51
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Cascavilla N, De Stefano V, Pane F, Pancrazzi A, Iurlo A, Gobbi M, Palandri F, Specchia G, Liberati AM, D'Adda M, Gaidano G, Fjerza R, Achenbach H, Smith J, Wilde P, Vannucchi AM. Impact of JAK2(V617F) mutation status on treatment response to anagrelide in essential thrombocythemia: an observational, hypothesis-generating study. DRUG DESIGN DEVELOPMENT AND THERAPY 2015; 9:2687-94. [PMID: 26028965 PMCID: PMC4441358 DOI: 10.2147/dddt.s79576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A JAK2(V617F) mutation is found in approximately 55% of patients with essential thrombocythemia (ET), and represents a key World Health Organization diagnostic criterion. This hypothesis-generating study (NCT01352585) explored the impact of JAK2(V617F) mutation status on treatment response to anagrelide in patients with ET who were intolerant/refractory to their current cytoreductive therapy. The primary objective was to compare the proportion of JAK2-positive versus JAK2-negative patients who achieved at least a partial platelet response (≤600×109/L) after anagrelide therapy. Of the 47 patients enrolled, 46 were included in the full analysis set (JAK2-positive, n=22; JAK2-negative, n=24). At 12 months, 35 patients (n=14 and n=21, respectively) had a suitable platelet sample; of these, 74.3% (n=26) achieved at least a partial response. The response rate was higher in JAK2-positive (85.7%, n=12) versus JAK2-negative patients (66.7%, n=14) (odds ratio [OR] 3.00; 95% confidence interval [CI] 0.44, 33.97). By using the last observation carried forward approach in the sensitivity analysis, which considered the imbalance in patients with suitable samples between groups, the overall response rate was 71.7% (n=33/46), with 77.3% (n=17/22) of JAK2-positive and 66.7% (n=16/24) of JAK2-negative patients achieving at least a partial response (OR 1.70; 95% CI 0.39, 8.02). There was no significant change in median allele burden over 12 months in the 12 patients who achieved a response. In conclusion, the overall platelet response rate was high in both JAK2-positive and JAK2-negative patients; however, a larger study would be required to confirm the differences observed according to JAK2(V617F) mutation status.
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Affiliation(s)
- Nicola Cascavilla
- Division of Hematology, Casa Sollievo della Sofferenza Hospital, IRCCS, San Giovanni Rotondo, Italy
| | | | - Fabrizio Pane
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Alessandro Pancrazzi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Alessandra Iurlo
- Oncohematology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Francesca Palandri
- Department of Specialistic, Diagnostic and Experimental Medicine, St Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Giorgina Specchia
- Unit of Hematology with Transplantation, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | | | - Mariella D'Adda
- Division of Hematology, Azienda Ospedaliera Spedali Civili di Brescia, Brescia, Italy
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Rajmonda Fjerza
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Jonathan Smith
- Shire Pharmaceutical Development Ltd, Basingstoke, United Kingdom
| | - Paul Wilde
- Shire Pharmaceutical Development Ltd, Basingstoke, United Kingdom
| | - Alessandro M Vannucchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Barbui T, Vannucchi AM, Carobbio A, Thiele J, Rumi E, Gisslinger H, Rodeghiero F, Randi ML, Rambaldi A, Pieri L, Pardanani A, Passamonti F, Finazzi G, Tefferi A. Patterns of presentation and thrombosis outcome in patients with polycythemia vera strictly defined by WHO-criteria and stratified by calendar period of diagnosis. Am J Hematol 2015; 90:434-7. [PMID: 25683038 DOI: 10.1002/ajh.23970] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 02/08/2015] [Indexed: 01/08/2023]
Abstract
Most studies in polycythemia vera (PV) include patients with both remote and most recent diagnostic periods and are therefore vulnerable to inaccurate interpretation of time-dependent data. We addressed the particular issue by analyzing presenting characteristics and outcome data among 1,545 patients with WHO-defined PV stratified by a diagnosis period of before or after 2005, which coincides with the first description of JAK2V617F as the molecular marker of PV. Patients diagnosed after 2005 displayed lower hemoglobin values (P < 0.0001) and older age (P = 0.007) at diagnosis; we suggest ease of diagnosis offered by a molecular marker enabled earlier diagnosis and broader application across older age groups that is further enhanced by recent trends in increased attention and health monitoring for the elderly. Post-2005 diagnosed patients were also more or less likely to receive aspirin and cytoreductive therapy, respectively, and, despite their older age distribution, displayed significantly lower risk of thrombosis in high risk disease. Regardless of the contributing factors to the latter phenomenon, our observations underscore the need to reassess current demographics and frequencies of thrombosis in clinical trial designs including thrombosis prevention in PV.
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Affiliation(s)
- Tiziano Barbui
- Research Foundation Papa Giovanni XXIII Hospital; Bergamo Italy
| | | | | | - Jurgen Thiele
- Institute of Pathology; University of Cologne; Cologne Germany
| | - Elisa Rumi
- Division of Hematology; University of Pavia, I.R.C.C.S. Policlinico San Matteo; Pavia Italy
| | - Heinz Gisslinger
- Division of Hematology; Medical University of Vienna; Vienna Austria
| | | | | | | | - Lisa Pieri
- Division of Hematology; University of Padua; Padua Italy
| | | | | | - Guido Finazzi
- Division of Hematology; Papa Giovanni XXIII Hospital; Bergamo Italy
| | - Ayalew Tefferi
- Division of Hematology; Mayo Clinic; Rochester Minnesota
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Limitations of fibrosis grade as diagnostic criteria for post polycythemia vera and essential thrombocytosis myelofibrosis. Leuk Res 2015; 39:684-8. [PMID: 25922307 DOI: 10.1016/j.leukres.2015.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 03/23/2015] [Accepted: 04/06/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND The clinical phenotype of patients with myeloproliferative neoplasms (MPNs) including primary myelofibrosis (PMF), polycythemia vera (PV), and essential thrombocytosis (ET) whom manifest WHO grade 1 marrow fibrosis is poorly defined. Current IWG-MRT criteria require 2+ marrow fibrosis for diagnosis of post PV/ET myelofibrosis (MF). In contrast, the 2008 WHO definition of PMF does not require a minimum fibrosis threshold. METHODS We retrospectively analyzed the clinical characteristics of 91 MPN patients with 1+ marrow fibrosis. We compared the clinical phenotype of sub threshold fibrosis PV/ET with that manifested by PMF. We applied the IWG-MRT criteria for post-PV/ET MF with the fibrosis component omitted and evaluated for percentage of criteria fulfillment. RESULTS When IWG-MRT criteria were applied to the PV/ET group, 38/58 (66%) of patients fulfilled criteria for diagnosis of post-PV/ET myelofibrosis except for the 2+ fibrosis requirement. Comparison of sub threshold fibrotic PV/ET clinical phenotype to PMF revealed similar characteristics including heavy symptomatic burden (57% and 52%), presence of splenomegaly (43% and 55%), leukoerythroblastic blood smear (38% and 45%), and median hemoglobin (12.8g/dL and 11.1g/dL). CONCLUSION MPN progression represents a biological spectrum and definitions of progression in ET/PV may benefit from criteria not restricted by degree of fibrosis.
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Ashrani AA, Tefferi A, Pruthi RK, Pardanani A. Acquired factor V deficiency in myeloproliferative neoplasms: a Mayo Clinic series of 33 patients. Br J Haematol 2015; 171:875-9. [PMID: 25854415 DOI: 10.1111/bjh.13438] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Aneel A Ashrani
- Division of Hematology, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Ayalew Tefferi
- Division of Hematology, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Rajiv K Pruthi
- Division of Hematology, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Animesh Pardanani
- Division of Hematology, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, MN, USA
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Pósfai É, Marton I, Nemes A, Borbényi Z. [Thrombotic events and significance of the IPSET thrombosis risk evaluation score in essential thrombocythaemia]. Orv Hetil 2015; 156:558-63. [PMID: 25819149 DOI: 10.1556/oh.2015.30117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Thrombo-haemorrhagic complications contribute to both morbidity and mortality in patients with essential thrombocythaemia. AIM The aim of the authors was to estimate the incidence of thrombotic events and to examine the clinical utility of IPSET thrombosis risk evaluation score against conventional two-categorical (low and high) risk assessment. METHOD A retrospective analysis was carried out on 155 patients with essential thrombocythaemia (106 females; median age, 61 years) in a period between 1999 and 2014. RESULTS The analysis revealed 55 (35.5%) major thrombotic events before and 25 (16.1%) major thrombotic complications after establishment of the haematologic diagnosis. Significant differences were observed in thrombosis-free survival between the different IPSET groups (p = 0.002). CONCLUSIONS The IPSET model was first examined in this cohort of patients with essential thrombocythaemia diagnosed in a single Hungarian haematologic centre. The results suggest that this score may provide more information than the conventional thrombosis risk assessment.
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Affiliation(s)
- Éva Pósfai
- Szegedi Tudományegyetem, Szent-Györgyi Albert Klinikai Központ, Általános Orvostudományi Kar II. Belgyógyászati Klinika és Kardiológiai Központ, Haematológiai Osztály Szeged
| | - Imelda Marton
- Szegedi Tudományegyetem, Szent-Györgyi Albert Klinikai Központ, Általános Orvostudományi Kar II. Belgyógyászati Klinika és Kardiológiai Központ, Haematológiai Osztály Szeged
| | - Attila Nemes
- Szegedi Tudományegyetem, Szent-Györgyi Albert Klinikai Központ, Általános Orvostudományi Kar II. Belgyógyászati Klinika és Kardiológiai Központ Szeged Semmelweis utca 6. 6720
| | - Zita Borbényi
- Szegedi Tudományegyetem, Szent-Györgyi Albert Klinikai Központ, Általános Orvostudományi Kar II. Belgyógyászati Klinika és Kardiológiai Központ, Haematológiai Osztály Szeged
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Them NC, Bagienski K, Berg T, Gisslinger B, Schalling M, Chen D, Buxhofer‐Ausch V, Thaler J, Schloegl E, Gastl GA, Wolf D, Strecker K, Egle A, Melchardt T, Burgstaller S, Willenbacher E, Zagrijtschuk O, Klade C, Greil R, Gisslinger H, Kralovics R. Molecular responses and chromosomal aberrations in patients with polycythemia vera treated with peg-proline-interferon alpha-2b. Am J Hematol 2015; 90:288-94. [PMID: 25545244 PMCID: PMC4657499 DOI: 10.1002/ajh.23928] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 12/20/2014] [Indexed: 01/22/2023]
Abstract
Fifty-one polycythemia vera (PV) patients were enrolled in the phase I/II clinical study PEGINVERA to receive a new formulation of pegylated interferon alpha (peg-proline-IFNα-2b, AOP2014/P1101). Peg-proline-IFNα-2b treatment led to high response rates on both hematologic and molecular levels. Hematologic and molecular responses were achieved for 46 and 18 patients (90 and 35% of the whole cohort), respectively. Although interferon alpha (IFNα) is known to be an effective antineoplastic therapy for a long time, it is currently not well understood which genetic alterations influence therapeutic outcomes. Apart from somatic changes in specific genes, large chromosomal aberrations could impact responses to IFNα. Therefore, we evaluated the interplay of cytogenetic changes and IFNα responses in the PEGINVERA cohort. We performed high-resolution SNP microarrays to analyze chromosomal aberrations prior and during peg-proline-IFNα-2b therapy. Similar numbers and types of chromosomal aberrations in responding and non-responding patients were observed, suggesting that peg-proline-IFNα-2b responses are achieved independently of chromosomal aberrations. Furthermore, complete cytogenetic remissions were accomplished in three patients, of which two showed more than one chromosomal aberration. These results imply that peg-proline-IFNα-2b therapy is an effective drug for PV patients, possibly including patients with complex cytogenetic changes. Am. J. Hematol. 90:288–294, 2015. © 2014 The Authors. American Journal of Hematology published by Wiley Periodicals, Inc.
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Affiliation(s)
- Nicole C.C. Them
- CeMM Research Center for Molecular Medicine of the Austrian Academy of SciencesVienna Austria
| | - Klaudia Bagienski
- CeMM Research Center for Molecular Medicine of the Austrian Academy of SciencesVienna Austria
| | - Tiina Berg
- CeMM Research Center for Molecular Medicine of the Austrian Academy of SciencesVienna Austria
| | - Bettina Gisslinger
- Department of Internal Medicine IDivision of Hematology and Blood CoagulationMedical University of ViennaVienna Austria
| | - Martin Schalling
- Department of Internal Medicine IDivision of Hematology and Blood CoagulationMedical University of ViennaVienna Austria
| | - Doris Chen
- CeMM Research Center for Molecular Medicine of the Austrian Academy of SciencesVienna Austria
| | - Veronika Buxhofer‐Ausch
- 2nd Medical DepartmentSozialmedizinisches Zentrum Ost—DonauspitalVienna Austria
- Interne 1 Hemato‐OncologyKrankenhaus Der Elisabethinen LinzLinz Austria
| | - Josef Thaler
- Department of Internal Medicine IVWels‐Grieskirchen HospitalWels Austria
| | | | - Guenther A. Gastl
- Department of Internal Medicine V Haematology & OncologyInnsbruck Medical UniversityInnsbruck Austria
| | - Dominik Wolf
- Department of Internal Medicine V Haematology & OncologyInnsbruck Medical UniversityInnsbruck Austria
- Medical Clinic IIIOncologyHematology and RheumatologyUniversity Clinic of Bonn (UKB)Bonn Germany
| | - Karin Strecker
- 2nd Medical DepartmentSozialmedizinisches Zentrum Ost—DonauspitalVienna Austria
| | - Alexander Egle
- Laboratory for Immunological and Molecular Cancer ResearchDepartment of Internal Medicine III with HematologyMedical OncologyHemostaseologyInfectious DiseasesRheumatologyOncologic Center, Paracelsus Medical UniversitySalzburg Austria
| | - Thomas Melchardt
- Laboratory for Immunological and Molecular Cancer ResearchDepartment of Internal Medicine III with HematologyMedical OncologyHemostaseologyInfectious DiseasesRheumatologyOncologic Center, Paracelsus Medical UniversitySalzburg Austria
| | - Sonja Burgstaller
- Department of Internal Medicine IVWels‐Grieskirchen HospitalWels Austria
| | - Ella Willenbacher
- Department of Internal Medicine V Haematology & OncologyInnsbruck Medical UniversityInnsbruck Austria
| | | | | | - Richard Greil
- Laboratory for Immunological and Molecular Cancer ResearchDepartment of Internal Medicine III with HematologyMedical OncologyHemostaseologyInfectious DiseasesRheumatologyOncologic Center, Paracelsus Medical UniversitySalzburg Austria
| | - Heinz Gisslinger
- Department of Internal Medicine IDivision of Hematology and Blood CoagulationMedical University of ViennaVienna Austria
| | - Robert Kralovics
- CeMM Research Center for Molecular Medicine of the Austrian Academy of SciencesVienna Austria
- Department of Internal Medicine IDivision of Hematology and Blood CoagulationMedical University of ViennaVienna Austria
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Ischemic Stroke with Essential Thrombocythemia: A Case Series. J Stroke Cerebrovasc Dis 2015; 24:890-3. [DOI: 10.1016/j.jstrokecerebrovasdis.2014.12.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 08/20/2014] [Accepted: 12/08/2014] [Indexed: 01/23/2023] Open
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Lekovic D, Gotic M, Sefer D, Mitrovic-Ajtic O, Cokic V, Milic N. Predictors of survival and cause of death in patients with essential thrombocythemia. Eur J Haematol 2015; 95:461-6. [PMID: 25645731 DOI: 10.1111/ejh.12517] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Standard risk stratification for overall survival (OS) in patients with essential thrombocythemia (ET) is based on advanced age and history of thrombotic events. Recently, International Prognostic Score for ET (IPSET) incorporated also leukocytosis in prognostic model. The aim of this study was to establish additional risk factors for OS in ET patients. METHODS After the median follow-up of 7 yr, in 244 consecutive ET patients, 32 deaths were documented (13.2%). The 5- and 10-yr OS was 95.9% and 79.7%, respectively. Considered additional risk factors at diagnosis of ET were the presence of arterial hypertension, diabetes, hyperlipidemia, and smoking attitude. RESULTS The main cause of death in 75% of patients was cardiovascular (CV) comorbidity. Patients with CV risk factors had increased risk of death (HR = 2.33). Cox regression model identified age, leukocytosis, presence of CV risk factors, and previous thrombosis as unfavorable predictors of survival. Based on these parameters, four risk groups were defined, with significantly different survivals (P < 0.001). Improved prognostic model displayed a better hazard ratio profile compared to the standard risk stratification and IPSET. CONCLUSION The addition of CV risk factors allows better prognostic assessment by delineating the intermediate-risk category and improved identification of the high-risk patients.
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Affiliation(s)
- Danijela Lekovic
- Clinic for Hematology, Clinical Center of Serbia, Belgrade, Serbia
| | - Mirjana Gotic
- Clinic for Hematology, Clinical Center of Serbia, Belgrade, Serbia.,Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Dijana Sefer
- Clinic for Hematology, Clinical Center of Serbia, Belgrade, Serbia
| | | | - Vladan Cokic
- Institute for Medical Research, University of Belgrade, Belgrade, Serbia
| | - Natasa Milic
- Medical Faculty, University of Belgrade, Belgrade, Serbia.,Institute for Medical Statistics, University of Belgrade, Belgrade, Serbia
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Yang M, Bai XY, Ni JJ, Xu JC, Tang JY, Zeng Y, Fang Q. Recurrent coronary arterial thromboses as the tip of the iceberg: The JAK2 mutation-related disease. Int J Cardiol 2015; 182:48-9. [DOI: 10.1016/j.ijcard.2015.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 01/02/2015] [Indexed: 11/26/2022]
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LI YUYING, AN WEI, WEI WEI, LIU MIN, WANG GUANJUN, WANG XU. Prostatic metastases and polycythemia vera on bone magnetic resonance imaging: A case report. Oncol Lett 2015; 9:1317-1320. [PMID: 25663905 PMCID: PMC4314976 DOI: 10.3892/ol.2014.2809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 11/21/2014] [Indexed: 11/11/2022] Open
Abstract
Localized prostate cancer and polycythemia vera (PV) are rare, and can be difficult to distinguish from bone marrow metastatic prostate cancer. The present study describes a case of prostate cancer occurring with PV. Magnetic resonance imaging revealed diffusely inhomogeneous bone marrow of the pelvis and a localized prostatic mass. The bone marrow biopsy indicated erythrocytosis and leukocytosis. The patient was treated with aspirin and twice-weekly phlebotomy procedures for two weeks, followed by a radical prostatectomy. Following the surgery, the patient was continually treated with interferon-α2b and aspirin, and demonstrated no abnormalities within the one-year follow-up period. The findings of the present study may aid in the future diagnosis and treatment of patients with prostate cancer and PV.
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Affiliation(s)
- YUYING LI
- Cancer Center, The First Hospital, Jilin University, Changchun, Jilin 130021, P.R. China
| | - WEI AN
- Department of Urology, The First Hospital, Jilin University, Changchun, Jilin 130021, P.R. China
| | - WEI WEI
- Department of Urology, The First Hospital, Jilin University, Changchun, Jilin 130021, P.R. China
| | - MIN LIU
- Cancer Center, The First Hospital, Jilin University, Changchun, Jilin 130021, P.R. China
| | - GUANJUN WANG
- Cancer Center, The First Hospital, Jilin University, Changchun, Jilin 130021, P.R. China
| | - XU WANG
- Cancer Center, The First Hospital, Jilin University, Changchun, Jilin 130021, P.R. China
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Abstract
Polycythemia vera (PV) is a chronic myeloproliferative neoplasm defined by erythrocytosis and often accompanied by leukocytosis and thrombocytosis. Current treatment options, including IFN-α and hydroxyurea, effectively manage PV in many patients. However, some high-risk patients, particularly those who become hydroxyurea-intolerant/resistant, may benefit from IFN-α or new treatment options. A better understanding of PV pathophysiology, including the role of the JAK/STAT pathway, has inspired the development of new therapies. Several JAK inhibitors directly target JAK/STAT pathway activation and have been evaluated in Phase II/III trials with promising results. Pegylated variants of IFN-α, which reduce dosing frequency and toxicity associated with recombinant IFN-α, have yielded favorable efficacy results in Phase II trials. Finally, histone deacetylase inhibitors have been developed to manage PV at the level of chromatin-regulated gene expression. The earliest Phase III results from these next-generation therapies are expected in 2014.
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Affiliation(s)
- Srdan Verstovsek
- Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 418, Houston, TX 77030, USA
| | - Rami S Komrokji
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL 33612, USA
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Vannucchi AM, Kiladjian JJ, Griesshammer M, Masszi T, Durrant S, Passamonti F, Harrison CN, Pane F, Zachee P, Mesa R, He S, Jones MM, Garrett W, Li J, Pirron U, Habr D, Verstovsek S. Ruxolitinib versus standard therapy for the treatment of polycythemia vera. N Engl J Med 2015; 372:426-35. [PMID: 25629741 PMCID: PMC4358820 DOI: 10.1056/nejmoa1409002] [Citation(s) in RCA: 594] [Impact Index Per Article: 66.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Ruxolitinib, a Janus kinase (JAK) 1 and 2 inhibitor, was shown to have a clinical benefit in patients with polycythemia vera in a phase 2 study. We conducted a phase 3 open-label study to evaluate the efficacy and safety of ruxolitinib versus standard therapy in patients with polycythemia vera who had an inadequate response to or had unacceptable side effects from hydroxyurea. METHODS We randomly assigned phlebotomy-dependent patients with splenomegaly, in a 1:1 ratio, to receive ruxolitinib (110 patients) or standard therapy (112 patients). The primary end point was both hematocrit control through week 32 and at least a 35% reduction in spleen volume at week 32, as assessed by means of imaging. RESULTS The primary end point was achieved in 21% of the patients in the ruxolitinib group versus 1% of those in the standard-therapy group (P<0.001). Hematocrit control was achieved in 60% of patients receiving ruxolitinib and 20% of those receiving standard therapy; 38% and 1% of patients in the two groups, respectively, had at least a 35% reduction in spleen volume. A complete hematologic remission was achieved in 24% of patients in the ruxolitinib group and 9% of those in the standard-therapy group (P=0.003); 49% versus 5% had at least a 50% reduction in the total symptom score at week 32. In the ruxolitinib group, grade 3 or 4 anemia occurred in 2% of patients, and grade 3 or 4 thrombocytopenia occurred in 5%; the corresponding percentages in the standard-therapy group were 0% and 4%. Herpes zoster infection was reported in 6% of patients in the ruxolitinib group and 0% of those in the standard-therapy group (grade 1 or 2 in all cases). Thromboembolic events occurred in one patient receiving ruxolitinib and in six patients receiving standard therapy. CONCLUSIONS In patients who had an inadequate response to or had unacceptable side effects from hydroxyurea, ruxolitinib was superior to standard therapy in controlling the hematocrit, reducing the spleen volume, and improving symptoms associated with polycythemia vera. (Funded by Incyte and others; RESPONSE ClinicalTrials.gov number, NCT01243944.).
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Affiliation(s)
- Alessandro M Vannucchi
- From Azienda Ospedaliera-Universitaria Careggi, University of Florence, Florence (A.M.V.), Ospedale di Circolo e Fondazione Macchi, Varese (F. Passamonti), and University of Naples Federico II, Naples (F. Pane) - all in Italy; Hôpital Saint-Louis et Université Paris Diderot, Paris (J.J.K.); Johannes Wesling Clinic, Minden, Germany (M.G.); St. István and St. László Hospital and Semmelweis University, Budapest, Hungary (T.M.); Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia (S.D.); Guy's and St. Thomas' NHS Foundation Trust, London (C.N.H.); Ziekenhuis Netwerk Antwerpen Stuivenberg, Antwerp, Belgium (P.Z.); Mayo Clinic Cancer Center, Scottsdale, AZ (R.M.); Incyte, Wilmington, DE (S.H., M.M.J., W.G.); Novartis Pharmaceuticals, East Hanover, NJ (J.L., D.H.); Novartis Pharma, Basel, Switzerland (U.P.); and University of Texas M.D. Anderson Cancer Center, Houston (S.V.)
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JAK2 V617F, MPL, and CALR Mutations in Essential Thrombocythaemia and Major Thrombotic Complications: A Single-Institute Retrospective Analysis. Pathol Oncol Res 2015; 21:751-8. [DOI: 10.1007/s12253-014-9885-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 12/22/2014] [Indexed: 02/02/2023]
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Kiladjian JJ. Current therapies and their indications for the Philadelphia-negative myeloproliferative neoplasms. Am Soc Clin Oncol Educ Book 2015:e389-e396. [PMID: 25993201 DOI: 10.14694/edbook_am.2015.35.e389] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The groundbreaking discovery of the Janus-associated kinase 2 (JAK2) V617F mutation 10 years ago resulted in an unprecedented intensive basic and clinical research in Philadelphia-negative myeloproliferative neoplasms (MPNs). During these years, many new potential targets for therapy were identified that opened the era of targeted therapy for these diseases. However, only one new drug (ruxolitinib) has been approved during the past 40 years, and, although promising new therapies are evaluated, the armamentarium to treat MPN still relies on conventional drugs, like cytotoxic agents and anagrelide. The exact role of interferon (IFN) alfa still needs to be clarified in randomized studies, although it has been shown to be effective in MPNs for more than 25 years. The current therapeutic strategy for MPNs is based on the risk of vascular complication, which is the main cause of mortality and mortality in the medium term. However, the long-term outcome may be different, with an increasing risk of transformation to myelodysplastic syndrome or acute leukemia during follow-up times. Medicines able to change this natural history have not been clearly identified yet, and allogeneic stem cell transplantation currently remains the unique curative approach, which is only justified for patients with high-risk myelofibrosis or for patients with MPNs that have transformed to myelodysplasia or acute leukemia.
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Abstract
Thrombotic and cardiovascular events are among the leading causes of death for patients with polycythemia vera (PV), and thrombosis history is a key criterion for patient risk stratification and treatment strategy. Little is known, however, about mechanisms of thrombogenesis in patients with PV. This report provides an overview of thrombogenesis pathophysiology in patients with PV and elucidates the roles of conventional and nonconventional thrombotic risk factors. In addition to several conventional risk factors for thrombosis, clinical data have implicated increased hematocrit and red blood cell adhesiveness, activated platelets, leukocytosis, and elevated JAK2(V617F) allele burden in patients with PV. Furthermore, PV-related inflammation may exacerbate thrombogenesis through varied mechanisms, including endothelial damage, inhibition of natural anticoagulant pathways, and secretion of procoagulant factors. These findings suggest a direct link between myeloproliferation and thrombogenesis in PV, which is likely to provide new opportunities for targeted antithrombotic interventions aimed at decreasing PV-related morbidity and mortality.
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66
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Sever M, Newberry KJ, Verstovsek S. Therapeutic options for patients with polycythemia vera and essential thrombocythemia refractory/resistant to hydroxyurea. Leuk Lymphoma 2014; 55:2685-90. [PMID: 24524340 PMCID: PMC4835800 DOI: 10.3109/10428194.2014.893310] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Hydroxyurea (HU) has traditionally been the first-line treatment for patients with polycythemia vera (PV) or essential thrombocythemia (ET) at high risk for vascular complications. However, approximately 20-25% of patients develop resistance or intolerance to HU and must be treated with second-line therapies. Resistance is associated with disease transformation and reduced survival. However, given the dearth of large-scale controlled clinical trials in this patient population, there is no clear consensus on how to best treat patients who develop resistance or intolerance to HU. Herein, we review current literature on treatment options for patients with HU-refractory/resistant PV or ET and provide recommendations for treating these patients.
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Affiliation(s)
- Matjaz Sever
- Deparment of Hematology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Kate J. Newberry
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Srdan Verstovsek
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Jones C, Levy Y, Tong AW. Elevated serum erythropoietin in a patient with polycythaemia vera presenting with Budd-Chiari syndrome. BMJ Case Rep 2014; 2014:bcr-2014-205663. [PMID: 25452296 DOI: 10.1136/bcr-2014-205663] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Polycythaemia vera (PV) is a clonal disorder of bone marrow stem cells characterised by erythrocytosis. Diagnosis of PV requires exclusion of secondary causes of polycythaemia. It has been held that an elevated erythropoietin (Epo) level strongly indicates secondary erythrocytosis and excludes PV diagnosis, to the extent that the reduced serum Epo level is currently listed as a minor criterion in the WHO classification scheme for PV. However, patients with PV who co-present with Budd-Chiari syndrome have been documented with elevated serum Epo levels. For these patients, identification of the Janus kinase 2 (JAK2) V617F point mutation along with the transient nature of the Epo elevation provides certainty of PV diagnosis, as illustrated by the proband. In this case report, the patient's positive response to cytoreductive therapy (hydroxyurea 500 mg daily) and phlebotomy (750 mL over three phlebotomies) further supports validity of PV diagnosis with elevated Epo. The patient remains on rivaroxaban (Xarelto) for treatment of her portal vein thrombosis.
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Affiliation(s)
- Catherine Jones
- Department of Hematology/Oncology, Baylor Charles A Sammons Cancer Center, Dallas, Texas, USA
| | - Yair Levy
- Department of Hematology/Oncology, Baylor Charles A Sammons Cancer Center, Dallas, Texas, USA
| | - Alex W Tong
- Department of Clinical Oncology Research, Baylor Charles A Sammons Cancer Center, Dallas, Texas, USA
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Rupa-Matysek J, Lewandowski K, Lewandowska M, Wojtasińska E, Wojtaszewska ML, Walczak M, Bykowska K, Komarnicki M. Bleeding complications after arthroscopy in a JAK2V617F-positive patient with essential thrombocythemia and acquired von Willebrand syndrome (AVWS). Int J Hematol 2014; 101:405-10. [PMID: 25432436 DOI: 10.1007/s12185-014-1707-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 11/17/2014] [Accepted: 11/19/2014] [Indexed: 11/28/2022]
Abstract
Acquired von Willebrand syndrome (AVWS) is an acquired bleeding disorder with clinical and laboratory features similar to those of the inherited form of the disease. AVWS is reported in many disorders, most frequently in myeloproliferative neoplasms and in, among others, essential thrombocythemia (ET). Interestingly, ET is associated with both the thrombotic and haemorrhagic complications, which occur in 20 % and 5-30 % of patients, respectively. The present report concerns a 38-year-old man, suffering from ET, who presented with two episodes of post-arthroscopic joint bleeding after synovectomy required for the treatment of synovial hypertrophy and chronic left knee joint synovitis. We discuss the current diagnostic approaches, as well as the risk factors predisposing to bleeding and its management, in patients with essential thrombocythemia.
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Affiliation(s)
- Joanna Rupa-Matysek
- Department of Haematology, Poznan University of Medical Sciences, Szamarzewskiego 84, 60-569, Poznan, Poland,
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Borowczyk M, Wojtaszewska M, Lewandowski K, Gil L, Lewandowska M, Lehmann-Kopydłowska A, Kroll-Balcerzak R, Balcerzak A, Iwoła M, Michalak M, Komarnicki M. The JAK2 V617F mutational status and allele burden may be related with the risk of venous thromboembolic events in patients with Philadelphia-negative myeloproliferative neoplasms. Thromb Res 2014; 135:272-80. [PMID: 25559461 DOI: 10.1016/j.thromres.2014.11.006] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 11/03/2014] [Accepted: 11/10/2014] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Patients with Philadelphia-negative myeloproliferative neoplasms (Ph(-) MPNs) are at increased risk of thromboembolic and hemorrhagic complications. The aim of the study was to determine the relationship between JAK2 V617F mutational status, JAK2 V617F allele burden and the risk of vascular complications occurrence. MATERIALS AND METHODS Analysis was performed in a cohort of 186 patients diagnosed with polycythemia vera (53), essential thrombocythemia (114), primary myelofibrosis (11), and unclassified MPN (8). The risk of vascular complications development was analyzed in 126 JAK2 V617F-positive patients with respect to allele burden assessed with allele-specific 'real-time' quantitative polymerase chain reaction (AS RQ-PCR). RESULTS Overall prevalence of any vascular complications was 44.6%. Arterial thrombosis occurred in 20.4%, venous thromboembolism (VTE) in 11.3%, bleeding episodes in 24.7% of patients. Individuals harboring JAK2 V617F mutation, regardless of MPN type, were at higher risk of VTE (OR=5.15, 95%CI: 1.16-22.90, P=0.024), mainly deep vein thrombosis (DVT). JAK2 allele burden higher than 20% identified patients with 7.4-fold increased risk of VTE (95%CI: 1.6-33.7, P=0.004), but not of arterial thrombosis, neither of bleeding complications, and remained the only significant VTE risk factor in multivariate logistic regression. High allele burdens (over 50%) were strikingly associated with proximal DVT cases, but not with distal DVT. CONCLUSIONS The group of MPN patients with JAK2 V617F allele burden higher than 20% may benefit the most from vigilant monitoring and appropriate prophylaxis against vascular events. Inclusion of JAK2 V617F mutant allele burden in new risk stratifications seems to be justified and requires controlled prospective trials.
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Affiliation(s)
- Martyna Borowczyk
- Department of Hematology and Bone Marrow Transplantation, Poznań University of Medical Sciences, Poznań, Poland.
| | - Marzena Wojtaszewska
- Department of Hematology and Bone Marrow Transplantation, Poznań University of Medical Sciences, Poznań, Poland
| | - Krzysztof Lewandowski
- Department of Hematology and Bone Marrow Transplantation, Poznań University of Medical Sciences, Poznań, Poland
| | - Lidia Gil
- Department of Hematology and Bone Marrow Transplantation, Poznań University of Medical Sciences, Poznań, Poland
| | - Maria Lewandowska
- Department of Hematology and Bone Marrow Transplantation, Poznań University of Medical Sciences, Poznań, Poland
| | - Agata Lehmann-Kopydłowska
- Department of Hematology and Bone Marrow Transplantation, Poznań University of Medical Sciences, Poznań, Poland
| | - Renata Kroll-Balcerzak
- Department of Hematology and Bone Marrow Transplantation, Poznań University of Medical Sciences, Poznań, Poland
| | - Andrzej Balcerzak
- Department of Hematology and Bone Marrow Transplantation, Poznań University of Medical Sciences, Poznań, Poland
| | - Małgorzata Iwoła
- Department of Hematology and Bone Marrow Transplantation, Poznań University of Medical Sciences, Poznań, Poland
| | - Michał Michalak
- Department of Computer Science and Statistics, Poznań University of Medical Sciences, Poznań, Poland
| | - Mieczysław Komarnicki
- Department of Hematology and Bone Marrow Transplantation, Poznań University of Medical Sciences, Poznań, Poland
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70
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Martinelli I, De Stefano V, Carobbio A, Randi ML, Santarossa C, Rambaldi A, Finazzi MC, Cervantes F, Arellano-Rodrigo E, Rupoli S, Canafoglia L, Tieghi A, Facchini L, Betti S, Vannucchi AM, Pieri L, Cacciola R, Cacciola E, Cortelezzi A, Iurlo A, Pogliani EM, Elli EM, Spadea A, Barbui T. Cerebral vein thrombosis in patients with Philadelphia-negative myeloproliferative neoplasms. An European Leukemia Net study. Am J Hematol 2014; 89:E200-5. [PMID: 25042466 DOI: 10.1002/ajh.23809] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 07/16/2014] [Indexed: 01/23/2023]
Abstract
To investigate the characteristics and clinical course of cerebral vein thrombosis (CVT) in patients with myeloproliferative neoplasms (MPN) we compared 48 patients with MPN and CVT (group MPN-CVT) to 87 with MPN and other venous thrombosis (group MPN-VT) and 178 with MPN and no thrombosis (group MPN-NoT) matched by sex, age at diagnosis of MPN (±5 years) and type of MPN. The study population was identified among 5,500 patients with MPN, from January 1982 to June 2013. Thrombophilia abnormalities were significantly more prevalent in the MPN-CVT and MPN-VT than in MPN-NoT group (P = 0.015), as well as the JAK2 V617F mutation in patients with essential thrombocythemia (P = 0.059). Compared to MPN-VT, MPN-CVT patients had a higher rate of recurrent thrombosis (42% vs. 25%, P = 0.049) despite a shorter median follow-up period (6.1 vs. 10.3 years, P = 0.019), a higher long-term antithrombotic (94% vs. 84%, P = 0.099) and a similar cytoreductive treatment (79% vs. 70%, P = 0.311). The incidence of recurrent thrombosis was double in MPN-CVT than in MPN-VT group (8.8% and 4.2% patient-years, P = 0.022), and CVT and unprovoked event were the only predictive variables in a multivariate model including also sex, blood count, thrombophilia, cytoreductive, and antithrombotic treatment (HR 1.97, 95%CI 1.05-3.72 and 2.09, 1.09-4.00, respectively).
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Affiliation(s)
- Ida Martinelli
- Angelo Bianchi Bonomi Hemophilia and Thrombosis; Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, University of Milan; Italy
| | | | | | | | | | | | | | | | | | | | | | - Alessia Tieghi
- Hematology Oncology Department; AO Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia; Italy
| | - Luca Facchini
- Hematology Oncology Department; AO Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia; Italy
| | - Silvia Betti
- Institute of Hematology; Catholic University; Rome Italy
| | | | - Lisa Pieri
- Department of Experimental and Clinical Medicine; University of Florence; Italy
| | - Rossella Cacciola
- Haemostasis Unit, Department of Clinical and Molecular Biology; AOU Policlinico Vittorio Emanuele; Catania Italy
| | - Emma Cacciola
- Haemostasis Unit, Department of Clinical and Molecular Biology; AOU Policlinico Vittorio Emanuele; Catania Italy
| | - Agostino Cortelezzi
- Hematology and Transplantation Unit; Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, University of Milan; Italy
| | - Alessandra Iurlo
- Hematology and Transplantation Unit; Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, University of Milan; Italy
| | - Enrico M. Pogliani
- Hematology Division and BMT Unit; San Gerardo Hospital, Milan Bicocca University; Monza Italy
| | - Elena M. Elli
- Hematology Division and BMT Unit; San Gerardo Hospital, Milan Bicocca University; Monza Italy
| | - Antonio Spadea
- Unit of Hematology; Regina Elena National Cancer Institute; Rome Italy
| | - Tiziano Barbui
- Research Foundation; AO Papa Giovanni XXIII; Bergamo Italy
- Hematology Division; AO Papa Giovanni XXIII; Bergamo Italy
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Youk HJ, Cho CH, Lee JH, Choi CW, Lim CS, Yoon SY. A rare case of polycythemia vera following acute undifferentiated leukemia remission. Ann Lab Med 2014; 34:469-70. [PMID: 25368824 PMCID: PMC4215407 DOI: 10.3343/alm.2014.34.6.469] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 04/30/2014] [Accepted: 08/27/2014] [Indexed: 11/23/2022] Open
Affiliation(s)
- Hee-Jeong Youk
- Department of Laboratory Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Chi-Hyun Cho
- Department of Laboratory Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Jong-Han Lee
- Department of Laboratory Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Chul Won Choi
- Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Chae Seung Lim
- Department of Laboratory Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Soo-Young Yoon
- Department of Laboratory Medicine, Korea University Guro Hospital, Seoul, Korea
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72
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Ye B, Li C, Yang Z, Wang Y, Hao J, Wang L, Li Y, Du Y, Hao L, Liu B, Wang S, Xia P, Huang G, Sun L, Tian Y, Fan Z. Cytosolic carboxypeptidase CCP6 is required for megakaryopoiesis by modulating Mad2 polyglutamylation. ACTA ACUST UNITED AC 2014; 211:2439-54. [PMID: 25332286 PMCID: PMC4235637 DOI: 10.1084/jem.20141123] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Ye et al. identify cytosolic carboxypeptidase CCP6 as a protein required for the regulation of bone marrow megakaryopoiesis in mice. The authors find that Mad2 (a core component of spindle checkpoint in mitosis) is a substrate of CCP6 in megakaryocytes and is polyglutamylated by proteins TTLL6 and TTLL4, subsequently affecting the activity of Aurora B kinase. Mad2 is thus additionally implicated in megakaryopoiesis regulation. Bone marrow progenitor cells develop into mature megakaryocytes (MKs) to produce platelets for hemostasis and other physiological functions. However, the molecular mechanisms underlying megakaryopoiesis are not completely defined. We show that cytosolic carboxypeptidase (CCP) 6 deficiency in mice causes enlarged spleens and increased platelet counts with underdeveloped MKs and dysfunctional platelets. The prominent phenotypes of CCP6 deficiency are different from those of CCP1-deficient mice. We found that CCP6 and tubulin tyrosine ligase-like family (TTLL) members TTLL4 and TTLL6 are highly expressed in MKs. We identify Mad2 (mitotic arrest deficient 2) as a novel substrate for CCP6 and not CCP1. Mad2 can be polyglutamylated by TTLL4 and TTLL6 to modulate the maturation of MKs. CCP6 deficiency causes hyperglutamylation of Mad2 to promote activation of Aurora B, leading to suppression of MK maturation. We reveal that Mad2 polyglutamylation plays a critical role in the regulation of megakaryopoiesis.
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Affiliation(s)
- Buqing Ye
- Key Laboratory of Infection and Immunity of CAS, Center for Laboratory Animal Research, Center for Biological Imaging, Key Laboratory of RNA Biology and Beijing Noncoding RNA Laboratory, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China
| | - Chong Li
- Key Laboratory of Infection and Immunity of CAS, Center for Laboratory Animal Research, Center for Biological Imaging, Key Laboratory of RNA Biology and Beijing Noncoding RNA Laboratory, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China
| | - Zhao Yang
- Key Laboratory of Infection and Immunity of CAS, Center for Laboratory Animal Research, Center for Biological Imaging, Key Laboratory of RNA Biology and Beijing Noncoding RNA Laboratory, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China University of Chinese Academy of Sciences, Beijing 100049, China
| | - Yanying Wang
- Key Laboratory of Infection and Immunity of CAS, Center for Laboratory Animal Research, Center for Biological Imaging, Key Laboratory of RNA Biology and Beijing Noncoding RNA Laboratory, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China
| | - Junfeng Hao
- Key Laboratory of Infection and Immunity of CAS, Center for Laboratory Animal Research, Center for Biological Imaging, Key Laboratory of RNA Biology and Beijing Noncoding RNA Laboratory, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China
| | - Li Wang
- Key Laboratory of Infection and Immunity of CAS, Center for Laboratory Animal Research, Center for Biological Imaging, Key Laboratory of RNA Biology and Beijing Noncoding RNA Laboratory, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China
| | - Yi Li
- Department of Anesthesiology, Peking University Third Hospital, Beijing 100191, China
| | - Ying Du
- Key Laboratory of Infection and Immunity of CAS, Center for Laboratory Animal Research, Center for Biological Imaging, Key Laboratory of RNA Biology and Beijing Noncoding RNA Laboratory, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China
| | - Lu Hao
- Key Laboratory of Infection and Immunity of CAS, Center for Laboratory Animal Research, Center for Biological Imaging, Key Laboratory of RNA Biology and Beijing Noncoding RNA Laboratory, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China
| | - Benyu Liu
- Key Laboratory of Infection and Immunity of CAS, Center for Laboratory Animal Research, Center for Biological Imaging, Key Laboratory of RNA Biology and Beijing Noncoding RNA Laboratory, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China
| | - Shuo Wang
- Key Laboratory of Infection and Immunity of CAS, Center for Laboratory Animal Research, Center for Biological Imaging, Key Laboratory of RNA Biology and Beijing Noncoding RNA Laboratory, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China
| | - Pengyan Xia
- Key Laboratory of Infection and Immunity of CAS, Center for Laboratory Animal Research, Center for Biological Imaging, Key Laboratory of RNA Biology and Beijing Noncoding RNA Laboratory, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China
| | - Guanling Huang
- Key Laboratory of Infection and Immunity of CAS, Center for Laboratory Animal Research, Center for Biological Imaging, Key Laboratory of RNA Biology and Beijing Noncoding RNA Laboratory, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China
| | - Lei Sun
- Key Laboratory of Infection and Immunity of CAS, Center for Laboratory Animal Research, Center for Biological Imaging, Key Laboratory of RNA Biology and Beijing Noncoding RNA Laboratory, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China
| | - Yong Tian
- Key Laboratory of Infection and Immunity of CAS, Center for Laboratory Animal Research, Center for Biological Imaging, Key Laboratory of RNA Biology and Beijing Noncoding RNA Laboratory, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China
| | - Zusen Fan
- Key Laboratory of Infection and Immunity of CAS, Center for Laboratory Animal Research, Center for Biological Imaging, Key Laboratory of RNA Biology and Beijing Noncoding RNA Laboratory, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China
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Abstract
Polycythemia vera (PV) is a chronic myeloproliferative neoplasm associated with JAK2 mutations (V617F or exon 12) in almost all cases. The World Health Organization has defined the criteria for diagnosis, but it is still unclear which parameter (hemoglobin or hematocrit) is the most reliable for demonstrating increased red cell volume and for monitoring response to therapy; also, the role of bone marrow biopsy is being revisited. PV is associated with reduced survival because of cardiovascular complications and progression to post-PV myelofibrosis or leukemia. Criteria for risk-adapted treatment rely on the likelihood of thrombosis. Controlled trials have demonstrated that incidence of cardiovascular events is reduced by sustained control of hematocrit with phlebotomies (low-risk patients) and/or cytotoxic agents (high-risk patients) and antiplatelet therapy with aspirin. Hydroxyurea and interferon may be used as first-line treatments, whereas busulfan is reserved for patients that are refractory or resistant to first-line agents. However, there is no evidence that therapy improves survival, and the significance of reduction of JAK2 mutated allele burden produced by interferon is unknown. PV is also associated with a plethora of symptoms that are poorly controlled by conventional therapy. This article summarizes my approach to the management of PV in daily clinical practice.
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74
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Polycythemia vera disease burden: contributing factors, impact on quality of life, and emerging treatment options. Ann Hematol 2014; 93:1965-76. [DOI: 10.1007/s00277-014-2205-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 08/27/2014] [Indexed: 12/21/2022]
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75
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Abstract
Essential thrombocythemia is a clonal myeloproliferative neoplasm characterized by an elevated platelet count, the potential for both microvascular and macrovascular sequelae, and a risk for transformation to myelofibrosis or acute myeloid leukemia. A systematic and detailed initial analysis is essential for accurate diagnosis of essential thrombocythemia, as many etiologies are reactive and benign. Once a diagnosis has been made, risk stratification and symptom assessment are vital to guide the subsequent therapy. Treatment may be required in high-risk disease, such as in cases of advanced age or prior thrombotic events. Systemic therapy is aimed at reducing the thrombotic risk and includes daily low dose aspirin and in some patients, cytoreductive therapy. Currently, the first line cytoreductive therapy includes hydroxyurea or pegylated interferon, with a phase III clinical trial underway comparing these two important agents. Anagrelide and clinical trials are reserved for refractory or intolerant patients. Looking to the future, new therapies including Janus kinase 2 (JAK2) and telomerase inhibitors are promising and may become valuable to the treatment armamentarium for those afflicted with essential thrombocythemia.
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Affiliation(s)
- Krisstina Gowin
- Department of Hematology and Medical Oncology, Mayo Clinic Arizona, Scottsdale, AZ, 85259, USA
| | - Ruben Mesa
- Division of Hematology and Medical Oncology, Mayo Clinic Cancer Center, Scottsdale, AZ, 85259, USA
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76
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Lekovic D, Gotic M, Milic N, Miljic P, Mitrovic M, Cokic V, Elezovic I. The importance of cardiovascular risk factors for thrombosis prediction in patients with essential thrombocythemia. Med Oncol 2014; 31:231. [PMID: 25223529 DOI: 10.1007/s12032-014-0231-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 09/03/2014] [Indexed: 02/02/2023]
Abstract
The current widely accepted stratification defined by age and previous thrombosis in patients with essential thrombocythemia (ET) probably deserves deeper analysis. The aim of our study was to identify additional factors at the time of diagnosis, which have an impact on the thrombosis prediction. We conducted a study of 244 consecutive ET patients with median follow-up of 83 months. We analyzed the influence of age, gender, laboratory parameters, history of previous thrombosis, spleen size, JAK2 mutation as well as cardiovascular (CV) risk factors including arterial hypertension, diabetes, active tobacco use and hyperlipidemia in the terms of thrombosis. The most important predictors of thrombosis in multivariate Cox regression model were the presence of CV risk factors (p=0.004) and previous thrombosis (p=0.038). Accordingly, we assigned risk scores based on multivariable analysis-derived hazard ratios (HR) to the presence of 1 CV risk factor (HR=3.5; 1 point), >1 CV risk factors (HR=8.3; 2 points) and previous thrombosis (HR=2.0; 1 point). A final three-tiered prognostic model for thrombosis prediction was developed as low (score 0), intermediate (score 1 or 2) and high risk (score 3) (p<0.001). The hazard of thrombosis was 3.8% in low-risk group, 16.7% in the intermediate-risk group and 60% in the high-risk group (p<0.001). Patients with thrombotic complications during the follow-up had a significantly shorter survival (p=0.018). The new score based on CV risk factors and previous thrombotic events allows a better patient selection within prognostic-risk groups and improved identification of the high-risk patients for thrombosis.
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Affiliation(s)
- Danijela Lekovic
- Clinic for Hematology, Clinical Center of Serbia, Koste Todorovica 2, 11 000, Belgrade, Serbia,
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77
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Panch SR, Yau YY, West K, Diggs K, Sweigart T, Leitman SF. Initial serum ferritin predicts number of therapeutic phlebotomies to iron depletion in secondary iron overload. Transfusion 2014; 55:611-22. [PMID: 25209879 DOI: 10.1111/trf.12854] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 07/26/2014] [Accepted: 07/28/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Therapeutic phlebotomy is increasingly used in patients with transfusional siderosis to mitigate organ injury associated with iron overload (IO). Laboratory response variables and therapy duration are not well characterized in such patients. STUDY DESIGN AND METHODS We retrospectively evaluated 99 consecutive patients undergoing therapeutic phlebotomy for either transfusional IO (TIO, n = 88; 76% had undergone hematopoietic transplantation) or nontransfusional indications (hyperferritinemia or erythrocytosis; n = 11). Complete blood cell count, serum ferritin (SF), transferrin saturation, and transaminases were measured serially. Phlebotomy goal was an SF level of less than 300 μg/L. RESULTS Mean SF levels before phlebotomy among TIO and nontransfusional subjects were 3093 and 396 μg/L, respectively. Transfusion burden in the TIO group was 94 ± 108 (mean ± SD) RBC units; approximately half completed therapy with 24 ± 23 phlebotomies (range, 1-103). One-third were lost to follow-up. Overall, 15% had mild adverse effects, including headache, nausea, and dizziness, mainly during first phlebotomy. Prior transfusion burden correlated poorly with initial ferritin and total number of phlebotomies to target in the TIO group. However, number of phlebotomies to target was strongly correlated with initial SF (R(2) = 0.8; p < 0.0001) in both TIO and nontransfusional groups. ALT decreased significantly with serial phlebotomy in all groups (mean initial and final values, 61 and 39 U/L; p = 0.03). CONCLUSIONS Initial SF but not transfusion burden predicted number of phlebotomies to target in patients with TIO. Despite good treatment tolerance, significant losses to follow-up were noted. Providing patients with an estimated phlebotomy number and follow-up duration, and thus a finite endpoint, may improve compliance. Hepatic function improved with iron offloading.
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Affiliation(s)
- Sandhya R Panch
- Hematology/Transfusion Medicine, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
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78
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D'Angelo G, Hotz AM, Ciambelli F, Pauli S. Simultaneous presentation of JAK2 V617F mutation-related essential thrombocythemia and B-cell chronic lymphocytic leukemia. Blood Res 2014; 49:134-7. [PMID: 25025018 PMCID: PMC4090337 DOI: 10.5045/br.2014.49.2.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 03/03/2014] [Accepted: 05/15/2014] [Indexed: 11/18/2022] Open
Affiliation(s)
- Guido D'Angelo
- Laboratorio di Chimica-Clinica, Ematologia e Microbiologia (Ematologia/Coagulazione), Azienda Ospedaliera "S. Antonio Abate" - Gallarate, Italy
| | - Anna Maria Hotz
- Anatomia Patologica, Azienda Ospedaliera "S. Antonio Abate" - Gallarate, Italy
| | - Fabrizio Ciambelli
- Oncologia - Ematologia, Azienda Ospedaliera "S. Antonio Abate" - Gallarate, Italy
| | - Sergio Pauli
- Oncologia - Ematologia, Azienda Ospedaliera "S. Antonio Abate" - Gallarate, Italy
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79
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Duclos G, Eté M, Bassez C, Gainnier M, Eon B. [Ischemic heart failure making the diagnosis of a Vaquez disease: a rare event]. ACTA ACUST UNITED AC 2014; 33:427-9. [PMID: 24953661 DOI: 10.1016/j.annfar.2014.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 05/05/2014] [Indexed: 11/17/2022]
Abstract
We present the case of a 46-year-old patient without any past medical history, admitted to our ICU for cardiogenic shock complicating acute coronary syndrome. The blood tests found polycethemia, a polycethemia vera was suspected and confirmed by genetic analysis. Ischemic heart failure as an initial symptom of polycethemia vera and its treatment by arterial bleeding is a rare event that we describe in this article.
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Affiliation(s)
- G Duclos
- Département d'anesthésie réanimation, hôpital Nord, rue Borely, 13015 Marseille, France.
| | - M Eté
- Service de réanimation médicale, hôpital de la Timone, 13005 Marseille, France
| | - C Bassez
- Soins intensifs cardiologiques, hôpital de la Timone, 13005 Marseille, France
| | - M Gainnier
- Service de réanimation médicale, hôpital de la Timone, 13005 Marseille, France
| | - B Eon
- Service de réanimation médicale, hôpital de la Timone, 13005 Marseille, France
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80
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Geyer H, Mesa RA. Assessing disease burden in patients with classic MPNs. Best Pract Res Clin Haematol 2014; 27:107-19. [DOI: 10.1016/j.beha.2014.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 07/11/2014] [Indexed: 01/26/2023]
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81
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Abstract
Although the revised World Health Organization (WHO) criteria for the diagnosis and classification of myeloproliferative neoplasms (MPN) were defined by a panel of expert hematopathologists and clinicians, controversy has been repeatedly expressed questioning the clinical usefulness and reproducibility of these diagnostic guidelines. In particular, the distinction between essential thrombocythemia (ET), early/prefibrotic primary myelofibrosis (PMF) and initial stages of polycythemia vera (PV) is still a matter of debate. In this context, it has been argued that clinical correlations with histological features were not firmly substantiated. On the other hand, recently published data from independently performed studies have repeatedly validated the reproducibility of the WHO criteria and provided persuasive evidence that discrimination of early/prefibrotic PMF has a significant impact on the risk of myelofibrotic and leukemic transformation. However, as has been explicitly required, the WHO concept is based on the recognition of characteristic bone marrow patterns and a consensus of clinical and molecular data.
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82
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Breda L, Rivella S. Modulators of erythropoiesis: emerging therapies for hemoglobinopathies and disorders of red cell production. Hematol Oncol Clin North Am 2014; 28:375-86. [PMID: 24589272 PMCID: PMC3970239 DOI: 10.1016/j.hoc.2013.12.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Use of new compound such as inhibitors of JAK2 or transforming growth factor β-like molecules might soon revolutionize the treatment of β-thalassemia and related disorders. However, this situation requires careful optimization, noting the potential for off-target immune suppression for JAK2 inhibitors and the lack of mechanistic insights for the use of the ligand trap soluble molecules that sequester ligands of activin receptor IIA and B.
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Affiliation(s)
- Laura Breda
- Department of Pediatrics, Hematology-Oncology, Weill Cornell Medical College, 1300 York Avenue, New York, NY 10021, USA.
| | - Stefano Rivella
- Department of Pediatrics, Hematology-Oncology, Weill Cornell Medical College, 1300 York Avenue, New York, NY 10021, USA; Department of Cell and Developmental Biology, Weill Cornell Medical College, 1300 York Avenue, New York, NY 10021, USA
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83
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Pecci A, Croci G, Balduini CL, Boveri E. Cutaneous involvement by post-polycythemia vera myelofibrosis. Am J Hematol 2014; 89:448. [PMID: 23877876 DOI: 10.1002/ajh.23539] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 07/01/2013] [Accepted: 07/02/2013] [Indexed: 11/07/2022]
Affiliation(s)
- Alessandro Pecci
- Department of Internal Medicine; IRCCS Policlinico San Matteo Foundation and University of Pavia; Italy
| | - Giorgio Croci
- Department of Molecular Medicine, Institute of Anatomic Pathology; University of Pavia; Italy
| | - Carlo L. Balduini
- Department of Internal Medicine; IRCCS Policlinico San Matteo Foundation and University of Pavia; Italy
| | - Emanuela Boveri
- Anatomic Pathology Service, IRCCS Policlinico San Matteo Foundation; Pavia Italy
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84
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Gianelli U, Iurlo A, Cattaneo D, Lambertenghi-Deliliers G. Cooperation between pathologists and clinicians allows a better diagnosis of Philadelphia chromosome-negative myeloproliferative neoplasms. Expert Rev Hematol 2014; 7:255-64. [PMID: 24524231 DOI: 10.1586/17474086.2014.876898] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
As no specific genetic lesions have yet been identified, the diagnosis of Philadelphia chromosome-negative myeloproliferative neoplasms is based on a simultaneous evaluation of the clinical, morphological and molecular features defined by the updated WHO classification, which allow most cases of full-blown disease to be classified. Nevertheless, about 10-15% of the patients have unclassifiable myeloproliferative neoplasms, most of whom are in the prodromal (early) phase of disease and identified by the presence of the JAK2 mutation, but lack the complete phenotype required by the WHO classification. The detection of these prodromal phases is extremely important in order to prevent dramatic thrombo-hemorrhagic complications and improve prognosis.
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Affiliation(s)
- Umberto Gianelli
- Department of Pathophysiology and Transplantation, Division of Pathology, Hematopathology Service, University of Milan Medical School, IRCCS Ca' Granda - Maggiore Policlinico Hospital Foundation, Via Francesco Sforza 35, 20122 Milano, Italy
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85
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Randi ML, Santarossa C, Peroni E, Cosi E, Duner E, Bertozzi I, Fabris F. Effect of busulfan on JAK2V617F allele burden. Haematologica 2014; 99:e44. [PMID: 24389308 DOI: 10.3324/haematol.2013.103051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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86
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Stroke in essential thrombocythemia. J Neurol Sci 2014; 336:260-2. [DOI: 10.1016/j.jns.2013.10.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 09/04/2013] [Accepted: 10/08/2013] [Indexed: 12/24/2022]
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87
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Buisson G, Kassis M, Belot MW, Huberman MM, Merville R, Pompians L, Miniac, Roux R, Solas J. [Preprosthetic surgery]. Future Oncol 1970; 11:719-33. [PMID: 4920055 DOI: 10.2217/fon.14.272] [Citation(s) in RCA: 44] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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