A population-based study in the Netherlands indicated that hematologic malignancies were slightly more common among older participants with anemia or thrombocytopenia, but most causes of death in the cohort were not associated with hematologic malignancies. The study results were published the journal Blood Advances.

Hematologic malignancies sometimes occur following the development of peripheral blood cytopenias and may appear as the first sign of such a malignancy. However, the rate at which peripheral blood cytopenias are associated with hematologic malignancies and their outcomes has not been clear. 

The researchers used data from the prospective, population-based Lifelines Cohort Study, which includes 167,729 community-dwelling individuals in The Netherlands. Multiple demographic and clinical factors were obtained from individuals in this cohort, and follow-up was to occur following approximately 5 years. Overall survival was a key outcome of the analysis.

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This analysis included data from 152,180 adults from the study cohort. Hemoglobin levels were evaluable for 147,170 participants, with platelet counts available for 147,074. Complete blood counts that included neutrophil levels were available for 144,676 participants. Follow-up visits occurred at a median of 46 months (range, 13-133), with 110,675 participants returning for follow-up.

Anemia and thrombocytopenia both became more common with increasing age, but neutropenia did not show an increase in prevalence with age. In survival analysis, with a median follow-up of 8.3 years, the overall mortality rate was 2.29 per 1000 person-years.

In an age- and sex-adjusted analysis, inferior survival was seen with anemia (hazard ratio [HR], 1.84; 95% CI, 1.59-2.12; P <.001). Poorer survival was also seen with thrombocytopenia (HR, 1.58; 95% CI, 1.32-1.89; P <.001) and with the combination of anemia and thrombocytopenia (HR, 4.75; 95% CI, 2.98-7.55; P <.001). Neutropenia, however, did not impact overall survival when evaluated alone (HR, 0.88; 95% CI, 0.73-1.06; P =.168). Neutropenia combined with thrombocytopenia was associated with higher mortality, but neutropenia combined with anemia was not.

The 5-year cumulative incidence of hematologic malignancies in participants of 60 years of age or older was 0.60%. Anemia and thrombocytopenia were each associated with a higher incidence of hematologic malignancy in older participants, with a 5-year probability of 2.5% for each (P <.001 for both). However, neutropenia was not (P =.201). The presence of more than 1 cytopenia was associated with a higher rate of diagnosis of hematologic malignancy than seen with just 1 type of cytopenia.

Deaths from hematologic malignancies were more common in participants with anemia, thrombocytopenia, or neutropenia, and the presence of more than 1 cytopenia was associated with an even higher mortality risk with a hematologic malignancy. Most deaths in individuals with cytopenias did not involve a hematologic malignancy.

“In summary, our study provides important insight into the emergence of peripheral cytopenias and associated outcomes at the population level,” the researchers concluded in their report.


van Zeventer IA, de Graaf AO, van der Klauw MM, et al. Peripheral blood cytopenias in the aging general population and risk of incident hematological disease and mortality. Blood Adv. 2021;5(17):3266-3278. doi:10.1182/bloodadvances.2021004355

This article originally appeared on Hematology Advisor