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Langabeer SE. An increase in diagnostic JAK2 V617F mutation testing: Is masked polycythaemia vera the explanantion? Eur J Intern Med 2018; 52:e37-e38. [PMID: 29622375 DOI: 10.1016/j.ejim.2018.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 03/28/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Stephen E Langabeer
- FRCPath, Cancer Molecular Diagnostics, St. James's Hospital, Dublin 8 D08 E9P6, Ireland.
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52
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Jakovic L, Gotic M, Gisslinger H, Soldatovic I, Sefer D, Tirnanic M, Lekovic D, Jovanovic MP, Schalling M, Gisslinger B, Beham-Schmid C, Simonitsch-Klupp I, Thiele J. The WHO diagnostic criteria for polycythemia vera—role of red cell mass versus hemoglobin/hematocrit level and morphology. Ann Hematol 2018; 97:1581-1590. [DOI: 10.1007/s00277-018-3344-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 04/22/2018] [Indexed: 11/24/2022]
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53
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Post-ET and Post-PV Myelofibrosis: Updates on a Distinct Prognosis from Primary Myelofibrosis. Curr Hematol Malig Rep 2018; 13:173-182. [DOI: 10.1007/s11899-018-0453-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Barbui T, Thiele J, Gisslinger H, Kvasnicka HM, Vannucchi AM, Guglielmelli P, Orazi A, Tefferi A. The 2016 WHO classification and diagnostic criteria for myeloproliferative neoplasms: document summary and in-depth discussion. Blood Cancer J 2018. [PMID: 29426921 DOI: 10.1038/s41408-018-0054-y.pmid:29426921;pmcid:pmc5807384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Abstract
The new edition of the 2016 World Health Organization (WHO) classification system for tumors of the hematopoietic and lymphoid tissues was published in September 2017. Under the category of myeloproliferative neoplasms (MPNs), the revised document includes seven subcategories: chronic myeloid leukemia, chronic neutrophilic leukemia, polycythemia vera (PV), primary myelofibrosis (PMF), essential thrombocythemia (ET), chronic eosinophilic leukemia-not otherwise specified and MPN, unclassifiable (MPN-U); of note, mastocytosis is no longer classified under the MPN category. In the current review, we focus on the diagnostic criteria for JAK2/CALR/MPL mutation-related MPNs: PV, ET, and PMF. In this regard, the 2016 changes were aimed at facilitating the distinction between masked PV and JAK2-mutated ET and between prefibrotic/early and overtly fibrotic PMF. In the current communication, we (i) provide practically useful resource tables and graphs on the new diagnostic criteria including outcome, (ii) elaborate on the rationale for the 2016 changes, (iii) discuss the complementary role of mutation screening, (iv) address ongoing controversies and propose solutions, (v) attend to the challenges of applying WHO criteria in routine clinical practice, and (vi) outline future directions from the perspectives of the clinical pathologist.
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Affiliation(s)
- Tiziano Barbui
- FROM Research Foundation, Papa Giovanni XXIII Hospital, Bergamo, Italy.
| | - Jürgen Thiele
- Institute of Pathology, University of Cologne, Cologne, Germany
| | | | | | | | - Paola Guglielmelli
- CRIMM-Centro Ricerca e Innovazione delle Malattie Mieloproliferative, Azienda Ospedaliera-Universitaria Careggi, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Attilio Orazi
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA
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Barbui T, Thiele J, Gisslinger H, Kvasnicka HM, Vannucchi AM, Guglielmelli P, Orazi A, Tefferi A. The 2016 WHO classification and diagnostic criteria for myeloproliferative neoplasms: document summary and in-depth discussion. Blood Cancer J 2018; 8:15. [PMID: 29426921 PMCID: PMC5807384 DOI: 10.1038/s41408-018-0054-y] [Citation(s) in RCA: 366] [Impact Index Per Article: 61.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 11/24/2017] [Accepted: 12/05/2017] [Indexed: 12/17/2022] Open
Abstract
The new edition of the 2016 World Health Organization (WHO) classification system for tumors of the hematopoietic and lymphoid tissues was published in September 2017. Under the category of myeloproliferative neoplasms (MPNs), the revised document includes seven subcategories: chronic myeloid leukemia, chronic neutrophilic leukemia, polycythemia vera (PV), primary myelofibrosis (PMF), essential thrombocythemia (ET), chronic eosinophilic leukemia-not otherwise specified and MPN, unclassifiable (MPN-U); of note, mastocytosis is no longer classified under the MPN category. In the current review, we focus on the diagnostic criteria for JAK2/CALR/MPL mutation-related MPNs: PV, ET, and PMF. In this regard, the 2016 changes were aimed at facilitating the distinction between masked PV and JAK2-mutated ET and between prefibrotic/early and overtly fibrotic PMF. In the current communication, we (i) provide practically useful resource tables and graphs on the new diagnostic criteria including outcome, (ii) elaborate on the rationale for the 2016 changes, (iii) discuss the complementary role of mutation screening, (iv) address ongoing controversies and propose solutions, (v) attend to the challenges of applying WHO criteria in routine clinical practice, and (vi) outline future directions from the perspectives of the clinical pathologist.
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Affiliation(s)
- Tiziano Barbui
- FROM Research Foundation, Papa Giovanni XXIII Hospital, Bergamo, Italy.
| | - Jürgen Thiele
- Institute of Pathology, University of Cologne, Cologne, Germany
| | | | | | | | - Paola Guglielmelli
- CRIMM-Centro Ricerca e Innovazione delle Malattie Mieloproliferative, Azienda Ospedaliera-Universitaria Careggi, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Attilio Orazi
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA
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Bose P, Gotlib J, Harrison CN, Verstovsek S. SOHO State-of-the-Art Update and Next Questions: MPN. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2018; 18:1-12. [PMID: 29277359 PMCID: PMC5915302 DOI: 10.1016/j.clml.2017.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 11/27/2017] [Indexed: 12/28/2022]
Abstract
The discovery of the activating Janus kinase (JAK)2V617F mutation in 2005 in most patients with the classic Philadelphia chromosome-negative myeloproliferative neoplasms (MPN) spurred intense interest in research into these disorders, culminating in the identification of activating mutations in MPL in 2006 and indels in the gene encoding calreticulin (CALR) in 2013, thus providing additional mechanistic explanations for the universal activation of JAK-signal transducer and activator of transcription (JAK-STAT) observed in these conditions, and the success of the JAK1/2 inhibitor ruxolitinib, which first received regulatory approval in 2011. The field has continued to advance rapidly since then, and the past 2 years have witnessed important changes to the classification of MPN and diagnostic criteria for polycythemia vera (PV), novel insights into the mechanisms of bone marrow fibrosis in primary myelofibrosis (PMF), increasing appreciation of the biologic differences between essential thrombocythemia (ET), prefibrotic and overt PMF, and between primary and post-PV/ET myelofibrosis (MF). Additionally, the mechanisms through which mutant CALR drives JAK-STAT pathway activation and oncogenic transformation are now better understood. Although mastocytosis is no longer included under the broad heading of MPN in the 2016 revision to the World Health Organization classification, an important milestone in mastocytosis research was reached in 2017 with the regulatory approval of midostaurin for patients with advanced systemic mastocytosis (AdvSM). In this article, we review the major recent developments in the areas of PV, ET, and MF, and also briefly summarize the literature on midostaurin and other KIT inhibitors for patients with AdvSM.
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Affiliation(s)
- Prithviraj Bose
- Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston, TX.
| | - Jason Gotlib
- Department of Medicine - Hematology, Stanford University, Palo Alto, CA
| | | | - Srdan Verstovsek
- Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston, TX
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Changes in the World Health Organization 2016 classification of myeloid neoplasms everyone should know. Curr Opin Hematol 2017; 25:120-128. [PMID: 29256927 DOI: 10.1097/moh.0000000000000404] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This review highlights the main changes in the revised 2016 WHO classification of myeloid neoplasms (published in 2017) that impact diagnosis and ultimately impact management of patients with these diseases. RECENT FINDINGS The revision was based on data accumulated since the 2008 WHO classification, much of which relate to new molecular genetic information about these neoplasms. This massive recent influx of data concerning the significance of pathogenic mutations has affected all myeloid neoplasm categories. The new information has been incorporated as part of the diagnostic criteria of many diseases and has led to the creation of new provisional entities defined by genetic features. Germline mutations that predispose to myeloid neoplasms are also emerging as important findings that impact disease classification. SUMMARY The growing body of genetic data have not only altered the classification of myeloid neoplasms, but are also impacting patient management. Genetically-defined disease categories have characteristic prognoses and predicted clinical behavior. Some mutations are associated with responsiveness to certain therapies, including those that target relevant oncogenes. The disease categories in the new classification facilitate the application of risk-adapted therapy based on the most recently available data.
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Tefferi A, Betti S, Barraco D, Mudireddy M, Shah S, Hanson CA, Ketterling RP, Pardanani A, Gangat N, Coltro G, Guglielmelli P, Vannucchi AM. Gender and survival in essential thrombocythemia: A two-center study of 1,494 patients. Am J Hematol 2017; 92:1193-1197. [PMID: 28795425 DOI: 10.1002/ajh.24882] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 08/07/2017] [Accepted: 08/07/2017] [Indexed: 12/30/2022]
Abstract
Based on suggestive information from recent epidemiologic data and earlier retrospective studies, we revisited the effect of gender on survival in 1,494 patients with essential thrombocythemia (ET). The primary study population included 904 patients from the Mayo Clinic (median age 58 years; 65% females); risk distribution, according to the international prognostic score for ET (IPSET), was 23% high, 42% intermediate and 35% low. Multivariable analysis that included IPSET-relevant risk factors identified male sex (HR 1.6, 95% CI 1.3-2.0), age ≥60 years (HR 4.3, 95% CI 3.4-5.4) and leukocyte count ≥11 × 10(9)/L (HR 1.5, 95% CI 1.3-1.9) as independent predictors of shortened survival. These findings were confirmed by analysis of a separate cohort of 590 ET patients (65% females) from the University of Florence, Italy, with corresponding HRs (95% CI) of 1.6 (1.1-2.5), 4.6 (2.2-9.5) and 1.8 (1.1-2.8). The independent prognostic effect of gender was further corroborated by a separate multivariable analysis against IPSET risk categories; HR (95% CI) for the Mayo Clinic/Florence cohorts were 1.5/1.6 (1.2/1.1-1.8/2.5) for male sex, 6.8/7.5 (5.0/3.1-9.3/18.3) for IPSET high risk and 2.8/4.1 (2.1/1.8-3.8/9.5) for IPSET intermediate risk. Furthermore, the survival disadvantage in men was most apparent in IPSET high risk category and in patients older than 60 years. In both patient cohorts, thrombosis history garnered significance in univariate, but not in multivariable analysis. The observations from the current study suggest that women with ET live longer than their male counterparts and that gender might supersede thrombosis history as a risk variable for overall survival.
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Affiliation(s)
- Ayalew Tefferi
- Divisions of Hematology; Mayo Clinic; Rochester Minnesota
| | - Silvia Betti
- Divisions of Hematology; Mayo Clinic; Rochester Minnesota
| | | | | | - Sahrish Shah
- Divisions of Hematology; Mayo Clinic; Rochester Minnesota
| | | | - Rhett P. Ketterling
- Cytogenetics, Departments of Medicine and Laboratory Medicine; Mayo Clinic; Rochester Minnesota
| | | | - Naseema Gangat
- Divisions of Hematology; Mayo Clinic; Rochester Minnesota
| | - Giacomo Coltro
- Department of Experimental and Clinical Medicine; CRIMM, Center Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliera Universitaria Careggi, University of Florence; Florence Italy
| | - Paola Guglielmelli
- Department of Experimental and Clinical Medicine; CRIMM, Center Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliera Universitaria Careggi, University of Florence; Florence Italy
| | - Alessandro M. Vannucchi
- Department of Experimental and Clinical Medicine; CRIMM, Center Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliera Universitaria Careggi, University of Florence; Florence Italy
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Kvasnicka HM, Orazi A, Thiele J, Barosi G, Bueso-Ramos CE, Vannucchi AM, Hasserjian RP, Kiladjian JJ, Gianelli U, Silver R, Mughal TI, Barbui T. European LeukemiaNet study on the reproducibility of bone marrow features in masked polycythemia vera and differentiation from essential thrombocythemia. Am J Hematol 2017; 92:1062-1067. [PMID: 28685840 DOI: 10.1002/ajh.24837] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 06/26/2017] [Indexed: 01/24/2023]
Abstract
The purpose of the study was to assess consensus and interobserver agreement among an international panel of six hematopathologists regarding characterization and reproducibility of bone marrow (BM) histologic features used to diagnose early stage myeloproliferative neoplasms, in particular differentiation of so-called masked/prodromal polycythemia vera (mPV) from JAK2-mutated essential thrombocythemia (ET). The six members of the hematopathology panel evaluated 98 BM specimens independently and in a blinded fashion without knowledge of clinical data. The specimens included 48 cases of mPV according to the originally published hemoglobin threshold values for this entity (male: 16.0-18.4 g/dL, female: 15.0-16.4 g/dL), 31 cases with overt PV according to the updated 2016 WHO criteria, and 19 control cases. The latter group included cases of JAK2-mutated ET, primary myelofibrosis, myelodysplastic syndrome, and various reactive conditions. Inter-rater agreement between the panelists was very high (overall agreement 92.6%, kappa 0.812), particularly with respect to separating mPV from ET. Virtually all cases of mPV were correctly classified as PV according to their BM morphology. In conclusion, a central blinded review of histology slides by six hematopathologists demonstrated that highly reproducible specific histological pattern characterize PV and confirmed the notion that there are no significant differences between mPV and overt PV in relation to BM morphology.
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Affiliation(s)
| | - Attilio Orazi
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY
| | - Juergen Thiele
- Institute of Pathology, University of Cologne, Cologne, Germany
| | - Giovanni Barosi
- Center for the Study of Myelofibrosis, Biotechnology Research Area, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico S. Matteo Foundation, Pavia, Italy
| | | | - Alessandro M Vannucchi
- Dipartimento di Medicina Sperimentale e Clinica, University of Florence, Florence, Italy
| | | | | | - Umberto Gianelli
- Pathology Unit, University of Milan Medical School, Fondazione IRCCS Cà Granda, Ospedale, Italy
| | | | | | - Tiziano Barbui
- Division of Hematology and Research Foundation, Ospedale Papa Giovanni XXIII, Bergamo, Italy
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Yogarajah M, Tefferi A. Leukemic Transformation in Myeloproliferative Neoplasms: A Literature Review on Risk, Characteristics, and Outcome. Mayo Clin Proc 2017; 92:1118-1128. [PMID: 28688466 DOI: 10.1016/j.mayocp.2017.05.010] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 05/08/2017] [Accepted: 05/17/2017] [Indexed: 01/01/2023]
Abstract
Myeloproliferative neoplasms (MPNs) operationally include essential thrombocythemia, polycythemia vera, primary myelofibrosis (PMF), and prefibrotic PMF. All 4 MPN variants might progress into blast-phase disease (MPN-BP). For essential thrombocythemia, reported risk factors for leukemic transformation include advanced age, extreme thrombocytosis, anemia, leukocytosis, and sequence variants/mutations involving TP53 and EZH2 (for expansion of gene symbols, see www.genenames.org); for polycythemia vera, advanced age, leukocytosis, abnormal karyotype, mutations involving SRSF2 and IDH2, and treatment with pipobroman, chlorambucil, or P32; and for PMF, increased blast percentage, thrombocytopenia, abnormal karyotype, triple-negative driver mutational status, and sequence variants/mutations involving SRSF2, RUNX1, CEBPA, and SH2B3. The reported median survival figures for MPN-BP range from 1.5 to 2.5 months in patients treated with supportive care only, from 2.5 to 10 months in those receiving hypomethylating agents or low-dose chemotherapy, and from 3.9 to 9.4 months in those receiving induction chemotherapy. Three-year survival after allogeneic stem cell transplant was reported in 16% to 33% of patients. These observations validate the extremely poor prognosis associated with MPN-BP and the lack of effective drug therapy and highlight the need for urgent assessment of therapeutic values of investigational agents. In the meantime, affected patients might be best served with aggressive chemotherapy followed by allogeneic stem cell transplant after adequate blast clearance.
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Affiliation(s)
- Meera Yogarajah
- Division of Hematology and Oncology, Brody School of Medicine, East Carolina University, Greenville, NC
| | - Ayalew Tefferi
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN.
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Latagliata R, Polverelli N, Tieghi A, Palumbo GA, Breccia M, Sabattini E, Villari L, Riminucci M, Valli R, Catani L, Alimena G, Ottaviani E, Fama A, Martinelli G, Perricone M, Spinsanti M, Cavo M, Vianelli N, Palandri F. Comparison of JAK2 V617F -positive essential thrombocythaemia and early primary myelofibrosis: The impact of mutation burden and histology. Hematol Oncol 2017; 36:269-275. [PMID: 28509339 DOI: 10.1002/hon.2430] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 03/29/2017] [Accepted: 04/11/2017] [Indexed: 02/02/2023]
Abstract
An accurate histological diagnosis may distinguish essential thrombocythaemia (ET) from early primary myelofibrosis (early-PMF), which is associated with worse outcome. Outcome of ET is also negatively affected by the presence of the JAK2V617F mutation. To investigate the impact of JAK2V617F mutation burden and histology on outcome, we collected 475 WHO-diagnosed ET (69.2%) or early-PMF JAK2V617F -positive patients followed in 4 Italian haematology centers. JAK2V617F allele burden was ≤50% in 90% and 87% of ET and early-PMF patients, respectively (P = .34). During follow-up, 32 (9.7%) ET and 18 (12.3%) early-PMF patients experienced 59 thrombotic events, and 27 patients (5.6%) and 6 (1.2%) patients evolved to myelofibrosis and acute leukemia, respectively. At last contact, 28 (5.8%) patients had died. In early-PMF compared to ET, the 10-year mortality rates (6.7% and 4.3%, P = .73), leukemic transformation rates (1.4% and 1.2%, P = .45), and thrombosis rates (16.7% and 12.2%, P = .12) were comparable. Only progression to overt myelofibrosis at 10 years was significantly worse (11.4% and 1.5%, P = .004). In multivariate analysis, a higher (>50%) JAK2V617F burden was significantly correlated with fibrotic progression and histology. Considering JAK2V617F -positive disease, a higher (>50%) JAK2V617F burden and histological classification are independent prognostic risk factors for disease progression. These findings reinforce the need for standardized detection of this mutation.
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Affiliation(s)
- Roberto Latagliata
- Division of Hematology-Department of Cellular Biotechnologies and Hematology, University La Sapienza of Rome, Rome, Italy
| | - Nicola Polverelli
- Unit of Stem Cell Transplantation, Chair of Hematology, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Alessia Tieghi
- Division of Hematology, Azienda Ospedaliera-IRCSS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | | | - Massimo Breccia
- Division of Hematology-Department of Cellular Biotechnologies and Hematology, University La Sapienza of Rome, Rome, Italy
| | - Elena Sabattini
- Haematopathology Unit, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Loredana Villari
- Division of Hematopathology, Ospedale Ferrarotto, University of Catania, Catania, Italy
| | - Mara Riminucci
- Haematopathology Unit, Cellular Biotechnologies and Hematology, University Sapienza, Rome, Italy
| | - Riccardo Valli
- Haematopathology Unit, Azienda Ospedaliera Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Lucia Catani
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Giuliana Alimena
- Division of Hematology-Department of Cellular Biotechnologies and Hematology, University La Sapienza of Rome, Rome, Italy
| | - Emanuela Ottaviani
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Angelo Fama
- Division of Hematology, Azienda Ospedaliera-IRCSS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Giovanni Martinelli
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Margherita Perricone
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Marco Spinsanti
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Michele Cavo
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Nicola Vianelli
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Francesca Palandri
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
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Sandes AF, Gonçalves MV, Chauffaille MDL. Frequency of polycythemia in individuals with normal complete blood cell counts according to the new 2016 WHO classification of myeloid neoplasms. Int J Lab Hematol 2017; 39:528-531. [PMID: 28497563 DOI: 10.1111/ijlh.12686] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 03/21/2017] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Polycythemia vera (PV) is a disorder characterized by clonal proliferation of myeloid cells and increased red blood cell mass. Recently, the revised 2016 WHO classification of myeloid neoplasms decreased the threshold levels of hemoglobin and hematocrit for the diagnosis of PV. However, the new proposed cutoffs have remarkable overlap with the normal reference values reported and the clinical impact of these new cutoffs has not been widely assessed in the general population. METHODS We retrospectively examined 248 839 patients with presumptively normal complete blood cell results, consecutively obtained in an outpatient setting. RESULTS The proportion of men with Hb >165 g/L was 5.99%, Hct>49% was 2.4%, and Hb >165 g/dL or Hct>49% was 6.48%, while the proportion of women with Hb >160 g/L was 0.22%, Hct>48% was 0.11%, and Hb >160 g/L or Hct>48% was 0.28%. CONCLUSION The isolated use of the proposed Hb/Hct levels as a definer of polycythemia may lead to a substantial increase in unnecessary diagnostic tests. In cases with borderline levels of hemoglobin, the diagnostic workup of PV should only be indicated in the presence of clinical and/or laboratorial features associated with MPN.
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Affiliation(s)
- A F Sandes
- Division of Hematology, Fleury Group, São Paulo, Brazil
| | - M V Gonçalves
- Division of Hematology, Fleury Group, São Paulo, Brazil
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Barbui T, Thiele J, Gisslinger H, Carobbio A, Vannucchi AM, Tefferi A. Diagnostic impact of the 2016 revised who criteria for polycythemia vera. Am J Hematol 2017; 92:417-419. [PMID: 28196400 DOI: 10.1002/ajh.24684] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 02/10/2017] [Indexed: 01/22/2023]
Affiliation(s)
- Tiziano Barbui
- FROM Research Foundation, Papa Giovanni XXIII HospitalBergamo Italy
| | - Juergen Thiele
- Institute of pathology, University of CologneCologne Germany
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Grinfeld J, Godfrey AL. After 10 years of JAK2V617F: Disease biology and current management strategies in polycythaemia vera. Blood Rev 2017; 31:101-118. [DOI: 10.1016/j.blre.2016.11.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 11/08/2016] [Accepted: 11/14/2016] [Indexed: 12/12/2022]
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Abdulkarim K, Samuelsson J, Johansson P, Andréasson B. Risk factors for vascular complications and treatment patterns at diagnosis of 2389 PV and ET patients: Real-world data from the Swedish MPN Registry. Eur J Haematol 2017; 98:577-583. [DOI: 10.1111/ejh.12873] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2017] [Indexed: 12/14/2022]
Affiliation(s)
| | - Jan Samuelsson
- Department of Education and Medical Science; Karolinska Institute at Stockholm South Hospital; Stockholm Sweden
| | - Peter Johansson
- Hematology section; NU hospital group; Uddevalla Sweden
- Hematology and Coagulation section; Sahlgrenska University Hospital; Gothenburg Sweden
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Iurlo A, Gianelli U, Cattaneo D, Thiele J, Orazi A. Impact of the 2016 revised WHO criteria for myeloproliferative neoplasms, unclassifiable: Comparison with the 2008 version. Am J Hematol 2017; 92:E48-E51. [PMID: 28109016 DOI: 10.1002/ajh.24657] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 01/18/2017] [Indexed: 01/24/2023]
Affiliation(s)
- Alessandra Iurlo
- Oncohematology Division; IRCCS Ca' Granda-Maggiore Policlinico Hospital Foundation, and Department of Oncology and Onco-Hematology, University of Milan; Milan Italy
| | - Umberto Gianelli
- Division of Pathology; Department of Pathophysiology and Transplantation, University of Milan, and IRCCS Ca' Granda-Maggiore Policlinico Hospital Foundation; Milan Italy
| | - Daniele Cattaneo
- Oncohematology Division; IRCCS Ca' Granda-Maggiore Policlinico Hospital Foundation, and Department of Oncology and Onco-Hematology, University of Milan; Milan Italy
| | - Juergen Thiele
- Institute of Pathology, University of Cologne; Cologne Germany
| | - Attilio Orazi
- Department of Pathology and Laboratory Medicine; Weill Cornell Medical College/New York Presbyterian Hospital; New York New York
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Silver RT, Krichevsky S, Gjoni S, Cross NCP. Evaluation of serum erythropoietin values as defined by 2016 World Health Organization criteria for the diagnosis of polycythemia vera. Leuk Lymphoma 2017; 58:2768-2769. [DOI: 10.1080/10428194.2017.1300892] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Richard T. Silver
- Division of Hematology/Medical Oncology, Myeloproliferative Neoplasm Center, Weill Cornell Medicine, New York, NY, USA
| | - Spencer Krichevsky
- Division of Hematology/Medical Oncology, Myeloproliferative Neoplasm Center, Weill Cornell Medicine, New York, NY, USA
| | - Stefani Gjoni
- Division of Hematology/Medical Oncology, Myeloproliferative Neoplasm Center, Weill Cornell Medicine, New York, NY, USA
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Tefferi A, Barbui T. Polycythemia vera and essential thrombocythemia: 2017 update on diagnosis, risk-stratification, and management. Am J Hematol 2017; 92:94-108. [PMID: 27991718 DOI: 10.1002/ajh.24607] [Citation(s) in RCA: 139] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 11/11/2016] [Indexed: 12/12/2022]
Abstract
DISEASE OVERVIEW Polycythemia Vera (PV) and essential thrombocythemia (ET) are myeloproliferative neoplasms respectively characterized by erythrocytosis and thrombocytosis; other disease features include leukocytosis, splenomegaly, thrombosis, bleeding, microcirculatory symptoms, pruritus, and risk of leukemic or fibrotic transformation. DIAGNOSIS PV is defined by a JAK2 mutation, whose absence, combined with normal or increased serum erythropoietin level, makes the diagnosis unlikely. JAK2, CALR, and MPL mutations are the mutually exclusive "driver" mutations in ET with respective incidences of 55%, 25%, and 3%; approximately 17% are triple-negative. However, the same molecular markers might also be present in prefibrotic myelofibrosis, whose morphological distinction from ET is prognostically relevant. SURVIVAL AND LEUKEMIC/FIBROTIC TRANSFORMATION Median survivals are approximately 14 years for PV and 20 years for ET; the corresponding values for younger patients (age <60 years) are 24 and 33 years. Life-expectancy in ET is inferior to the control population. Driver mutational status has not been shown to affect survival in ET whereas the presence of JAK2/MPL mutations has been associated with higher risk of arterial thrombosis and that of MPL with higher risk of fibrotic progression. Risk factors for overall survival in both ET and PV include advanced age, leukocytosis and thrombosis. Leukemic transformation rates at 20 years are estimated at <10% for PV and 5% for ET; fibrotic transformation rates are slightly higher. Most recently, ASXL1, SRSF2, and IDH2 mutations have been associated with inferior overall, leukemia-free or fibrosis-free survival in PV; similarly adverse mutations in ET included SH2B3, SF3B1, U2AF1, TP53, IDH2, and EZH2. THROMBOSIS RISK STRATIFICATION Current risk stratification in PV and ET is designed to estimate the likelihood of recurrent thrombosis. Accordingly, PV includes two risk categories: high-risk (age >60 years or thrombosis history) and low-risk (absence of both risk factors). In ET, risk stratification includes four categories: very low risk (age ≤60 years, no thrombosis history, JAK2/MPL un-mutated), low risk (age ≤60 years, no thrombosis history, JAK2/MPL mutated), intermediate risk (age >60 years, no thrombosis history, JAK2/MPL un-mutated), and high risk (thrombosis history or age >60 years with JAK2/MPL mutation). In addition, presence of extreme thrombocytosis (platelets >1000 × 10(9)/L) might be associated with acquired von Willebrand syndrome (AvWS) and, therefore, risk of bleeding. RISK-ADAPTED THERAPY The main goal of therapy in PV and ET is to prevent thrombohemorrhagic complications. All patients with PV require phlebotomy to keep hematocrit below 45% and once-daily aspirin (81 mg). In addition, high-risk patients with PV require cytoreductive therapy. Very low risk ET patients might not require any form of therapy while low-risk patients require at least once-daily aspirin therapy. Cytoreductive therapy is also recommended for high-risk ET patients but it is not mandatory for intermediate-risk patients. First-line drug of choice for cytoreductive therapy, in both ET and PV, is hydroxyurea and second-line drugs of choice are interferon-α and busulfan. We currently do not recommend treatment with ruxolutinib or other JAK2 inhibitors in PV or ET, unless in the presence of severe and protracted pruritus or marked splenomegaly that is not responding to the aforementioned drugs. Screening for AvWS is recommended before administrating aspirin, in the presence of extreme thrombocytosis. Am. J. Hematol. 92:95-108, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Ayalew Tefferi
- Division of Hematology, Department of Medicine; Mayo Clinic; Rochester Minnesota USA
| | - Tiziano Barbui
- Research Foundation, Papa Giovanni XXIII Hospital; Bergamo Italy
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Diagnosis, risk stratification, and response evaluation in classical myeloproliferative neoplasms. Blood 2016; 129:680-692. [PMID: 28028026 DOI: 10.1182/blood-2016-10-695957] [Citation(s) in RCA: 162] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 12/02/2016] [Indexed: 12/14/2022] Open
Abstract
Philadelphia-negative classical myeloproliferative neoplasms (MPNs) include polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF). The 2016 revision of the WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues includes new criteria for the diagnosis of these disorders. Somatic mutations in the 3 driver genes, that is, JAK2, CALR, and MPL, represent major diagnostic criteria in combination with hematologic and morphological abnormalities. PV is characterized by erythrocytosis with suppressed endogenous erythropoietin production, bone marrow panmyelosis, and JAK2 mutation. Thrombocytosis, bone marrow megakaryocytic proliferation, and presence of JAK2, CALR, or MPL mutation are the main diagnostic criteria for ET. PMF is characterized by bone marrow megakaryocytic proliferation, reticulin and/or collagen fibrosis, and presence of JAK2, CALR, or MPL mutation. Prefibrotic myelofibrosis represents an early phase of myelofibrosis, and is characterized by granulocytic/megakaryocytic proliferation and lack of reticulin fibrosis in the bone marrow. The genomic landscape of MPNs is more complex than initially thought and involves several mutant genes beyond the 3 drivers. Comutated, myeloid tumor-suppressor genes contribute to phenotypic variability, phenotypic shifts, and progression to more aggressive disorders. Patients with myeloid neoplasms are at variable risk of vascular complications, including arterial or venous thrombosis and bleeding. Current prognostic models are mainly based on clinical and hematologic parameters, but innovative models that include genetic data are being developed for both clinical and trial settings. In perspective, molecular profiling of MPNs might also allow for accurate evaluation and monitoring of response to innovative drugs that target the mutant clone.
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71
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Passamonti F, Maffioli M. Update from the latest WHO classification of MPNs: a user's manual. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2016; 2016:534-542. [PMID: 27913526 PMCID: PMC6142477 DOI: 10.1182/asheducation-2016.1.534] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The 2016 multiparameter World Health Organization (WHO) classification for Philadelphia-negative myeloproliferative neoplasms (MPNs) integrates clinical features, morphology, and genetic data to diagnose polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF). The main novelties are: (1) the reduction of the hemoglobin (Hb) level threshold to diagnose PV, now established at 16.5 g/dL for men and 16 g/dL for women (based on the identification of MPN patients with PV-consistent bone marrow [BM] features and a Hb level lower than that established in the 2008 WHO classification for PV); (2) the recognition of prefibrotic/early PMF, distinguishable from ET on the basis of BM morphology, an entity having a higher tendency to develop overt myelofibrosis or acute leukemia, and characterized by inferior survival; (3) the central role of BM morphology in the diagnosis of ET, prefibrotic/early PMF, PMF, and PV with borderline Hb values; megakaryocyte number and morphology (typical in ET, atypical in both PMF forms) accompanied by a new distinction of reticulin fibrosis grade in PMF (grade 1 in prefibrotic/early PMF and grade 2-3 in PMF) constitute diagnostic criteria; and (4) the inclusion of all mutually exclusive MPN driver mutations (JAK2, CALR, and MPL) as major diagnostic criteria in ET and PMF; 10% to 15% of these patients are triple negative, and in these cases the search for an additional clonal marker (eg, mutations in ASXL1, EZH2, TET2, IDH1/IDH2, SRSF2, and SF3B1) is warranted.
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Affiliation(s)
- Francesco Passamonti
- Department of Experimental and Clinical Medicine, University of Insubria, Varese, Italy; and
- Hematology, Department of Specialistic Medicine, Ospedale di Circolo, Azienda Socio Sanitaria Territoriale Sette Laghi, Varese, Italy
| | - Margherita Maffioli
- Hematology, Department of Specialistic Medicine, Ospedale di Circolo, Azienda Socio Sanitaria Territoriale Sette Laghi, Varese, Italy
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72
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Wang JC, Shi G, Baptiste S, Yarotska M, Sindhu H, Wong C, Kalavar M, Gotlieb V, Bandarchuk A, Chen H. Quantification of IGF-1 Receptor May Be Useful in Diagnosing Polycythemia Vera-Suggestion to Be Added to Be One of the Minor Criterion. PLoS One 2016; 11:e0165299. [PMID: 27812134 PMCID: PMC5094699 DOI: 10.1371/journal.pone.0165299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 10/10/2016] [Indexed: 01/12/2023] Open
Abstract
Endogenous erythroid colony (EEC) formation is one of the minor criteria for diagnosing polycythemia vera (PV) according to 2008 WHO diagnostic criteria. But EEC requires bone marrow aspiration and sophisticated laboratory procedures; therefore, practically it is rarely used to diagnose PV. Insulin-like growth factor 1 receptor (IGF-1R) was found to be constitutively phosphorylated and was responsible for the EEC formation in PV; therefore, we measured IGF-1R levels in the peripheral blood of 26 PV patients and compared them with those of 33 patients with secondary polycythemia and 29 normal controls. Among the PV patients, 16 were treated with only phlebotomy, 9 received hydroxyurea, and 1 was treated with ruxolinitinib. We found that PV patients treated with only phlebotomy had significantly higher IGF-1R levels than did those PV patients treated with hydroxyurea or ruxolinitinib. None of the secondary PV patients or normal controls had elevated IGR-1R levels, while 14 of 16 (87%) PV patients had significantly elevated IGF-1R levels. The new 2016 WHO has eliminated EEC as a minor criterion for diagnosing PV, but there are still some cases that cannot be definitively diagnosed by the current criteria. Therefore, we suggest that quantifying the IGF-1R level in peripheral blood by flow cytometry to replace EEC as the minor criterion for diagnosing PV.
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Affiliation(s)
- Jen C. Wang
- Division of Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY, United States of America
- * E-mail:
| | - Guanfang Shi
- Division of Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY, United States of America
| | - Stacey Baptiste
- Division of Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY, United States of America
| | - Maryna Yarotska
- Division of Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY, United States of America
| | - Hemant Sindhu
- Division of Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY, United States of America
| | - Ching Wong
- Division of Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY, United States of America
| | - Madhumati Kalavar
- Division of Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY, United States of America
| | - Vladimir Gotlieb
- Division of Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY, United States of America
| | - Andrei Bandarchuk
- Division of Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY, United States of America
| | - Hui Chen
- Division of Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY, United States of America
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73
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Shi ZX, Xiao ZJ. [Interpretation of the Chinese expert consensus on the diagnosis and treatment of polycythemia vera(2016)]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2016; 37:852-857. [PMID: 27801313 PMCID: PMC7364883 DOI: 10.3760/cma.j.issn.0253-2727.2016.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Indexed: 04/03/2023]
Affiliation(s)
- Z X Shi
- Institute of Hematology and Blood Diseases Hospital, State Key Laboratory of Experimental Hematology, CAMS & PUMC, Tianjin 300020, China
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74
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Rosenstein BE, Ives ST, Wiernik A. A Clue in JAK2: Masked Polycythemia Vera. Am J Med 2016; 129:1051-3. [PMID: 27427321 DOI: 10.1016/j.amjmed.2016.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 06/30/2016] [Accepted: 06/30/2016] [Indexed: 10/21/2022]
Affiliation(s)
| | - Samuel T Ives
- Department of General Internal Medicine, Hennepin County Medical Center, Minneapolis, Minn.
| | - Andres Wiernik
- Department of Hematology and Oncology, Hennepin County Medical Center, Minneapolis, Minn
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75
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Tiong IS, Casolari DA, Nguyen T, Van Velzen MJM, Ambler K, D'Andrea RJ, Ross DM. Masked polycythaemia vera is genetically intermediate between JAK2V617F mutated essential thrombocythaemia and overt polycythaemia vera. Blood Cancer J 2016; 6:e459. [PMID: 27540717 PMCID: PMC5022181 DOI: 10.1038/bcj.2016.70] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- I S Tiong
- Haematology Directorate, SA Pathology/Royal Adelaide Hospital, Adelaide, South Australia Australia.,School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - D A Casolari
- Haematology Directorate, SA Pathology/Royal Adelaide Hospital, Adelaide, South Australia Australia.,Centre for Cancer Biology, University of South Australia/SA Pathology, Adelaide, South Australia, Australia
| | - T Nguyen
- Haematology Directorate, SA Pathology/Royal Adelaide Hospital, Adelaide, South Australia Australia.,Centre for Cancer Biology, University of South Australia/SA Pathology, Adelaide, South Australia, Australia
| | - M J M Van Velzen
- Haematology Directorate, SA Pathology/Royal Adelaide Hospital, Adelaide, South Australia Australia.,Centre for Cancer Biology, University of South Australia/SA Pathology, Adelaide, South Australia, Australia.,School of Medical Sciences, VU University Medical Center, Amsterdam, The Netherlands
| | - K Ambler
- Genetics and Molecular Pathology Directorate, SA Pathology, Adelaide, South Australia, Australia
| | - R J D'Andrea
- Haematology Directorate, SA Pathology/Royal Adelaide Hospital, Adelaide, South Australia Australia.,Centre for Cancer Biology, University of South Australia/SA Pathology, Adelaide, South Australia, Australia
| | - D M Ross
- Haematology Directorate, SA Pathology/Royal Adelaide Hospital, Adelaide, South Australia Australia.,School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
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76
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Melikian AL, Subortseva IN, Kovrigina AM, Kolosheynova TI, Abdullaev AO, Kuznetsova PI, Sudarikov AB, Kulikov SM. [Diagnosis of latent polycythemia vera: A clinician's opinion]. TERAPEVT ARKH 2016; 88:25-30. [PMID: 27459611 DOI: 10.17116/terarkh201688725-30] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM to identify the clinical features of latent polycythemia vera (PV) as an independent nosological entity. SUBJECTS AND METHODS The investigation enrolled 81 patients (50 with extensive (manifest) PV and 31 with latent PV) who had visited the Outpatient Department, Hematology Research Center, Ministry of Health of Russia, in 2014 to October 2015. RESULTS The gender distribution of the patients was statistically comparable in the analyzed groups. The patients with manifest PV were slightly older than those with latent PV: the median age in the compared groups was 56 and 44 years, respectively. Red blood cell counts, hemoglobin concentrations, and packed cell volume were higher in the patients with manifest PV. Blood platelet counts were higher in the latent PV group. There were no differences in the number of white blood cells in the compared groups. All the patients were JAK2 V617F mutation carriers. The JAK2 allele load was significantly higher in the manifest PV group than in the latent PV group. The compared patient groups differed in the rate of thromboses in the history or at diagnosis. In the patients with latent PV, thromboses were detected in 38% of cases versus 16% in those with manifest PV. In latent PV, there were mainly venous thromboses; abdominal vascular thromboses were diagnosed with a high frequency. Arterial thromboses were revealed in only 2 cases. CONCLUSION Chronic myeloproliferative disease that is characterized by the JAK2 V617F mutation, borderline hemoglobin counts, and morphological features of a bone marrow trephine biopsy specimen, which are specific for PV, is an independent PV variant, namely: latent PV.
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Affiliation(s)
- A L Melikian
- National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - I N Subortseva
- National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - A M Kovrigina
- National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - T I Kolosheynova
- National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - A O Abdullaev
- National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - P I Kuznetsova
- Neurology Research Center, Ministry of Health of Russia, Moscow, Russia
| | - A B Sudarikov
- National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - S M Kulikov
- National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
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77
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The 2016 revision of WHO classification of myeloproliferative neoplasms: Clinical and molecular advances. Blood Rev 2016; 30:453-459. [PMID: 27341755 DOI: 10.1016/j.blre.2016.06.001] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 05/26/2016] [Accepted: 06/06/2016] [Indexed: 12/18/2022]
Abstract
Clinical evidence supports the need of changing the diagnostic criteria of the 2008 updated WHO classification for polycythemia vera (PV), essential thrombocythemia (ET) and primary myelofibrosis (PMF). In JAK2-mutated patients who show characteristic bone marrow (BM) morphology, clinical studies demonstrated that a hemoglobin level of 16.5g/dL in men and 16.0g/dl for women or a hematocrit value of 49% in men and 48% in women are the optimal cut off levels for distinguishing JAK2-mutated ET from "masked/prodromal" PV. Therefore BM morphology was upgraded to a major diagnostic criterion. Regarding ET the key issue was to improve standardization of prominent BM features enhancing differentiation between "true" ET and prefibrotic/early primary myelofibrosis (prePMF). These two entities have shown a different epidemiology and clinical outcomes. Concerning prePMF a more explicit clinical characterization of minor criteria is mandated for an improved distinction from ET and overt PMF and accurate diagnosis and outcome prediction.
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78
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Barbui T, Thiele J, Vannucchi AM, Tefferi A. Myeloproliferative neoplasms: Morphology and clinical practice. Am J Hematol 2016; 91:430-3. [PMID: 26718907 DOI: 10.1002/ajh.24288] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 12/22/2015] [Indexed: 12/26/2022]
Abstract
In myeloproliferative neoplasms (MPNs), controversy persists regarding the usefulness and reproducibility of bone marrow (BM) features. Disagreements concerning the WHO classification are mainly focused on the discrimination between essential thrombocythemia (ET) and prefibrotic/early primary myelofibrosis (prePMF) and prodromal polycythemia vera (PV). Criticism mostly refers to lack of standardization of distinctive BM features precluding correct morphological pattern recognition. The distinction between WHO-defined ET and prePMF is not trivial because outcome is significantly worse in prePMF. Morphology was generally considered to be non-specific for the diagnosis of PV. Recent studies have revealed under-diagnosis of morphologically and biologically consistent PV.
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Affiliation(s)
- Tiziano Barbui
- Research Foundation, Papa Giovanni XXIII Hospital; Bergamo Italy
| | - Jürgen Thiele
- Institute of pathology, University of Cologne; Cologne Germany
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Geyer JT, Orazi A. Myeloproliferative neoplasms (BCR-ABL1 negative) and myelodysplastic/myeloproliferative neoplasms: current diagnostic principles and upcoming updates. Int J Lab Hematol 2016; 38 Suppl 1:12-9. [PMID: 27161873 DOI: 10.1111/ijlh.12509] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 05/04/2016] [Indexed: 01/24/2023]
Abstract
Since the publication of the latest World Health Organization (WHO) classification in 2008, there has been a significant effort for clarification of unresolved questions, especially with the help of the rapidly developing field of molecular genetic studies, next-generation sequencing in particular. Numerous entities within the WHO categories of myeloproliferative neoplasms (MPNs) and myelodysplastic (MDS)/MPNs have been extensively studied, with large published series attempting to characterize and better define their morphologic and molecular genetic features. This emerging genetic landscape maintains a robust correlation with the various disease entities recognized by the WHO classification scheme based on a careful integration of detailed clinical information, bone marrow and peripheral blood morphology, immunohistology, and genomics. This brief review summarizes the current guidelines as they apply to diagnosing both the classical BCR-ABL1 negative MPN (polycythemia vera, essential thrombocythemia, and primary myelofibrosis) and the more common subtypes of MDS/MPN overlap syndromes. The more important recent molecular updates as well as the upcoming changes to the current WHO classification, expected to be published in late 2016, will also be briefly reviewed.
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Affiliation(s)
- J T Geyer
- Division of Hematopathology, Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA
| | - A Orazi
- Division of Hematopathology, Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA
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80
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The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia. Blood 2016; 127:2391-405. [PMID: 27069254 DOI: 10.1182/blood-2016-03-643544] [Citation(s) in RCA: 6242] [Impact Index Per Article: 780.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 04/06/2016] [Indexed: 02/06/2023] Open
Abstract
The World Health Organization (WHO) classification of tumors of the hematopoietic and lymphoid tissues was last updated in 2008. Since then, there have been numerous advances in the identification of unique biomarkers associated with some myeloid neoplasms and acute leukemias, largely derived from gene expression analysis and next-generation sequencing that can significantly improve the diagnostic criteria as well as the prognostic relevance of entities currently included in the WHO classification and that also suggest new entities that should be added. Therefore, there is a clear need for a revision to the current classification. The revisions to the categories of myeloid neoplasms and acute leukemia will be published in a monograph in 2016 and reflect a consensus of opinion of hematopathologists, hematologists, oncologists, and geneticists. The 2016 edition represents a revision of the prior classification rather than an entirely new classification and attempts to incorporate new clinical, prognostic, morphologic, immunophenotypic, and genetic data that have emerged since the last edition. The major changes in the classification and their rationale are presented here.
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81
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Duangnapasatit B, Rattarittamrong E, Rattanathammethee T, Hantrakool S, Chai-Adisaksopha C, Tantiworawit A, Norasetthada L. Clinical Manifestations and Risk Factors for Complications of Philadelphia Chromosome-Negative Myeloproliferative Neoplasms. Asian Pac J Cancer Prev 2016; 16:5013-8. [PMID: 26163633 DOI: 10.7314/apjcp.2015.16.12.5013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Myeloproliferative neoplasms (MPNs) are clonal hematopoietic stem cell disorders characterized by proliferation of one or more myeloid lineages. Polycythemia vera (PV), essential thrombocythemia (ET) and primary myelofibrosis (PMF) are classical Philadelphia chromosome (Ph)-negative MPN that have a Janus Kinase 2 (JAK2) mutation, especially JAK2V617F in the majority of patients. The major complications of Ph-negative MPNs are thrombosis, hemorrhage, and leukemic transformation. OBJECTIVE To study clinical manifestations including symptoms, signs, laboratory findings, and JAK2V617F mutations of Ph-negative MPN (PV, ET and PMF) as well as their complications. MATERIALS AND METHODS All Ph-negative MPN (PV, ET and PMF) patients who attended the Hematology Clinic at Maharaj Nakorn Chiang Mai Hospital from January, 1 2003 through December, 31 2013 were retrospectively reviewed for demographic data, clinical characteristics, complete blood count, JAK2V617F mutation analysis, treatment, and complications. RESULTS One hundred and fifty seven patients were included in the study. They were classified as PV, ET and PMF for 68, 83 and 6 with median ages of 60, 61, and 68 years, respectively. JAK2V617F mutations were detected in 88%, 69%, and 100% of PV, ET and PMF patients. PV had the highest incidence of thrombosis (PV 29%, ET 14%, and PMF 0%) that occurred in both arterial and venous sites whereas PMF had the highest incidence of bleeding (PMF 17%, ET 11%, and PV 7%). During follow up, there was one ET patient that transformed to acute leukemia and five cases that developed thrombosis (three ET and two PV patients). No secondary myelofibrosis and death cases were encountered. CONCLUSIONS Ph-negative MPNs have various clinical manifestations. JAK2V617F mutations are present in the majority of PV, ET, and PMF patients. This study confirmed that thrombosis and bleeding are the most significant complications in patients with Ph-negative MPN.
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Affiliation(s)
- Boonlerd Duangnapasatit
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand E-mail : ,
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83
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Silver RT, Hasselbalch HC. Optimal therapy for polycythemia vera and essential thrombocythemia: Preferred use of interferon therapy based on phase 2 trials. ACTA ACUST UNITED AC 2016; 21:387-91. [PMID: 26900719 DOI: 10.1080/10245332.2015.1111644] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To determine the value of recombinant interferon-alfa (rIFNα) in the treatment of polycythemia vera (PV) and essential thrombocythemia (ET) based on its biological activities and phase 2 clinical studies, pending completion of phase 3 trials; to determine importance of the Internet in patient decision-making in treatment selection. RESULTS The value of rIFNα in PV and ET is based upon its biological effects on PV stem cells and megakaryocyte proliferation. Single-arm trials are useful for life-threatening diseases when there are relatively few patients to evaluate endpoints, such as rIFNα treatment of PV and ET. Proper diagnostic criteria are mandatory; for PV, the current World Health Organization criteria emphasizing increased hemoglobin values exclude approximately one-third of eligible patients. Importance of these data: Single-arm studies in diseases exemplified by rIFNα in PV require updated diagnostic criteria for research and for clinical practice. The influence of the Internet on patient decisions for treatment is noteworthy. CONCLUSION The biologic basis for selecting therapy is exemplified by rIFNα in treating PV and ET. Current single-arm studies of rIFNα in PV and ET are relevant and acceptable. The importance of the Internet in patient decision-making is important.
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Affiliation(s)
- Richard T Silver
- a Myeloproliferative Neoplasms Center, Division of Hematology-Oncology, Department of Medicine , Weill Cornell Medical Center , New York , USA
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Stein BL, Gotlib J, Arcasoy M, Nguyen MH, Shah N, Moliterno A, Jamieson C, Pollyea DA, Scott B, Wadleigh M, Levine R, Komrokji R, Klisovic R, Gundabolu K, Kropf P, Wetzler M, Oh ST, Ribeiro R, Paschal R, Mohan S, Podoltsev N, Prchal J, Talpaz M, Snyder D, Verstovsek S, Mesa RA. Historical views, conventional approaches, and evolving management strategies for myeloproliferative neoplasms. J Natl Compr Canc Netw 2016; 13:424-34. [PMID: 25870379 DOI: 10.6004/jnccn.2015.0058] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The classical Philadelphia chromosome-negative myeloproliferative neoplasms (MPN), which include essential thrombocythemia, polycythemia vera, and myelofibrosis (MF), are in a new era of molecular diagnosis, ushered in by the identification of the JAK2(V617F) and cMPL mutations in 2005 and 2006, respectively, and the CALR mutations in 2013. Coupled with increased knowledge of disease pathogenesis and refined diagnostic criteria and prognostic scoring systems, a more nuanced appreciation has emerged of the burden of MPN in the United States, including the prevalence, symptom burden, and impact on quality of life. Biological advances in MPN have translated into the rapid development of novel therapeutics, culminating in the approval of the first treatment for MF, the JAK1/JAK2 inhibitor ruxolitinib. However, certain practical aspects of care, such as those regarding diagnosis, prevention of vascular events, choice of cytoreductive agent, and planning for therapies, present challenges for hematologists/oncologists, and are discussed in this article.
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Affiliation(s)
- Brady L Stein
- From Northwestern University Feinberg School of Medicine, Chicago, Illinois; Stanford Cancer Institute, Stanford University, Stanford, California; Duke Cancer Institute, Duke University, Durham, North Carolina; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; University of California, San Francisco, San Francisco, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; Moores Cancer Center, UC San Diego, San Diego, California; University of Colorado Cancer Center, Aurora, Colorado; Fred Hutchinson Cancer Research Center, Seattle, Washington; Dana Farber Cancer Institute, Boston, Massachusetts; Memorial Sloan Kettering Cancer Center, New York; New York; Moffitt Cancer Center and Research Institute, Tampa, Florida; The Ohio State University, Columbus, Ohio; Fred & Pamela Buffett Cancer Center, Omaha, Nebraska; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Roswell Park Cancer Institute, Buffalo, New York; Washington University-Siteman Cancer Center, St Louis, Missouri; St. Jude Children's Research Hospital, Memphis, Tennessee; University of Alabama at Birmingham, Birmingham, Alabama; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Yale University School of Medicine; New Haven, Connecticut; University of Utah, Salt Lake City, Utah; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; City of Hope Cancer Center, Los Angeles, California; The University of Texas MD Anderson Cancer Center, Houston, Texas; and Mayo Clinic Cancer Center, Scottsdale, Arizona
| | - Jason Gotlib
- From Northwestern University Feinberg School of Medicine, Chicago, Illinois; Stanford Cancer Institute, Stanford University, Stanford, California; Duke Cancer Institute, Duke University, Durham, North Carolina; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; University of California, San Francisco, San Francisco, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; Moores Cancer Center, UC San Diego, San Diego, California; University of Colorado Cancer Center, Aurora, Colorado; Fred Hutchinson Cancer Research Center, Seattle, Washington; Dana Farber Cancer Institute, Boston, Massachusetts; Memorial Sloan Kettering Cancer Center, New York; New York; Moffitt Cancer Center and Research Institute, Tampa, Florida; The Ohio State University, Columbus, Ohio; Fred & Pamela Buffett Cancer Center, Omaha, Nebraska; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Roswell Park Cancer Institute, Buffalo, New York; Washington University-Siteman Cancer Center, St Louis, Missouri; St. Jude Children's Research Hospital, Memphis, Tennessee; University of Alabama at Birmingham, Birmingham, Alabama; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Yale University School of Medicine; New Haven, Connecticut; University of Utah, Salt Lake City, Utah; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; City of Hope Cancer Center, Los Angeles, California; The University of Texas MD Anderson Cancer Center, Houston, Texas; and Mayo Clinic Cancer Center, Scottsdale, Arizona
| | - Murat Arcasoy
- From Northwestern University Feinberg School of Medicine, Chicago, Illinois; Stanford Cancer Institute, Stanford University, Stanford, California; Duke Cancer Institute, Duke University, Durham, North Carolina; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; University of California, San Francisco, San Francisco, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; Moores Cancer Center, UC San Diego, San Diego, California; University of Colorado Cancer Center, Aurora, Colorado; Fred Hutchinson Cancer Research Center, Seattle, Washington; Dana Farber Cancer Institute, Boston, Massachusetts; Memorial Sloan Kettering Cancer Center, New York; New York; Moffitt Cancer Center and Research Institute, Tampa, Florida; The Ohio State University, Columbus, Ohio; Fred & Pamela Buffett Cancer Center, Omaha, Nebraska; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Roswell Park Cancer Institute, Buffalo, New York; Washington University-Siteman Cancer Center, St Louis, Missouri; St. Jude Children's Research Hospital, Memphis, Tennessee; University of Alabama at Birmingham, Birmingham, Alabama; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Yale University School of Medicine; New Haven, Connecticut; University of Utah, Salt Lake City, Utah; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; City of Hope Cancer Center, Los Angeles, California; The University of Texas MD Anderson Cancer Center, Houston, Texas; and Mayo Clinic Cancer Center, Scottsdale, Arizona
| | - Marie Huong Nguyen
- From Northwestern University Feinberg School of Medicine, Chicago, Illinois; Stanford Cancer Institute, Stanford University, Stanford, California; Duke Cancer Institute, Duke University, Durham, North Carolina; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; University of California, San Francisco, San Francisco, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; Moores Cancer Center, UC San Diego, San Diego, California; University of Colorado Cancer Center, Aurora, Colorado; Fred Hutchinson Cancer Research Center, Seattle, Washington; Dana Farber Cancer Institute, Boston, Massachusetts; Memorial Sloan Kettering Cancer Center, New York; New York; Moffitt Cancer Center and Research Institute, Tampa, Florida; The Ohio State University, Columbus, Ohio; Fred & Pamela Buffett Cancer Center, Omaha, Nebraska; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Roswell Park Cancer Institute, Buffalo, New York; Washington University-Siteman Cancer Center, St Louis, Missouri; St. Jude Children's Research Hospital, Memphis, Tennessee; University of Alabama at Birmingham, Birmingham, Alabama; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Yale University School of Medicine; New Haven, Connecticut; University of Utah, Salt Lake City, Utah; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; City of Hope Cancer Center, Los Angeles, California; The University of Texas MD Anderson Cancer Center, Houston, Texas; and Mayo Clinic Cancer Center, Scottsdale, Arizona
| | - Neil Shah
- From Northwestern University Feinberg School of Medicine, Chicago, Illinois; Stanford Cancer Institute, Stanford University, Stanford, California; Duke Cancer Institute, Duke University, Durham, North Carolina; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; University of California, San Francisco, San Francisco, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; Moores Cancer Center, UC San Diego, San Diego, California; University of Colorado Cancer Center, Aurora, Colorado; Fred Hutchinson Cancer Research Center, Seattle, Washington; Dana Farber Cancer Institute, Boston, Massachusetts; Memorial Sloan Kettering Cancer Center, New York; New York; Moffitt Cancer Center and Research Institute, Tampa, Florida; The Ohio State University, Columbus, Ohio; Fred & Pamela Buffett Cancer Center, Omaha, Nebraska; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Roswell Park Cancer Institute, Buffalo, New York; Washington University-Siteman Cancer Center, St Louis, Missouri; St. Jude Children's Research Hospital, Memphis, Tennessee; University of Alabama at Birmingham, Birmingham, Alabama; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Yale University School of Medicine; New Haven, Connecticut; University of Utah, Salt Lake City, Utah; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; City of Hope Cancer Center, Los Angeles, California; The University of Texas MD Anderson Cancer Center, Houston, Texas; and Mayo Clinic Cancer Center, Scottsdale, Arizona
| | - Alison Moliterno
- From Northwestern University Feinberg School of Medicine, Chicago, Illinois; Stanford Cancer Institute, Stanford University, Stanford, California; Duke Cancer Institute, Duke University, Durham, North Carolina; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; University of California, San Francisco, San Francisco, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; Moores Cancer Center, UC San Diego, San Diego, California; University of Colorado Cancer Center, Aurora, Colorado; Fred Hutchinson Cancer Research Center, Seattle, Washington; Dana Farber Cancer Institute, Boston, Massachusetts; Memorial Sloan Kettering Cancer Center, New York; New York; Moffitt Cancer Center and Research Institute, Tampa, Florida; The Ohio State University, Columbus, Ohio; Fred & Pamela Buffett Cancer Center, Omaha, Nebraska; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Roswell Park Cancer Institute, Buffalo, New York; Washington University-Siteman Cancer Center, St Louis, Missouri; St. Jude Children's Research Hospital, Memphis, Tennessee; University of Alabama at Birmingham, Birmingham, Alabama; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Yale University School of Medicine; New Haven, Connecticut; University of Utah, Salt Lake City, Utah; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; City of Hope Cancer Center, Los Angeles, California; The University of Texas MD Anderson Cancer Center, Houston, Texas; and Mayo Clinic Cancer Center, Scottsdale, Arizona
| | - Catriona Jamieson
- From Northwestern University Feinberg School of Medicine, Chicago, Illinois; Stanford Cancer Institute, Stanford University, Stanford, California; Duke Cancer Institute, Duke University, Durham, North Carolina; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; University of California, San Francisco, San Francisco, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; Moores Cancer Center, UC San Diego, San Diego, California; University of Colorado Cancer Center, Aurora, Colorado; Fred Hutchinson Cancer Research Center, Seattle, Washington; Dana Farber Cancer Institute, Boston, Massachusetts; Memorial Sloan Kettering Cancer Center, New York; New York; Moffitt Cancer Center and Research Institute, Tampa, Florida; The Ohio State University, Columbus, Ohio; Fred & Pamela Buffett Cancer Center, Omaha, Nebraska; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Roswell Park Cancer Institute, Buffalo, New York; Washington University-Siteman Cancer Center, St Louis, Missouri; St. Jude Children's Research Hospital, Memphis, Tennessee; University of Alabama at Birmingham, Birmingham, Alabama; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Yale University School of Medicine; New Haven, Connecticut; University of Utah, Salt Lake City, Utah; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; City of Hope Cancer Center, Los Angeles, California; The University of Texas MD Anderson Cancer Center, Houston, Texas; and Mayo Clinic Cancer Center, Scottsdale, Arizona
| | - Daniel A Pollyea
- From Northwestern University Feinberg School of Medicine, Chicago, Illinois; Stanford Cancer Institute, Stanford University, Stanford, California; Duke Cancer Institute, Duke University, Durham, North Carolina; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; University of California, San Francisco, San Francisco, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; Moores Cancer Center, UC San Diego, San Diego, California; University of Colorado Cancer Center, Aurora, Colorado; Fred Hutchinson Cancer Research Center, Seattle, Washington; Dana Farber Cancer Institute, Boston, Massachusetts; Memorial Sloan Kettering Cancer Center, New York; New York; Moffitt Cancer Center and Research Institute, Tampa, Florida; The Ohio State University, Columbus, Ohio; Fred & Pamela Buffett Cancer Center, Omaha, Nebraska; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Roswell Park Cancer Institute, Buffalo, New York; Washington University-Siteman Cancer Center, St Louis, Missouri; St. Jude Children's Research Hospital, Memphis, Tennessee; University of Alabama at Birmingham, Birmingham, Alabama; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Yale University School of Medicine; New Haven, Connecticut; University of Utah, Salt Lake City, Utah; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; City of Hope Cancer Center, Los Angeles, California; The University of Texas MD Anderson Cancer Center, Houston, Texas; and Mayo Clinic Cancer Center, Scottsdale, Arizona
| | - Bart Scott
- From Northwestern University Feinberg School of Medicine, Chicago, Illinois; Stanford Cancer Institute, Stanford University, Stanford, California; Duke Cancer Institute, Duke University, Durham, North Carolina; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; University of California, San Francisco, San Francisco, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; Moores Cancer Center, UC San Diego, San Diego, California; University of Colorado Cancer Center, Aurora, Colorado; Fred Hutchinson Cancer Research Center, Seattle, Washington; Dana Farber Cancer Institute, Boston, Massachusetts; Memorial Sloan Kettering Cancer Center, New York; New York; Moffitt Cancer Center and Research Institute, Tampa, Florida; The Ohio State University, Columbus, Ohio; Fred & Pamela Buffett Cancer Center, Omaha, Nebraska; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Roswell Park Cancer Institute, Buffalo, New York; Washington University-Siteman Cancer Center, St Louis, Missouri; St. Jude Children's Research Hospital, Memphis, Tennessee; University of Alabama at Birmingham, Birmingham, Alabama; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Yale University School of Medicine; New Haven, Connecticut; University of Utah, Salt Lake City, Utah; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; City of Hope Cancer Center, Los Angeles, California; The University of Texas MD Anderson Cancer Center, Houston, Texas; and Mayo Clinic Cancer Center, Scottsdale, Arizona
| | - Martha Wadleigh
- From Northwestern University Feinberg School of Medicine, Chicago, Illinois; Stanford Cancer Institute, Stanford University, Stanford, California; Duke Cancer Institute, Duke University, Durham, North Carolina; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; University of California, San Francisco, San Francisco, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; Moores Cancer Center, UC San Diego, San Diego, California; University of Colorado Cancer Center, Aurora, Colorado; Fred Hutchinson Cancer Research Center, Seattle, Washington; Dana Farber Cancer Institute, Boston, Massachusetts; Memorial Sloan Kettering Cancer Center, New York; New York; Moffitt Cancer Center and Research Institute, Tampa, Florida; The Ohio State University, Columbus, Ohio; Fred & Pamela Buffett Cancer Center, Omaha, Nebraska; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Roswell Park Cancer Institute, Buffalo, New York; Washington University-Siteman Cancer Center, St Louis, Missouri; St. Jude Children's Research Hospital, Memphis, Tennessee; University of Alabama at Birmingham, Birmingham, Alabama; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Yale University School of Medicine; New Haven, Connecticut; University of Utah, Salt Lake City, Utah; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; City of Hope Cancer Center, Los Angeles, California; The University of Texas MD Anderson Cancer Center, Houston, Texas; and Mayo Clinic Cancer Center, Scottsdale, Arizona
| | - Ross Levine
- From Northwestern University Feinberg School of Medicine, Chicago, Illinois; Stanford Cancer Institute, Stanford University, Stanford, California; Duke Cancer Institute, Duke University, Durham, North Carolina; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; University of California, San Francisco, San Francisco, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; Moores Cancer Center, UC San Diego, San Diego, California; University of Colorado Cancer Center, Aurora, Colorado; Fred Hutchinson Cancer Research Center, Seattle, Washington; Dana Farber Cancer Institute, Boston, Massachusetts; Memorial Sloan Kettering Cancer Center, New York; New York; Moffitt Cancer Center and Research Institute, Tampa, Florida; The Ohio State University, Columbus, Ohio; Fred & Pamela Buffett Cancer Center, Omaha, Nebraska; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Roswell Park Cancer Institute, Buffalo, New York; Washington University-Siteman Cancer Center, St Louis, Missouri; St. Jude Children's Research Hospital, Memphis, Tennessee; University of Alabama at Birmingham, Birmingham, Alabama; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Yale University School of Medicine; New Haven, Connecticut; University of Utah, Salt Lake City, Utah; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; City of Hope Cancer Center, Los Angeles, California; The University of Texas MD Anderson Cancer Center, Houston, Texas; and Mayo Clinic Cancer Center, Scottsdale, Arizona
| | - Rami Komrokji
- From Northwestern University Feinberg School of Medicine, Chicago, Illinois; Stanford Cancer Institute, Stanford University, Stanford, California; Duke Cancer Institute, Duke University, Durham, North Carolina; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; University of California, San Francisco, San Francisco, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; Moores Cancer Center, UC San Diego, San Diego, California; University of Colorado Cancer Center, Aurora, Colorado; Fred Hutchinson Cancer Research Center, Seattle, Washington; Dana Farber Cancer Institute, Boston, Massachusetts; Memorial Sloan Kettering Cancer Center, New York; New York; Moffitt Cancer Center and Research Institute, Tampa, Florida; The Ohio State University, Columbus, Ohio; Fred & Pamela Buffett Cancer Center, Omaha, Nebraska; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Roswell Park Cancer Institute, Buffalo, New York; Washington University-Siteman Cancer Center, St Louis, Missouri; St. Jude Children's Research Hospital, Memphis, Tennessee; University of Alabama at Birmingham, Birmingham, Alabama; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Yale University School of Medicine; New Haven, Connecticut; University of Utah, Salt Lake City, Utah; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; City of Hope Cancer Center, Los Angeles, California; The University of Texas MD Anderson Cancer Center, Houston, Texas; and Mayo Clinic Cancer Center, Scottsdale, Arizona
| | - Rebecca Klisovic
- From Northwestern University Feinberg School of Medicine, Chicago, Illinois; Stanford Cancer Institute, Stanford University, Stanford, California; Duke Cancer Institute, Duke University, Durham, North Carolina; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; University of California, San Francisco, San Francisco, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; Moores Cancer Center, UC San Diego, San Diego, California; University of Colorado Cancer Center, Aurora, Colorado; Fred Hutchinson Cancer Research Center, Seattle, Washington; Dana Farber Cancer Institute, Boston, Massachusetts; Memorial Sloan Kettering Cancer Center, New York; New York; Moffitt Cancer Center and Research Institute, Tampa, Florida; The Ohio State University, Columbus, Ohio; Fred & Pamela Buffett Cancer Center, Omaha, Nebraska; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Roswell Park Cancer Institute, Buffalo, New York; Washington University-Siteman Cancer Center, St Louis, Missouri; St. Jude Children's Research Hospital, Memphis, Tennessee; University of Alabama at Birmingham, Birmingham, Alabama; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Yale University School of Medicine; New Haven, Connecticut; University of Utah, Salt Lake City, Utah; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; City of Hope Cancer Center, Los Angeles, California; The University of Texas MD Anderson Cancer Center, Houston, Texas; and Mayo Clinic Cancer Center, Scottsdale, Arizona
| | - Krishna Gundabolu
- From Northwestern University Feinberg School of Medicine, Chicago, Illinois; Stanford Cancer Institute, Stanford University, Stanford, California; Duke Cancer Institute, Duke University, Durham, North Carolina; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; University of California, San Francisco, San Francisco, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; Moores Cancer Center, UC San Diego, San Diego, California; University of Colorado Cancer Center, Aurora, Colorado; Fred Hutchinson Cancer Research Center, Seattle, Washington; Dana Farber Cancer Institute, Boston, Massachusetts; Memorial Sloan Kettering Cancer Center, New York; New York; Moffitt Cancer Center and Research Institute, Tampa, Florida; The Ohio State University, Columbus, Ohio; Fred & Pamela Buffett Cancer Center, Omaha, Nebraska; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Roswell Park Cancer Institute, Buffalo, New York; Washington University-Siteman Cancer Center, St Louis, Missouri; St. Jude Children's Research Hospital, Memphis, Tennessee; University of Alabama at Birmingham, Birmingham, Alabama; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Yale University School of Medicine; New Haven, Connecticut; University of Utah, Salt Lake City, Utah; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; City of Hope Cancer Center, Los Angeles, California; The University of Texas MD Anderson Cancer Center, Houston, Texas; and Mayo Clinic Cancer Center, Scottsdale, Arizona
| | - Patricia Kropf
- From Northwestern University Feinberg School of Medicine, Chicago, Illinois; Stanford Cancer Institute, Stanford University, Stanford, California; Duke Cancer Institute, Duke University, Durham, North Carolina; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; University of California, San Francisco, San Francisco, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; Moores Cancer Center, UC San Diego, San Diego, California; University of Colorado Cancer Center, Aurora, Colorado; Fred Hutchinson Cancer Research Center, Seattle, Washington; Dana Farber Cancer Institute, Boston, Massachusetts; Memorial Sloan Kettering Cancer Center, New York; New York; Moffitt Cancer Center and Research Institute, Tampa, Florida; The Ohio State University, Columbus, Ohio; Fred & Pamela Buffett Cancer Center, Omaha, Nebraska; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Roswell Park Cancer Institute, Buffalo, New York; Washington University-Siteman Cancer Center, St Louis, Missouri; St. Jude Children's Research Hospital, Memphis, Tennessee; University of Alabama at Birmingham, Birmingham, Alabama; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Yale University School of Medicine; New Haven, Connecticut; University of Utah, Salt Lake City, Utah; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; City of Hope Cancer Center, Los Angeles, California; The University of Texas MD Anderson Cancer Center, Houston, Texas; and Mayo Clinic Cancer Center, Scottsdale, Arizona
| | - Meir Wetzler
- From Northwestern University Feinberg School of Medicine, Chicago, Illinois; Stanford Cancer Institute, Stanford University, Stanford, California; Duke Cancer Institute, Duke University, Durham, North Carolina; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; University of California, San Francisco, San Francisco, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; Moores Cancer Center, UC San Diego, San Diego, California; University of Colorado Cancer Center, Aurora, Colorado; Fred Hutchinson Cancer Research Center, Seattle, Washington; Dana Farber Cancer Institute, Boston, Massachusetts; Memorial Sloan Kettering Cancer Center, New York; New York; Moffitt Cancer Center and Research Institute, Tampa, Florida; The Ohio State University, Columbus, Ohio; Fred & Pamela Buffett Cancer Center, Omaha, Nebraska; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Roswell Park Cancer Institute, Buffalo, New York; Washington University-Siteman Cancer Center, St Louis, Missouri; St. Jude Children's Research Hospital, Memphis, Tennessee; University of Alabama at Birmingham, Birmingham, Alabama; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Yale University School of Medicine; New Haven, Connecticut; University of Utah, Salt Lake City, Utah; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; City of Hope Cancer Center, Los Angeles, California; The University of Texas MD Anderson Cancer Center, Houston, Texas; and Mayo Clinic Cancer Center, Scottsdale, Arizona
| | - Stephen T Oh
- From Northwestern University Feinberg School of Medicine, Chicago, Illinois; Stanford Cancer Institute, Stanford University, Stanford, California; Duke Cancer Institute, Duke University, Durham, North Carolina; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; University of California, San Francisco, San Francisco, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; Moores Cancer Center, UC San Diego, San Diego, California; University of Colorado Cancer Center, Aurora, Colorado; Fred Hutchinson Cancer Research Center, Seattle, Washington; Dana Farber Cancer Institute, Boston, Massachusetts; Memorial Sloan Kettering Cancer Center, New York; New York; Moffitt Cancer Center and Research Institute, Tampa, Florida; The Ohio State University, Columbus, Ohio; Fred & Pamela Buffett Cancer Center, Omaha, Nebraska; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Roswell Park Cancer Institute, Buffalo, New York; Washington University-Siteman Cancer Center, St Louis, Missouri; St. Jude Children's Research Hospital, Memphis, Tennessee; University of Alabama at Birmingham, Birmingham, Alabama; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Yale University School of Medicine; New Haven, Connecticut; University of Utah, Salt Lake City, Utah; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; City of Hope Cancer Center, Los Angeles, California; The University of Texas MD Anderson Cancer Center, Houston, Texas; and Mayo Clinic Cancer Center, Scottsdale, Arizona
| | - Raul Ribeiro
- From Northwestern University Feinberg School of Medicine, Chicago, Illinois; Stanford Cancer Institute, Stanford University, Stanford, California; Duke Cancer Institute, Duke University, Durham, North Carolina; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; University of California, San Francisco, San Francisco, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; Moores Cancer Center, UC San Diego, San Diego, California; University of Colorado Cancer Center, Aurora, Colorado; Fred Hutchinson Cancer Research Center, Seattle, Washington; Dana Farber Cancer Institute, Boston, Massachusetts; Memorial Sloan Kettering Cancer Center, New York; New York; Moffitt Cancer Center and Research Institute, Tampa, Florida; The Ohio State University, Columbus, Ohio; Fred & Pamela Buffett Cancer Center, Omaha, Nebraska; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Roswell Park Cancer Institute, Buffalo, New York; Washington University-Siteman Cancer Center, St Louis, Missouri; St. Jude Children's Research Hospital, Memphis, Tennessee; University of Alabama at Birmingham, Birmingham, Alabama; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Yale University School of Medicine; New Haven, Connecticut; University of Utah, Salt Lake City, Utah; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; City of Hope Cancer Center, Los Angeles, California; The University of Texas MD Anderson Cancer Center, Houston, Texas; and Mayo Clinic Cancer Center, Scottsdale, Arizona
| | - Rita Paschal
- From Northwestern University Feinberg School of Medicine, Chicago, Illinois; Stanford Cancer Institute, Stanford University, Stanford, California; Duke Cancer Institute, Duke University, Durham, North Carolina; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; University of California, San Francisco, San Francisco, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; Moores Cancer Center, UC San Diego, San Diego, California; University of Colorado Cancer Center, Aurora, Colorado; Fred Hutchinson Cancer Research Center, Seattle, Washington; Dana Farber Cancer Institute, Boston, Massachusetts; Memorial Sloan Kettering Cancer Center, New York; New York; Moffitt Cancer Center and Research Institute, Tampa, Florida; The Ohio State University, Columbus, Ohio; Fred & Pamela Buffett Cancer Center, Omaha, Nebraska; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Roswell Park Cancer Institute, Buffalo, New York; Washington University-Siteman Cancer Center, St Louis, Missouri; St. Jude Children's Research Hospital, Memphis, Tennessee; University of Alabama at Birmingham, Birmingham, Alabama; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Yale University School of Medicine; New Haven, Connecticut; University of Utah, Salt Lake City, Utah; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; City of Hope Cancer Center, Los Angeles, California; The University of Texas MD Anderson Cancer Center, Houston, Texas; and Mayo Clinic Cancer Center, Scottsdale, Arizona
| | - Sanjay Mohan
- From Northwestern University Feinberg School of Medicine, Chicago, Illinois; Stanford Cancer Institute, Stanford University, Stanford, California; Duke Cancer Institute, Duke University, Durham, North Carolina; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; University of California, San Francisco, San Francisco, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; Moores Cancer Center, UC San Diego, San Diego, California; University of Colorado Cancer Center, Aurora, Colorado; Fred Hutchinson Cancer Research Center, Seattle, Washington; Dana Farber Cancer Institute, Boston, Massachusetts; Memorial Sloan Kettering Cancer Center, New York; New York; Moffitt Cancer Center and Research Institute, Tampa, Florida; The Ohio State University, Columbus, Ohio; Fred & Pamela Buffett Cancer Center, Omaha, Nebraska; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Roswell Park Cancer Institute, Buffalo, New York; Washington University-Siteman Cancer Center, St Louis, Missouri; St. Jude Children's Research Hospital, Memphis, Tennessee; University of Alabama at Birmingham, Birmingham, Alabama; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Yale University School of Medicine; New Haven, Connecticut; University of Utah, Salt Lake City, Utah; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; City of Hope Cancer Center, Los Angeles, California; The University of Texas MD Anderson Cancer Center, Houston, Texas; and Mayo Clinic Cancer Center, Scottsdale, Arizona
| | - Nikolai Podoltsev
- From Northwestern University Feinberg School of Medicine, Chicago, Illinois; Stanford Cancer Institute, Stanford University, Stanford, California; Duke Cancer Institute, Duke University, Durham, North Carolina; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; University of California, San Francisco, San Francisco, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; Moores Cancer Center, UC San Diego, San Diego, California; University of Colorado Cancer Center, Aurora, Colorado; Fred Hutchinson Cancer Research Center, Seattle, Washington; Dana Farber Cancer Institute, Boston, Massachusetts; Memorial Sloan Kettering Cancer Center, New York; New York; Moffitt Cancer Center and Research Institute, Tampa, Florida; The Ohio State University, Columbus, Ohio; Fred & Pamela Buffett Cancer Center, Omaha, Nebraska; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Roswell Park Cancer Institute, Buffalo, New York; Washington University-Siteman Cancer Center, St Louis, Missouri; St. Jude Children's Research Hospital, Memphis, Tennessee; University of Alabama at Birmingham, Birmingham, Alabama; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Yale University School of Medicine; New Haven, Connecticut; University of Utah, Salt Lake City, Utah; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; City of Hope Cancer Center, Los Angeles, California; The University of Texas MD Anderson Cancer Center, Houston, Texas; and Mayo Clinic Cancer Center, Scottsdale, Arizona
| | - Josef Prchal
- From Northwestern University Feinberg School of Medicine, Chicago, Illinois; Stanford Cancer Institute, Stanford University, Stanford, California; Duke Cancer Institute, Duke University, Durham, North Carolina; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; University of California, San Francisco, San Francisco, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; Moores Cancer Center, UC San Diego, San Diego, California; University of Colorado Cancer Center, Aurora, Colorado; Fred Hutchinson Cancer Research Center, Seattle, Washington; Dana Farber Cancer Institute, Boston, Massachusetts; Memorial Sloan Kettering Cancer Center, New York; New York; Moffitt Cancer Center and Research Institute, Tampa, Florida; The Ohio State University, Columbus, Ohio; Fred & Pamela Buffett Cancer Center, Omaha, Nebraska; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Roswell Park Cancer Institute, Buffalo, New York; Washington University-Siteman Cancer Center, St Louis, Missouri; St. Jude Children's Research Hospital, Memphis, Tennessee; University of Alabama at Birmingham, Birmingham, Alabama; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Yale University School of Medicine; New Haven, Connecticut; University of Utah, Salt Lake City, Utah; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; City of Hope Cancer Center, Los Angeles, California; The University of Texas MD Anderson Cancer Center, Houston, Texas; and Mayo Clinic Cancer Center, Scottsdale, Arizona
| | - Moshe Talpaz
- From Northwestern University Feinberg School of Medicine, Chicago, Illinois; Stanford Cancer Institute, Stanford University, Stanford, California; Duke Cancer Institute, Duke University, Durham, North Carolina; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; University of California, San Francisco, San Francisco, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; Moores Cancer Center, UC San Diego, San Diego, California; University of Colorado Cancer Center, Aurora, Colorado; Fred Hutchinson Cancer Research Center, Seattle, Washington; Dana Farber Cancer Institute, Boston, Massachusetts; Memorial Sloan Kettering Cancer Center, New York; New York; Moffitt Cancer Center and Research Institute, Tampa, Florida; The Ohio State University, Columbus, Ohio; Fred & Pamela Buffett Cancer Center, Omaha, Nebraska; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Roswell Park Cancer Institute, Buffalo, New York; Washington University-Siteman Cancer Center, St Louis, Missouri; St. Jude Children's Research Hospital, Memphis, Tennessee; University of Alabama at Birmingham, Birmingham, Alabama; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Yale University School of Medicine; New Haven, Connecticut; University of Utah, Salt Lake City, Utah; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; City of Hope Cancer Center, Los Angeles, California; The University of Texas MD Anderson Cancer Center, Houston, Texas; and Mayo Clinic Cancer Center, Scottsdale, Arizona
| | - David Snyder
- From Northwestern University Feinberg School of Medicine, Chicago, Illinois; Stanford Cancer Institute, Stanford University, Stanford, California; Duke Cancer Institute, Duke University, Durham, North Carolina; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; University of California, San Francisco, San Francisco, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; Moores Cancer Center, UC San Diego, San Diego, California; University of Colorado Cancer Center, Aurora, Colorado; Fred Hutchinson Cancer Research Center, Seattle, Washington; Dana Farber Cancer Institute, Boston, Massachusetts; Memorial Sloan Kettering Cancer Center, New York; New York; Moffitt Cancer Center and Research Institute, Tampa, Florida; The Ohio State University, Columbus, Ohio; Fred & Pamela Buffett Cancer Center, Omaha, Nebraska; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Roswell Park Cancer Institute, Buffalo, New York; Washington University-Siteman Cancer Center, St Louis, Missouri; St. Jude Children's Research Hospital, Memphis, Tennessee; University of Alabama at Birmingham, Birmingham, Alabama; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Yale University School of Medicine; New Haven, Connecticut; University of Utah, Salt Lake City, Utah; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; City of Hope Cancer Center, Los Angeles, California; The University of Texas MD Anderson Cancer Center, Houston, Texas; and Mayo Clinic Cancer Center, Scottsdale, Arizona
| | - Srdan Verstovsek
- From Northwestern University Feinberg School of Medicine, Chicago, Illinois; Stanford Cancer Institute, Stanford University, Stanford, California; Duke Cancer Institute, Duke University, Durham, North Carolina; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; University of California, San Francisco, San Francisco, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; Moores Cancer Center, UC San Diego, San Diego, California; University of Colorado Cancer Center, Aurora, Colorado; Fred Hutchinson Cancer Research Center, Seattle, Washington; Dana Farber Cancer Institute, Boston, Massachusetts; Memorial Sloan Kettering Cancer Center, New York; New York; Moffitt Cancer Center and Research Institute, Tampa, Florida; The Ohio State University, Columbus, Ohio; Fred & Pamela Buffett Cancer Center, Omaha, Nebraska; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Roswell Park Cancer Institute, Buffalo, New York; Washington University-Siteman Cancer Center, St Louis, Missouri; St. Jude Children's Research Hospital, Memphis, Tennessee; University of Alabama at Birmingham, Birmingham, Alabama; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Yale University School of Medicine; New Haven, Connecticut; University of Utah, Salt Lake City, Utah; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; City of Hope Cancer Center, Los Angeles, California; The University of Texas MD Anderson Cancer Center, Houston, Texas; and Mayo Clinic Cancer Center, Scottsdale, Arizona
| | - Ruben A Mesa
- From Northwestern University Feinberg School of Medicine, Chicago, Illinois; Stanford Cancer Institute, Stanford University, Stanford, California; Duke Cancer Institute, Duke University, Durham, North Carolina; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; University of California, San Francisco, San Francisco, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; Moores Cancer Center, UC San Diego, San Diego, California; University of Colorado Cancer Center, Aurora, Colorado; Fred Hutchinson Cancer Research Center, Seattle, Washington; Dana Farber Cancer Institute, Boston, Massachusetts; Memorial Sloan Kettering Cancer Center, New York; New York; Moffitt Cancer Center and Research Institute, Tampa, Florida; The Ohio State University, Columbus, Ohio; Fred & Pamela Buffett Cancer Center, Omaha, Nebraska; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Roswell Park Cancer Institute, Buffalo, New York; Washington University-Siteman Cancer Center, St Louis, Missouri; St. Jude Children's Research Hospital, Memphis, Tennessee; University of Alabama at Birmingham, Birmingham, Alabama; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Yale University School of Medicine; New Haven, Connecticut; University of Utah, Salt Lake City, Utah; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; City of Hope Cancer Center, Los Angeles, California; The University of Texas MD Anderson Cancer Center, Houston, Texas; and Mayo Clinic Cancer Center, Scottsdale, Arizona
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85
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Sørensen AL, Hasselbalch HC. Antecedent cardiovascular disease and autoimmunity in Philadelphia-negative chronic myeloproliferative neoplasms. Leuk Res 2016; 41:27-35. [DOI: 10.1016/j.leukres.2015.11.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 11/14/2015] [Accepted: 11/28/2015] [Indexed: 01/07/2023]
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86
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Tefferi A. Myeloproliferative neoplasms: A decade of discoveries and treatment advances. Am J Hematol 2016; 91:50-8. [PMID: 26492355 DOI: 10.1002/ajh.24221] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 10/19/2015] [Indexed: 12/14/2022]
Abstract
Myeloproliferative neoplasms (MPN) are clonal stem cell diseases, first conceptualized in 1951 by William Dameshek, and historically included chronic myeloid leukemia (CML), polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF). In 1960, Nowell and Hungerford discovered an invariable association between the Philadelphia chromosome (subsequently shown to harbor the causal BCR-ABL1 mutation) and CML; accordingly, the term MPN is primarily reserved for PV, ET, and PMF, although it includes other related clinicopathologic entities, according to the World Health Organization (WHO) classification system. In 2005, William Vainchenker and others described a Janus kinase 2 mutation (JAK2V617F) in MPN and this was followed by a series of additional descriptions of mutations that directly or indirectly activate JAK-STAT: JAK2 exon 12, myeloproliferative leukemia virus oncogene (MPL) and calreticulin (CALR) mutations. The discovery of these, mostly mutually exclusive, "driver" mutations has contributed to revisions of the WHO diagnostic criteria and risk stratification in MPN. Mutations other than JAK2, CALR and MPL have also been described in MPN and shown to provide additional prognostic information. From the standpoint of treatment, over the last 50 years, Louis Wasserman from the Unites States and Tiziano Barbui from Italy had skillfully organized and led a number of important clinical trials, whose results form the basis for current treatment strategies in MPN. More recently, allogeneic stem cell transplant, as a potentially curative treatment modality, and JAK inhibitors, as palliative drugs, have been added to the overall therapeutic armamentarium in myelofibrosis. In the current review, I will summarize the important advances made in the last 10 years regarding the science and practice of MPN.
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Affiliation(s)
- Ayalew Tefferi
- Division of Hematology, Department of Medicine; Mayo Clinic; Rochester Minnesota
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87
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Clinical impact of bone marrow morphology for the diagnosis of essential thrombocythemia: comparison between the BCSH and the WHO criteria. Leukemia 2015; 30:1126-32. [PMID: 26710883 PMCID: PMC4858583 DOI: 10.1038/leu.2015.360] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 11/12/2015] [Accepted: 12/14/2015] [Indexed: 02/08/2023]
Abstract
Essential thrombocythemia (ET) is currently diagnosed either by the British Committee of Standards in Haematology (BCSH) criteria that are predominantly based on exclusion and not necessarily on bone marrow (BM) morphology, or the World Health Organization (WHO) criteria that require BM examination as essential criterion. We studied the morphological and clinical features in patients diagnosed according either to the BCSH (n=238) or the WHO guidelines (n=232). The BCSH-defined ET cohort was re-evaluated by applying the WHO classification. At presentation, patients of the BCSH group showed significantly higher values of serum lactate dehydrogenase and had palpable splenomegaly more frequently. Following the WHO criteria, the re-evaluation of the BCSH-diagnosed ET cohort displayed a heterogeneous population with 141 (59.2%) ET, 77 (32.4%) prefibrotic primary myelofibrosis (prePMF), 16 (6.7%) polycythemia vera and 4 (1.7%) primary myelofibrosis. Contrasting WHO-confirmed ET, the BCSH cohort revealed a significant worsening of fibrosis-free survival and prognosis. As demonstrated by the clinical data and different outcomes between WHO-diagnosed ET and prePMF, these adverse features were generated by the inadvertent inclusion of prePMF to the BCSH group. Taken together, the diagnosis of ET without a scrutinized examination of BM biopsy specimens will generate a heterogeneous cohort of patients impairing an appropriate clinical management.
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88
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Bai J, Ai L, Zhang L, Yang FC, Zhou Y, Xue Y. Incidence and risk factors for myelofibrotic transformation among 272 Chinese patients with JAK2-mutated polycythemia vera. Am J Hematol 2015; 90:1116-21. [PMID: 26370613 DOI: 10.1002/ajh.24191] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 09/05/2015] [Accepted: 09/10/2015] [Indexed: 01/30/2023]
Abstract
Post-polycythemia vera myelofibrosis (post-PV MF) is a critical hematologic evolution of polycythemia vera (PV). The main purpose of the present study was to identify the possible risk factors for the occurrence and prognosis of post-PV MF in Chinese patients with PV. A cohort of 272 Chinese PV patients with JAK2(V617F) or exon12 mutation was retrospectively analyzed. Of the 272 patients with PV, 63 developed post-PV MF. Platelet count >550 × 10(9) /L and splenomegaly were identified as independent risk factors for post-PV MF. The median duration of survival for post-PV MF patients was 8 years. Anemia and age >65 years at diagnosis of post-PV MF were identified as significant predictors for the poor prognosis of post-PV MF. In conclusion, platelet counts and splenomegaly were significant predictors for the transformation to post-PV MF, while anemia (hemoglobin levels <100 g/L) and age>65 years were significant predictors for poor prognosis of post-PV MF in Chinese PV patients with JAK2(V617F) or exon12 mutation.
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Affiliation(s)
- Jie Bai
- State Key Laboratory of Experimental Hematology; Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College; Tianjin People's Republic of China
| | - Limei Ai
- Department of Hematology; The First Affiliated Hospital of Liaoning Medical University; Jinzhou People's Republic of China
| | - Lei Zhang
- State Key Laboratory of Experimental Hematology; Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College; Tianjin People's Republic of China
| | - Feng-Chun Yang
- Department of Biochemistry and Molecular Biology; Sylvester Comprehensive Cancer Center, University of Miami Leonard M. Miller School of Medicine; Miami Florida
| | - Yuan Zhou
- State Key Laboratory of Experimental Hematology; Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College; Tianjin People's Republic of China
| | - Yanping Xue
- State Key Laboratory of Experimental Hematology; Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College; Tianjin People's Republic of China
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89
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Cerquozzi S, Tefferi A. Blast transformation and fibrotic progression in polycythemia vera and essential thrombocythemia: a literature review of incidence and risk factors. Blood Cancer J 2015; 5:e366. [PMID: 26565403 PMCID: PMC4670948 DOI: 10.1038/bcj.2015.95] [Citation(s) in RCA: 176] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Accepted: 09/18/2015] [Indexed: 12/12/2022] Open
Abstract
Polycythemia vera (PV) and essential thrombocythemia (ET) constitute two of the three BCR-ABL1-negative myeloproliferative neoplasms and are characterized by relatively long median survivals (approximately 14 and 20 years, respectively). Potentially fatal disease complications in PV and ET include disease transformation into myelofibrosis (MF) or acute myeloid leukemia (AML). The range of reported frequencies for post-PV MF were 4.9–6% at 10 years and 6–14% at 15 years and for post-ET MF were 0.8–4.9% at 10 years and 4–11% at 15 years. The corresponding figures for post-PV AML were 2.3–14.4% at 10 years and 5.5–18.7% at 15 years and for post-ET AML were 0.7–3% at 10 years and 2.1–5.3% at 15 years. Risk factors cited for post-PV MF include advanced age, leukocytosis, reticulin fibrosis, splenomegaly and JAK2V617F allele burden and for post-ET MF include advanced age, leukocytosis, anemia, reticulin fibrosis, absence of JAK2V617F, use of anagrelide and presence of ASXL1 mutation. Risk factors for post-PV AML include advanced age, leukocytosis, reticulin fibrosis, splenomegaly, abnormal karyotype, TP53 or RUNX1 mutations as well as use of pipobroman, radiophosphorus (P32) and busulfan and for post-ET AML include advanced age, leukocytosis, anemia, extreme thrombocytosis, thrombosis, reticulin fibrosis, TP53 or RUNX1 mutations. It is important to note that some of the aforementioned incidence figures and risk factor determinations are probably inaccurate and at times conflicting because of the retrospective nature of studies and the inadvertent labeling, in some studies, of patients with prefibrotic primary MF or ‘masked' PV, as ET. Ultimately, transformation of MPN leads to poor outcomes and management remains challenging. Further understanding of the molecular events leading to disease transformation is being investigated.
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Affiliation(s)
- S Cerquozzi
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - A Tefferi
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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90
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Chu D, Cho YU, Jang S, Seo EJ, Park CJ. Straightforward identification of masked polycythemia vera based on proposed revision of World Health Organization diagnostic criteria for BCR-ABL1-negative myeloproliferative neoplasms. Ann Lab Med 2015; 35:651-3. [PMID: 26354357 PMCID: PMC4579113 DOI: 10.3343/alm.2015.35.6.651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 03/06/2015] [Accepted: 07/17/2015] [Indexed: 11/30/2022] Open
Affiliation(s)
- Daehyun Chu
- Department of Laboratory Medicine, University of Ulsan, College of Medicine and Asan Medical Center, Seoul, Korea
| | - Young Uk Cho
- Department of Laboratory Medicine, University of Ulsan, College of Medicine and Asan Medical Center, Seoul, Korea.
| | - Seongsoo Jang
- Department of Laboratory Medicine, University of Ulsan, College of Medicine and Asan Medical Center, Seoul, Korea
| | - Eul Ju Seo
- Department of Laboratory Medicine, University of Ulsan, College of Medicine and Asan Medical Center, Seoul, Korea
| | - Chan Jeoung Park
- Department of Laboratory Medicine, University of Ulsan, College of Medicine and Asan Medical Center, Seoul, Korea
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91
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Tefferi A, Barbui T. Essential Thrombocythemia and Polycythemia Vera: Focus on Clinical Practice. Mayo Clin Proc 2015; 90:1283-93. [PMID: 26355403 DOI: 10.1016/j.mayocp.2015.05.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 05/14/2015] [Accepted: 05/20/2015] [Indexed: 02/07/2023]
Abstract
Bone marrow (BM) morphologic features remain the cornerstone of diagnosis in both essential thrombocythemia (ET) and polycythemia vera (PV). In addition, recently discovered mutations, such as JAK2, CALR, and MPL, have proven useful in facilitating the diagnostic process. A JAK2 mutation is expected in PV, and its absence makes the diagnosis unlikely. However, JAK2 mutations also occur in about 60% of patients with ET, which underlines the need for BM examination in distinguishing JAK2-mutated ET from PV when the hemoglobin/hematocrit level is diagnostically equivocal (ie, as in "masked" PV). Most patients with JAK2-unmutated ET express CALR or MPL mutations, with respective estimated incidences of 22% and 3%, while approxmately 15% are wild-type for all 3 mutations (ie, they are triple-negative). As such, CALR first, followed by MPL if CALR is absent, mutation screening is appropriate in the diagnostic work-up of JAK2-unmutated ET but does not replace the need for BM morphologic examination in (1) confirming the diagnosis in triple-negative ET and (2) distinguishing ET from other myeloproliferative neoplasms that share the same mutations, including masked PV and early/prefibrotic myelofibrosis. Young patients (aged < 60 years) with ET or PV and no history of thrombosis are conventionally regarded as having "low-risk" disease. First-line treatment in low-risk PV is phlebotomy to achieve a hematocrit target of 45% and low-dose aspirin, and first-line treatment in ET is observation alone in the absence of additional risk factors for arterial thrombosis (ie, JAK2 mutation and cardiovascular risk factors) or low-dose aspirin therapy, once or twice daily, in the presence of one or both of these risk factors, respectively. Cytoreductive therapy is indicated in high-risk (patients aged ≥ 60 years or a history of thrombosis) PV or ET in the form of hydroxyurea as first-line and interferon alfa or busulfan as second-line drugs of choice. We do not use ruxolitinib in patients with PV unless they have severe pruritus or symptomatic splenomegaly that is proved to be refractory to hydroxyurea, interferon alfa, and busulfan.
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Affiliation(s)
- Ayalew Tefferi
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN.
| | - Tiziano Barbui
- Research Foundation, Papa Giovanni XXIII Hospital, Bergamo, Italy
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92
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Stein BL, Oh ST, Berenzon D, Hobbs GS, Kremyanskaya M, Rampal RK, Abboud CN, Adler K, Heaney ML, Jabbour EJ, Komrokji RS, Moliterno AR, Ritchie EK, Rice L, Mascarenhas J, Hoffman R. Polycythemia Vera: An Appraisal of the Biology and Management 10 Years After the Discovery of JAK2 V617F. J Clin Oncol 2015; 33:3953-60. [PMID: 26324368 DOI: 10.1200/jco.2015.61.6474] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Polycythemia vera (PV) is a chronic myeloproliferative neoplasm that is associated with a substantial symptom burden, thrombohemorrhagic complications, and impaired survival. A decade after the seminal discovery of an activating mutation in the tyrosine kinase JAK2 in nearly all patients with PV, new treatment options are finally beginning to emerge, necessitating a critical reappraisal of the underlying pathogenesis and therapeutic modalities available for PV. Herein, we comprehensively review clinical aspects of PV including diagnostic considerations, natural history, and risk factors for thrombosis. We summarize recent studies delineating the genetic basis of PV, including their implications for evolution to myelofibrosis and secondary acute myeloid leukemia. We assess the quality of evidence to support the use of currently available therapies, including aspirin, phlebotomy, hydroxyurea, and interferon. We analyze recent studies evaluating the safety and efficacy of JAK inhibitors, such as ruxolitinib, and evaluate their role in the context of other available therapies for PV. This review provides a framework for practicing hematologists and oncologists to make rational treatment decisions for patients with PV.
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Affiliation(s)
- Brady L Stein
- Brady L. Stein, Northwestern Feinberg University School of Medicine, Chicago, IL; Stephen T. Oh and Camille Abboud, Washington University School of Medicine, St Louis, MO; Dmitriy Berenzon, Wake Forest University School of Medicine, Winston Salem, NC; Gabriela S. Hobbs, Massachusetts General Hospital, Boston, MA; Marina Kremyanskaya, John Mascarenhas, and Ronald Hoffman, Mount Sinai School of Medicine; Raajit K. Rampal, Memorial Sloan Kettering Cancer Center; Mark L. Heaney, Columbia University Medical Center; Ellen K. Ritchie, Cornell University School of Medicine, New York, NY; Kenneth Adler, Regional Cancer Care Associates, Morristown, NJ; Elias J. Jabbour, MD Anderson Cancer Center; Lawrence Rice, Cornell Houston Methodist Hospital, Houston, TX; Rami S. Komrokji, Moffitt Cancer Center, Tampa, FL; and Alison R. Moliterno, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Stephen T Oh
- Brady L. Stein, Northwestern Feinberg University School of Medicine, Chicago, IL; Stephen T. Oh and Camille Abboud, Washington University School of Medicine, St Louis, MO; Dmitriy Berenzon, Wake Forest University School of Medicine, Winston Salem, NC; Gabriela S. Hobbs, Massachusetts General Hospital, Boston, MA; Marina Kremyanskaya, John Mascarenhas, and Ronald Hoffman, Mount Sinai School of Medicine; Raajit K. Rampal, Memorial Sloan Kettering Cancer Center; Mark L. Heaney, Columbia University Medical Center; Ellen K. Ritchie, Cornell University School of Medicine, New York, NY; Kenneth Adler, Regional Cancer Care Associates, Morristown, NJ; Elias J. Jabbour, MD Anderson Cancer Center; Lawrence Rice, Cornell Houston Methodist Hospital, Houston, TX; Rami S. Komrokji, Moffitt Cancer Center, Tampa, FL; and Alison R. Moliterno, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dmitriy Berenzon
- Brady L. Stein, Northwestern Feinberg University School of Medicine, Chicago, IL; Stephen T. Oh and Camille Abboud, Washington University School of Medicine, St Louis, MO; Dmitriy Berenzon, Wake Forest University School of Medicine, Winston Salem, NC; Gabriela S. Hobbs, Massachusetts General Hospital, Boston, MA; Marina Kremyanskaya, John Mascarenhas, and Ronald Hoffman, Mount Sinai School of Medicine; Raajit K. Rampal, Memorial Sloan Kettering Cancer Center; Mark L. Heaney, Columbia University Medical Center; Ellen K. Ritchie, Cornell University School of Medicine, New York, NY; Kenneth Adler, Regional Cancer Care Associates, Morristown, NJ; Elias J. Jabbour, MD Anderson Cancer Center; Lawrence Rice, Cornell Houston Methodist Hospital, Houston, TX; Rami S. Komrokji, Moffitt Cancer Center, Tampa, FL; and Alison R. Moliterno, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Gabriela S Hobbs
- Brady L. Stein, Northwestern Feinberg University School of Medicine, Chicago, IL; Stephen T. Oh and Camille Abboud, Washington University School of Medicine, St Louis, MO; Dmitriy Berenzon, Wake Forest University School of Medicine, Winston Salem, NC; Gabriela S. Hobbs, Massachusetts General Hospital, Boston, MA; Marina Kremyanskaya, John Mascarenhas, and Ronald Hoffman, Mount Sinai School of Medicine; Raajit K. Rampal, Memorial Sloan Kettering Cancer Center; Mark L. Heaney, Columbia University Medical Center; Ellen K. Ritchie, Cornell University School of Medicine, New York, NY; Kenneth Adler, Regional Cancer Care Associates, Morristown, NJ; Elias J. Jabbour, MD Anderson Cancer Center; Lawrence Rice, Cornell Houston Methodist Hospital, Houston, TX; Rami S. Komrokji, Moffitt Cancer Center, Tampa, FL; and Alison R. Moliterno, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Marina Kremyanskaya
- Brady L. Stein, Northwestern Feinberg University School of Medicine, Chicago, IL; Stephen T. Oh and Camille Abboud, Washington University School of Medicine, St Louis, MO; Dmitriy Berenzon, Wake Forest University School of Medicine, Winston Salem, NC; Gabriela S. Hobbs, Massachusetts General Hospital, Boston, MA; Marina Kremyanskaya, John Mascarenhas, and Ronald Hoffman, Mount Sinai School of Medicine; Raajit K. Rampal, Memorial Sloan Kettering Cancer Center; Mark L. Heaney, Columbia University Medical Center; Ellen K. Ritchie, Cornell University School of Medicine, New York, NY; Kenneth Adler, Regional Cancer Care Associates, Morristown, NJ; Elias J. Jabbour, MD Anderson Cancer Center; Lawrence Rice, Cornell Houston Methodist Hospital, Houston, TX; Rami S. Komrokji, Moffitt Cancer Center, Tampa, FL; and Alison R. Moliterno, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Raajit K Rampal
- Brady L. Stein, Northwestern Feinberg University School of Medicine, Chicago, IL; Stephen T. Oh and Camille Abboud, Washington University School of Medicine, St Louis, MO; Dmitriy Berenzon, Wake Forest University School of Medicine, Winston Salem, NC; Gabriela S. Hobbs, Massachusetts General Hospital, Boston, MA; Marina Kremyanskaya, John Mascarenhas, and Ronald Hoffman, Mount Sinai School of Medicine; Raajit K. Rampal, Memorial Sloan Kettering Cancer Center; Mark L. Heaney, Columbia University Medical Center; Ellen K. Ritchie, Cornell University School of Medicine, New York, NY; Kenneth Adler, Regional Cancer Care Associates, Morristown, NJ; Elias J. Jabbour, MD Anderson Cancer Center; Lawrence Rice, Cornell Houston Methodist Hospital, Houston, TX; Rami S. Komrokji, Moffitt Cancer Center, Tampa, FL; and Alison R. Moliterno, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Camille N Abboud
- Brady L. Stein, Northwestern Feinberg University School of Medicine, Chicago, IL; Stephen T. Oh and Camille Abboud, Washington University School of Medicine, St Louis, MO; Dmitriy Berenzon, Wake Forest University School of Medicine, Winston Salem, NC; Gabriela S. Hobbs, Massachusetts General Hospital, Boston, MA; Marina Kremyanskaya, John Mascarenhas, and Ronald Hoffman, Mount Sinai School of Medicine; Raajit K. Rampal, Memorial Sloan Kettering Cancer Center; Mark L. Heaney, Columbia University Medical Center; Ellen K. Ritchie, Cornell University School of Medicine, New York, NY; Kenneth Adler, Regional Cancer Care Associates, Morristown, NJ; Elias J. Jabbour, MD Anderson Cancer Center; Lawrence Rice, Cornell Houston Methodist Hospital, Houston, TX; Rami S. Komrokji, Moffitt Cancer Center, Tampa, FL; and Alison R. Moliterno, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kenneth Adler
- Brady L. Stein, Northwestern Feinberg University School of Medicine, Chicago, IL; Stephen T. Oh and Camille Abboud, Washington University School of Medicine, St Louis, MO; Dmitriy Berenzon, Wake Forest University School of Medicine, Winston Salem, NC; Gabriela S. Hobbs, Massachusetts General Hospital, Boston, MA; Marina Kremyanskaya, John Mascarenhas, and Ronald Hoffman, Mount Sinai School of Medicine; Raajit K. Rampal, Memorial Sloan Kettering Cancer Center; Mark L. Heaney, Columbia University Medical Center; Ellen K. Ritchie, Cornell University School of Medicine, New York, NY; Kenneth Adler, Regional Cancer Care Associates, Morristown, NJ; Elias J. Jabbour, MD Anderson Cancer Center; Lawrence Rice, Cornell Houston Methodist Hospital, Houston, TX; Rami S. Komrokji, Moffitt Cancer Center, Tampa, FL; and Alison R. Moliterno, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mark L Heaney
- Brady L. Stein, Northwestern Feinberg University School of Medicine, Chicago, IL; Stephen T. Oh and Camille Abboud, Washington University School of Medicine, St Louis, MO; Dmitriy Berenzon, Wake Forest University School of Medicine, Winston Salem, NC; Gabriela S. Hobbs, Massachusetts General Hospital, Boston, MA; Marina Kremyanskaya, John Mascarenhas, and Ronald Hoffman, Mount Sinai School of Medicine; Raajit K. Rampal, Memorial Sloan Kettering Cancer Center; Mark L. Heaney, Columbia University Medical Center; Ellen K. Ritchie, Cornell University School of Medicine, New York, NY; Kenneth Adler, Regional Cancer Care Associates, Morristown, NJ; Elias J. Jabbour, MD Anderson Cancer Center; Lawrence Rice, Cornell Houston Methodist Hospital, Houston, TX; Rami S. Komrokji, Moffitt Cancer Center, Tampa, FL; and Alison R. Moliterno, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Elias J Jabbour
- Brady L. Stein, Northwestern Feinberg University School of Medicine, Chicago, IL; Stephen T. Oh and Camille Abboud, Washington University School of Medicine, St Louis, MO; Dmitriy Berenzon, Wake Forest University School of Medicine, Winston Salem, NC; Gabriela S. Hobbs, Massachusetts General Hospital, Boston, MA; Marina Kremyanskaya, John Mascarenhas, and Ronald Hoffman, Mount Sinai School of Medicine; Raajit K. Rampal, Memorial Sloan Kettering Cancer Center; Mark L. Heaney, Columbia University Medical Center; Ellen K. Ritchie, Cornell University School of Medicine, New York, NY; Kenneth Adler, Regional Cancer Care Associates, Morristown, NJ; Elias J. Jabbour, MD Anderson Cancer Center; Lawrence Rice, Cornell Houston Methodist Hospital, Houston, TX; Rami S. Komrokji, Moffitt Cancer Center, Tampa, FL; and Alison R. Moliterno, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Rami S Komrokji
- Brady L. Stein, Northwestern Feinberg University School of Medicine, Chicago, IL; Stephen T. Oh and Camille Abboud, Washington University School of Medicine, St Louis, MO; Dmitriy Berenzon, Wake Forest University School of Medicine, Winston Salem, NC; Gabriela S. Hobbs, Massachusetts General Hospital, Boston, MA; Marina Kremyanskaya, John Mascarenhas, and Ronald Hoffman, Mount Sinai School of Medicine; Raajit K. Rampal, Memorial Sloan Kettering Cancer Center; Mark L. Heaney, Columbia University Medical Center; Ellen K. Ritchie, Cornell University School of Medicine, New York, NY; Kenneth Adler, Regional Cancer Care Associates, Morristown, NJ; Elias J. Jabbour, MD Anderson Cancer Center; Lawrence Rice, Cornell Houston Methodist Hospital, Houston, TX; Rami S. Komrokji, Moffitt Cancer Center, Tampa, FL; and Alison R. Moliterno, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Alison R Moliterno
- Brady L. Stein, Northwestern Feinberg University School of Medicine, Chicago, IL; Stephen T. Oh and Camille Abboud, Washington University School of Medicine, St Louis, MO; Dmitriy Berenzon, Wake Forest University School of Medicine, Winston Salem, NC; Gabriela S. Hobbs, Massachusetts General Hospital, Boston, MA; Marina Kremyanskaya, John Mascarenhas, and Ronald Hoffman, Mount Sinai School of Medicine; Raajit K. Rampal, Memorial Sloan Kettering Cancer Center; Mark L. Heaney, Columbia University Medical Center; Ellen K. Ritchie, Cornell University School of Medicine, New York, NY; Kenneth Adler, Regional Cancer Care Associates, Morristown, NJ; Elias J. Jabbour, MD Anderson Cancer Center; Lawrence Rice, Cornell Houston Methodist Hospital, Houston, TX; Rami S. Komrokji, Moffitt Cancer Center, Tampa, FL; and Alison R. Moliterno, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ellen K Ritchie
- Brady L. Stein, Northwestern Feinberg University School of Medicine, Chicago, IL; Stephen T. Oh and Camille Abboud, Washington University School of Medicine, St Louis, MO; Dmitriy Berenzon, Wake Forest University School of Medicine, Winston Salem, NC; Gabriela S. Hobbs, Massachusetts General Hospital, Boston, MA; Marina Kremyanskaya, John Mascarenhas, and Ronald Hoffman, Mount Sinai School of Medicine; Raajit K. Rampal, Memorial Sloan Kettering Cancer Center; Mark L. Heaney, Columbia University Medical Center; Ellen K. Ritchie, Cornell University School of Medicine, New York, NY; Kenneth Adler, Regional Cancer Care Associates, Morristown, NJ; Elias J. Jabbour, MD Anderson Cancer Center; Lawrence Rice, Cornell Houston Methodist Hospital, Houston, TX; Rami S. Komrokji, Moffitt Cancer Center, Tampa, FL; and Alison R. Moliterno, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lawrence Rice
- Brady L. Stein, Northwestern Feinberg University School of Medicine, Chicago, IL; Stephen T. Oh and Camille Abboud, Washington University School of Medicine, St Louis, MO; Dmitriy Berenzon, Wake Forest University School of Medicine, Winston Salem, NC; Gabriela S. Hobbs, Massachusetts General Hospital, Boston, MA; Marina Kremyanskaya, John Mascarenhas, and Ronald Hoffman, Mount Sinai School of Medicine; Raajit K. Rampal, Memorial Sloan Kettering Cancer Center; Mark L. Heaney, Columbia University Medical Center; Ellen K. Ritchie, Cornell University School of Medicine, New York, NY; Kenneth Adler, Regional Cancer Care Associates, Morristown, NJ; Elias J. Jabbour, MD Anderson Cancer Center; Lawrence Rice, Cornell Houston Methodist Hospital, Houston, TX; Rami S. Komrokji, Moffitt Cancer Center, Tampa, FL; and Alison R. Moliterno, Johns Hopkins University School of Medicine, Baltimore, MD
| | - John Mascarenhas
- Brady L. Stein, Northwestern Feinberg University School of Medicine, Chicago, IL; Stephen T. Oh and Camille Abboud, Washington University School of Medicine, St Louis, MO; Dmitriy Berenzon, Wake Forest University School of Medicine, Winston Salem, NC; Gabriela S. Hobbs, Massachusetts General Hospital, Boston, MA; Marina Kremyanskaya, John Mascarenhas, and Ronald Hoffman, Mount Sinai School of Medicine; Raajit K. Rampal, Memorial Sloan Kettering Cancer Center; Mark L. Heaney, Columbia University Medical Center; Ellen K. Ritchie, Cornell University School of Medicine, New York, NY; Kenneth Adler, Regional Cancer Care Associates, Morristown, NJ; Elias J. Jabbour, MD Anderson Cancer Center; Lawrence Rice, Cornell Houston Methodist Hospital, Houston, TX; Rami S. Komrokji, Moffitt Cancer Center, Tampa, FL; and Alison R. Moliterno, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ronald Hoffman
- Brady L. Stein, Northwestern Feinberg University School of Medicine, Chicago, IL; Stephen T. Oh and Camille Abboud, Washington University School of Medicine, St Louis, MO; Dmitriy Berenzon, Wake Forest University School of Medicine, Winston Salem, NC; Gabriela S. Hobbs, Massachusetts General Hospital, Boston, MA; Marina Kremyanskaya, John Mascarenhas, and Ronald Hoffman, Mount Sinai School of Medicine; Raajit K. Rampal, Memorial Sloan Kettering Cancer Center; Mark L. Heaney, Columbia University Medical Center; Ellen K. Ritchie, Cornell University School of Medicine, New York, NY; Kenneth Adler, Regional Cancer Care Associates, Morristown, NJ; Elias J. Jabbour, MD Anderson Cancer Center; Lawrence Rice, Cornell Houston Methodist Hospital, Houston, TX; Rami S. Komrokji, Moffitt Cancer Center, Tampa, FL; and Alison R. Moliterno, Johns Hopkins University School of Medicine, Baltimore, MD.
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93
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Rationale for revision and proposed changes of the WHO diagnostic criteria for polycythemia vera, essential thrombocythemia and primary myelofibrosis. Blood Cancer J 2015; 5:e337. [PMID: 26832847 PMCID: PMC4558589 DOI: 10.1038/bcj.2015.64] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 06/30/2015] [Indexed: 12/19/2022] Open
Abstract
The 2001/2008 World Health Organization (WHO)-based diagnostic criteria for polycythemia vera (PV), essential thrombocythemia (ET) and primary myelofibrosis (PMF) were recently revised to accomodate new information on disease-specific mutations and underscore distinguishing morphologic features. In this context, it seems to be reasonable to compare first major diagnostic criteria of the former WHO classifications for myeloproliferative neoplasm (MPN) and then to focus on details that have been discussed and will be proposed for the upcoming revision of diagnostic guidelines. In PV, a characteristic bone marrow (BM) morphology was added as one of three major diagnostic criteria, which allowed lowering of the hemoglobin/hematocrit threshold for diagnosis, which is another major criterion, to 16.5 g/dl/49% in men and 16 g/dl/48% in women. The presence of a JAK2 mutation remains the third major diagnostic criterion in PV. Subnormal serum erythropoietin level is now the only minor criterion in PV and is used to capture JAK2-unmutated cases. In ET and PMF, mutations that are considered to confirm clonality and specific diagnosis now include CALR, in addition to JAK2 and MPL. Also in the 2015 discussed revision, overtly fibrotic PMF is clearly distinguished from early/prefibrotic PMF and each PMF variant now includes a separate list of diagnostic criteria. The main rationale for these changes was to enhance the distinction between so-called masked PV and JAK2-mutated ET and between ET and prefibrotic early PMF. The proposed changes also underscore the complementary role, as well as limitations of mutation analysis in morphologic diagnosis. On the other hand, discovery of new biological markers may probably be expected in the future to enhance discrimination of the different MPN subtypes in accordance with the histological BM patterns and corresponding clinical features.
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94
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Abstract
The new World Health Organization (WHO) diagnostic criteria for essential thrombocythemia (ET) issued in 2008 made an important distinction between true ET and early myelofibrosis (MF), which has helped to identify a more homogenous population for the diagnosis with longer survival and much less transformation to overt MF. The recent finding of a new mutation (CALR), which is mutually exclusive with JAK2 and MPL mutations, adds to the characterization of ET patients, since there are important phenotypic differences between the mutation types. CALR patients are younger, have lower white blood cell counts (WBC) and a lower thrombosis incidence. A growing field of interest is the state of hypercoagulation due to dysfunction of hemostatic systems, cell-cell interaction and hereditary prothrombotic traits. Activation of platelets, WBC and endothelial cells has been found, making the whole intravascular milieu prothrombotic. Several risk score models, based on retrospective studies, have been developed lately, distinguishing patient groups with graded risk for complications and death. Even if these may be helpful in evaluating patients, they have not been validated in prospective studies and there are not enough data to support their use as a basis for treatment algorithms. The traditional risk factors age, previous thrombosis and platelets >1500 × 10(9)/l are still recommended for the distinction between high risk and low risk ET and the decision to give cytoreductive therapy. However, cardiovascular (CV) risk factors add to thrombosis risk and should be considered both for specific treatment in any risk group and for upgrading low risk patients with high CV risk to an intermediary group where active therapy with aspirin and cytoreduction may be considered. First-line cytoreductive therapy differs with age; in younger patients interferon (IFN) or anagrelide are preferable, in older patients hydroxycarbamide (HC). Second-line therapy for younger patients is HC, for older patients IFN or anagrelide (ANA). JAK2 inhibitors may be suitable in rare cases with symptoms not responding to other therapy.
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Affiliation(s)
- Gunnar Birgegård
- Department of Medical Sciences, University Hospital, Uppsala University, Uppsala 75185, Sweden
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95
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Pozdnyakova O, Hasserjian RP, Verstovsek S, Orazi A. Impact of bone marrow pathology on the clinical management of Philadelphia chromosome-negative myeloproliferative neoplasms. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2015; 15:253-61. [PMID: 25515354 DOI: 10.1016/j.clml.2014.11.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 11/12/2014] [Indexed: 02/03/2023]
Abstract
Philadelphia chromosome-negative myeloproliferative neoplasms include primary myelofibrosis (PMF), polycythemia vera (PV), and essential thrombocythemia (ET). Although these 3 entities share many pathogenic characteristics, such as dysregulated Janus kinase (JAK)/signal transducer and activator of transcription signaling, they differ substantially regarding prognosis, progression to myelofibrosis (MF), risk of leukemic transformation, and specific medical needs. Accurate diagnosis and classification of myeloproliferative neoplasms are prerequisites for appropriate risk-based therapy and should be based on an integrated approach following the World Health Organization guidelines that, in addition to clinical, molecular, and cytogenetic evaluation, includes the examination of bone marrow morphology. Reticulin fibrosis at presentation in ET and PV is associated with increased risk of myelofibrotic transformation, and higher fibrosis grade in patients with MF is associated with worse prognosis. Additional assessment of collagen deposition and osteosclerosis may further increase diagnostic and prognostic precision. Moreover, the evaluation of bone marrow pathology has become very important in the new era of disease-modifying agents. In randomized controlled phase 3 studies, the JAK1/JAK2 inhibitor ruxolitinib provided rapid and lasting improvement in MF-related splenomegaly and symptom burden as well as a survival advantage compared with placebo or best available therapy. Follow-up for up to 5 years of patients who participated in a phase 1/2 study of ruxolitinib, revealed stabilization or reversal of bone marrow fibrosis in a proportion of patients with MF. Combinations of JAK inhibitors with other therapies, including agents with antifibrotic and/or anti-inflammatory properties, may possibly decrease bone marrow fibrosis further and favorably influence clinical outcomes.
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Affiliation(s)
| | | | | | - Attilio Orazi
- Weill Medical College of Cornell University, New York, NY.
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96
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Alvarez-Larrán A, Angona A, Ancochea A, García-Pallarols F, Fernández C, Longarón R, Bellosillo B, Besses C. Masked polycythaemia vera: presenting features, response to treatment and clinical outcomes. Eur J Haematol 2015; 96:83-9. [PMID: 25810304 DOI: 10.1111/ejh.12552] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2015] [Indexed: 01/23/2023]
Abstract
Masked polycythaemia vera (PV) has been proposed as a new entity with poorer outcome than overt PV. In this study, the initial clinical and laboratory characteristics, response to treatment and outcome of masked and overt PV were compared using red cell mass and haemoglobin or haematocrit levels for the distinction between both entities. Sixty-eight of 151 PV patients (45%) were classified as masked PV according to World Health Organisation diagnostic criteria, whereas 16 (11%) were classified as masked PV using the British Committee for Standards in Haematology (BCSH). In comparison with overt PV, a higher platelet count and a lower JAK2V617F allele burden at diagnosis were observed in masked PV. Patients with masked PV needed lower phlebotomies and responded faster to hydroxcarbamide than those with overt PV. Complete haematological response was more frequently achieved in masked than in overt PV (79% vs. 58%, P = 0.001). There were no significant differences in the duration of haematological response, the rate of resistance or intolerance to hydroxycarbamide and the probability of molecular response according to type of PV (masked vs. overt). Overall survival, rate of thrombosis and major bleeding, and probability of transformation was superimposable among patients with masked and overt PV.
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Affiliation(s)
- Alberto Alvarez-Larrán
- Hematology Department, Hospital del Mar, IMIM, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anna Angona
- Hematology Department, Hospital del Mar, IMIM, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Agueda Ancochea
- Hematology Department, Hospital del Mar, IMIM, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Concepción Fernández
- Pathology Department, Hospital del Mar, IMIM, Universitat Pompeu Fabra, Barcelona, Spain
| | - Raquel Longarón
- Pathology Department, Hospital del Mar, IMIM, Universitat Pompeu Fabra, Barcelona, Spain
| | - Beatriz Bellosillo
- Pathology Department, Hospital del Mar, IMIM, Universitat Pompeu Fabra, Barcelona, Spain
| | - Carlos Besses
- Hematology Department, Hospital del Mar, IMIM, Universitat Autònoma de Barcelona, Barcelona, Spain
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97
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Spivak JL. Diagnostic and treatment guidelines for the chronic myeloproliferative neoplasms: current challenges. Int J Hematol Oncol 2015. [DOI: 10.2217/ijh.15.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Jerry L Spivak
- Hematology Division, Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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98
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Barbui T, Thiele J, Carobbio A, Vannucchi AM, Tefferi A. The rate of transformation from JAK2-mutated ET to PV is influenced by an accurate WHO-defined clinico-morphological diagnosis. Leukemia 2014; 29:992-3. [PMID: 25425199 DOI: 10.1038/leu.2014.328] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- T Barbui
- Research Foundation, Papa Giovanni XXIII Hospital Bergamo, Bergamo, Italy
| | - J Thiele
- Institute of Pathology, University of Cologne, Cologne, Germany
| | - A Carobbio
- Research Foundation, Papa Giovanni XXIII Hospital Bergamo, Bergamo, Italy
| | - A M Vannucchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - A Tefferi
- Hematology Division, Mayo Clinic, Rochester, MN, USA
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99
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Mughal TI, Barbui T, Abdel-Wahab O, Kralovics R, Jamieson C, Kvasnicka HM, Mullaly A, Rampal R, Mesa R, Kiladjian JJ, Deininger M, Prchal J, Hehlmann R, Saglio G, Van Etten RA. Novel insights into the biology and treatment of chronic myeloproliferative neoplasms. Leuk Lymphoma 2014; 56:1938-48. [PMID: 25330439 DOI: 10.3109/10428194.2014.974594] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Myeloproliferative neoplasms (MPNs) are clonal disorders of hematopoiesis characterized by a high frequency of genetic alterations, and include chronic myeloid leukemia (CML) and the BCR-ABL1-negative MPNs. Herein we summarize recent advances and controversies in our understanding of the biology and therapy of these disorders, as discussed at the 8th post-American Society of Hematology CML-MPN workshop. The principal areas addressed include the breakthrough discovery of CALR mutations in patients with JAK2/MPL wild type MPN, candidate therapies based on novel genetic findings in leukemic transformation and new therapeutic targets in MPNs, and an appraisal of bone marrow histopathology in MPNs with a focus on the potential new clinical entity of "masked" polycythemia vera. An update on clinical trials of Janus kinase (JAK) inhibitors is presented as well as current understanding regarding the definitions and mechanisms of resistance to JAK inhibitors, and updated information on the safety and efficacy of discontinuation of tyrosine kinase inhibitors in patients with CML.
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100
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Affiliation(s)
- Richard T Silver
- Division of Hematology/Medical Oncology, Weill Cornell Medical College , New York, NY , USA
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