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Kim TO, Curry CV, Wiszniewska J, Elghetany MT, Satter LRF, Grimes AB, Despotovic JM. Pediatric autoimmune myelofibrosis: Experience from a large pediatric tertiary care center. Pediatr Blood Cancer 2023; 70:e30144. [PMID: 36661251 DOI: 10.1002/pbc.30144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 10/17/2022] [Accepted: 10/28/2022] [Indexed: 01/21/2023]
Abstract
Autoimmune myelofibrosis (AIMF) is a rare disorder characterized by cytopenias and autoimmunity, with characteristic bone marrow findings that include lymphocytic infiltration and fibrosis. AIMF is described predominantly in adult populations who have systemic lupus erythematosis (SLE), with scant pediatric cases described mainly in older adolescents with SLE. Here, we described the largest single-center pediatric experience of pediatric autoimmune myelofibrosis (PAIMF) series, demonstrating both similarities and distinctions from the adult experience. Patients overall respond well to steroid therapy, but these patients were significantly younger, infrequently carried a diagnosis of SLE, and causative genetic lesions were identified in many cases.
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Affiliation(s)
- Taylor Olmsted Kim
- Texas Children's Cancer and Hematology Center, Houston, Texas, USA.,Departments of Pediatrics and Pathology & Immunology, Baylor College of Medicine, Houston, Texas, USA
| | - Choladda V Curry
- Departments of Pediatrics and Pathology & Immunology, Baylor College of Medicine, Houston, Texas, USA.,Texas Children's Hospital, Department of Pathology, Houston, Texas, USA
| | - Joanna Wiszniewska
- Departments of Pathology and Molecular and Medical Genetics, Oregon Health & Science University, Portland, Oregon, USA
| | - M Tarek Elghetany
- Departments of Pediatrics and Pathology & Immunology, Baylor College of Medicine, Houston, Texas, USA.,Texas Children's Hospital, Department of Pathology, Houston, Texas, USA
| | - Lisa R Forbes Satter
- Departments of Pediatrics and Pathology & Immunology, Baylor College of Medicine, Houston, Texas, USA.,Immunology Allergy and Retrovirology and William T. Shearer Texas Children's Hospital Center for Human Immunobiology, Houston, Texas, USA
| | - Amanda B Grimes
- Texas Children's Cancer and Hematology Center, Houston, Texas, USA.,Departments of Pediatrics and Pathology & Immunology, Baylor College of Medicine, Houston, Texas, USA
| | - Jenny M Despotovic
- Texas Children's Cancer and Hematology Center, Houston, Texas, USA.,Departments of Pediatrics and Pathology & Immunology, Baylor College of Medicine, Houston, Texas, USA
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2
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Yenwongfai LN, Arora R, Smith AP, Kalfa T, Husami A, Radulescu V, Myers K, Lorsbach R. Pediatric myelofibrosis due to compound heterozygous MPIG6B mutations in a patient of European ancestry. Pediatr Blood Cancer 2023; 70:e30023. [PMID: 36184776 DOI: 10.1002/pbc.30023] [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: 05/27/2022] [Revised: 09/01/2022] [Accepted: 09/05/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Leonard N Yenwongfai
- Department of Pathology and Laboratory Medicine, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Ranjana Arora
- Department of Pathology and Laboratory Medicine, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Alexander P Smith
- Department of Pathology and Laboratory Medicine, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | | | | | - Vlad Radulescu
- Pediatric Hematology and Oncology, University of Kentucky College of Medicine, Lexington, Kentucky, USA
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Real world study of children and young adults with myeloproliferative neoplasms identifying risks and unmet needs. Blood Adv 2022; 6:5171-5183. [PMID: 35802458 PMCID: PMC9631631 DOI: 10.1182/bloodadvances.2022007201] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/06/2022] [Indexed: 11/21/2022] Open
Abstract
In a contemporary cohort of 444 young MPN patients, risks of thrombosis, hemorrhage, and transformation were 1% pt/y. Current risk scores had no utility. Uniquely, we identify that splenomegaly and hyperviscosity symptoms predict thrombosis and transformation.
Myeloproliferative neoplasms (MPNs) are uncommon in children/young adults. Here, we present data on unselected patients diagnosed before 25 years of age included from 38 centers in 15 countries. Sequential patients were included. We identified 444 patients, with median follow-up 9.7 years (0-47.8). Forty-nine (11.1%) had a history of thrombosis at diagnosis, 49 new thrombotic events were recorded (1.16% patient per year [pt/y]), perihepatic vein thromboses were most frequent (47.6% venous events), and logistic regression identified JAK2V617F mutation (P = .016) and hyperviscosity symptoms (visual disturbances, dizziness, vertigo, headache) as risk factors (P = .040). New hemorrhagic events occurred in 44 patients (9.9%, 1.04% pt/y). Disease transformation occurred in 48 patients (10.9%, 1.13% pt/y), usually to myelofibrosis (7.5%) with splenomegaly as a novel risk factor for transformation in essential thrombocythemia (ET) (P= .000) in logistical regression. Eight deaths (1.8%) were recorded, 3 after allogeneic stem cell transplantation. Concerning conventional risk scores: International Prognostic Score for Essential Thrombocythemia-Thrombosis and new International Prognostic Score for Essential Thrombocythemia-Thrombosis differentiated ET patients in terms of thrombotic risk. Both scores identified high-risk patients with the same median thrombosis-free survival of 28.5 years. No contemporary scores were able to predict survival for young ET or polycythemia vera patients. Our data represents the largest real-world study of MPN patients age < 25 years at diagnosis. Rates of thrombotic events and transformation were higher than expected compared with the previous literature. Our study provides new and reliable information as a basis for prospective studies, trials, and development of harmonized international guidelines for the specific management of young patients with MPN.
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Chauhan P, Gupta A, Bhandari P C, Gupta R, Kashyap R. Primary pediatric myelofibrosis with a novel calreticulin gene mutation. Pediatr Blood Cancer 2022; 69:e29597. [PMID: 35147286 DOI: 10.1002/pbc.29597] [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: 12/24/2021] [Revised: 01/23/2022] [Accepted: 01/25/2022] [Indexed: 11/12/2022]
Affiliation(s)
- Priyanka Chauhan
- Department of Haematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anshul Gupta
- Department of Haematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Chandni Bhandari P
- Department of Haematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ruchi Gupta
- Department of Haematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rajesh Kashyap
- Department of Haematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Guerra F, L'Imperio V, Bonanomi S, Spinelli M, Coliva TA, Dell'Acqua F, Ferrari GM, Corti P, Balduzzi A, Biondi A, Pagni F, Saettini F. Pediatric immune myelofibrosis (PedIMF) as a novel and distinct clinical pathological entity. Front Pediatr 2022; 10:1031687. [PMID: 36419910 PMCID: PMC9676962 DOI: 10.3389/fped.2022.1031687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/17/2022] [Indexed: 11/09/2022] Open
Abstract
Myelofibrosis is a rare myeloproliferative disorder. The detailed descriptions of myelofibrosis in children and adolescents is limited to a few case series and case reports describing fewer than 100 patients, thus suggesting the extreme rarity of this condition prior to adulthood. Though pediatric patients rarely present the typical features and outcomes usually observed in older people, pediatric myelofibrosis is not considered an independent entity. Here we aim to describe patients with pediatric myelofibrosis, showing different clinical and pathological features when compared to the World Health Organization 2016 Primary Myelofibrosis classification. We retrospectively collected and analyzed 14 consecutive pediatric myelofibrosis diagnosed in our Pediatric hematology outpatient clinic over a six-year period. According to clinical data and bone marrow biopsy findings, patients were classified into three subgroups: adult-like myelofibrosis, pediatric immune myelofibrosis, idiopathic myelofibrosis. Pediatric Immune Myelofibrosis was the predominant subgroup in our cohort (7/14). Pediatric Immune Myelofibrosis is characterized by peculiar bone marrow features (i.e., T lymphocyte infiltration) and a milder course compared to the other patients Pediatric Immune Myelofibrosis is a novel and distinct pathological entity. We suggest to carefully consider Pediatric Immune Myelofibrosis in case of bone marrow biopsies showing myelofibrosis that do not fulfill WHO criteria.
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Affiliation(s)
- Fabiola Guerra
- Pediatric Hematology Department, Fondazione MBBM, University of Milano Bicocca, Monza, Italy.,Tettamanti Research Center, University of Milano-Bicocca, University of Milano Bicocca, Monza, Italy
| | - Vincenzo L'Imperio
- Pathology, Department of Medicine and Surgery, ASST Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Sonia Bonanomi
- Pediatric Hematology Department, Fondazione MBBM, University of Milano Bicocca, Monza, Italy
| | - Marco Spinelli
- Pediatric Hematology Department, Fondazione MBBM, University of Milano Bicocca, Monza, Italy
| | - Tiziana Angela Coliva
- Pediatric Hematology Department, Fondazione MBBM, University of Milano Bicocca, Monza, Italy
| | - Fabiola Dell'Acqua
- Pediatric Hematology Department, Fondazione MBBM, University of Milano Bicocca, Monza, Italy
| | - Giulia Maria Ferrari
- Pediatric Hematology Department, Fondazione MBBM, University of Milano Bicocca, Monza, Italy
| | - Paola Corti
- Pediatric Hematology Department, Fondazione MBBM, University of Milano Bicocca, Monza, Italy
| | - Adriana Balduzzi
- Pediatric Hematology Department, Fondazione MBBM, University of Milano Bicocca, Monza, Italy
| | - Andrea Biondi
- Department of Pediatrics, University of Milano-Bicocca, European Reference Network (ERN) PaedCan, EuroBloodNet, MetabERN, Fondazione MBBM/Ospedale San Gerardo, Monza, Italy
| | - Fabio Pagni
- Pathology, Department of Medicine and Surgery, ASST Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Francesco Saettini
- Tettamanti Research Center, University of Milano-Bicocca, University of Milano Bicocca, Monza, Italy
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El-Sharkawy F, Margolskee E. Pediatric Myeloproliferative Neoplasms. Clin Lab Med 2021; 41:529-540. [PMID: 34304780 DOI: 10.1016/j.cll.2021.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Myeloproliferative neoplasms can present early in life and may present a diagnostic challenge. Very few studies have focused on the diagnosis, prognosis, and therapy for pediatric myeloproliferative neoplasms. This article focuses on chronic myeloid leukemia, essential thrombocythemia, polycythemia vera, and primary myelofibrosis in children.
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Affiliation(s)
- Farah El-Sharkawy
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Elizabeth Margolskee
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA; Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
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Batis H, Almugairi A, Almugren O, Aljabry M, Alqahtani F, Elbashir E, Elfaki M, Alsultan A. Detrimental variants in MPIG6B in two children with myelofibrosis: Does immune dysregulation contribute to myelofibrosis? Pediatr Blood Cancer 2021; 68:e29062. [PMID: 33871931 DOI: 10.1002/pbc.29062] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 12/26/2022]
Affiliation(s)
- Hasan Batis
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Oncology Center, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Areej Almugairi
- Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City and National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Omar Almugren
- Department of Pathology and Laboratory Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mansour Aljabry
- Department of Pathology and Laboratory Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Fatima Alqahtani
- Department of Pathology and Laboratory Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Enas Elbashir
- Department of Pediatric Hematology/Oncology, King Abdullah Specialist Children's Hospital, Riyadh, Saudi Arabia
| | - Mohammed Elfaki
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Oncology Center, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Abdulrahman Alsultan
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Oncology Center, King Saud University Medical City, Riyadh, Saudi Arabia
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