &lt;10g/dL, circulating blasts and decreased CHOL remained significant for decreased survival (p&lt;0.001).
CONCLUSIONS: The presence of hypocholesterolemia is very common in patients with PMF and is independently associated with inferior survival.
Survival by HDL-C and Serum Cholesterol (CHOL) in 154 patient’s with Primary Myelofibrosis Survival by HDL-C and Serum Cholesterol (CHOL) in 154 patient’s with Primary Myelofibrosis
Lipid Distributions in 558 MPD patients VALUE/ NCEP CATEGORY PMF (N=154) PV (N=149) ET (N=255) NHANES (USA MEANS;95th CI) NCEP: National Cholesterol Education Program: NHANES (National Health and Nutrition Examination Survey (values for all races ages 65–74) Serum Cholesterol (Median) 149 mg/dL 179 mg/dL 199 mg/dL 221 mg/dL (153–301) −&gt;200mg/dl (Desirable) 10% 31% 48% −150–200mg/dL (Desirable) 39% 25% 41% −100–149mg/dL (Desirable) 41% 41% 9% −&lt;100mg/dL (Low) 10% 3% 2% LDL Cholesterol (Median) 33 mg/dL 41 mg/dL 49 mg/dL 149 mg/dL (87–217) −&gt;100mg/dL (Low to high risk) 1% 1% 1% −&lt;100mg/dL (Optimal) 99% 99% 99% HDL Cholesterol (Median) 79 mg/dL 118 mg/dL 108 mg/dL 45.7 mg/dL (29–71) −&gt;60mg/dL (Optimal) 74% 90% 91% −40–60mg/dL (Normal) 16% 10% 8% −&lt;40mg/dL (Low) 10% 0% 1% Triglycerides (Median) 151 mg/dL 89 mg/dL 116 mg/dL 145 mg/dL (62–285) −&gt;200mg/dL (High) 28% 0% 3% −150–199mg/dL (Borderline) 23% 6% 14% −&lt;150mg/dL (low) 49% 94%% 83%