Smoking Affects Symptom Prevalence, Severity in Patients With MPN, Study Finds

The study included more than 400 patients with Philadelphia-negative MPNs, all of whom completed a questionnaire related to their tobacco use and symptoms related to their disease.

Whether or not a patient with a myeloproliferative neoplasm (MPN) smokes may have an impact on the presence and severity of disease symptoms, according to study findings, which also found that patients who reported never smoking had significantly better quality of life.

Across the study patients, less than half of current or former smokers (43.2%) said they had discussed tobacco use with their physician, and a significant amount (17.5%) said they did not believe smoking increased their risk of thrombosis. Based on these findings, the researchers suggest a need for more patient education around use of tobacco.

The study included more than 400 patients with Philadelphia-negative MPNs, all of whom completed a questionnaire related to their tobacco use and symptoms related to their disease. Responses to the questionnaires, ranked on a scale of 1 to 10, showed that current and former smokers reported worse fatigue than never smokers (mean severity, 5.6 vs 5.0). Across both groups of patients, fatigue was the most commonly reported symptom, with 97.8% of current/former smokers and 96% of never smokers reporting the symptom.

“Besides fatigue, this study identified several symptoms associated negatively with tobacco use; on average, current/former smokers reported significantly higher inactivity scores relative to never smokers,” reported the researchers, noting that severity of inactivity was also higher for these patients (mean severity, 4.0 vs 3.4). “Many reasons may account for this including fatigue, and a significantly higher prevalence of anemia and chronic obstructive pulmonary disease (COPD) among current/ former smokers. Moreover, previous research has demonstrated associations between sedentary lifestyles and pro-inflammatory states.”

Current and former smokers also more frequently reported early satiety (68.5% vs 58.3%) and difficulties concentrating (82.1% vs 71.1%).

Altogether, current and former smokers had higher total symptom burdens than never smokers, although the difference was not significant (mean, 30.4 vs 27.0).

“We speculate that the higher symptomatology found among current/former smokers diagnosed with MPN is a result of an accumulated level of chronic inflammation,” suggested the researchers. “In healthy, non-smoking individuals, the balance between pro-inflammatory and anti-inflammatory responses is carefully regulated. Conversely, as described comprehensively in two previous published reviews, dysregulation of this balance is a hallmark feature of MPN with the Janus kinase cascade playing a key role in the signaling of inflammatory cytokines.”

The researchers did find that symptom prevalence and severity sometimes varied based on the type of MPN a patient had. For example, among patients with polycythemia vera, current or former smokers had worse bone pain than never smokers. Meanwhile, symptom prevalence and severity did not different significantly among patients with myelofibrosis, although the researchers note that this could be due to 6 of these current/former smokers having a history of bone marrow transplantation compared with none of the never smokers.


Christensen S, Scherber R, Mazza G, et al. Tobacco use in the myeloproliferative neoplasms: symptom burden, patient opinions, and care. BMC Cancer. 2021;21(1):691. doi:10.1186/s12885-021-08439-7

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