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Lorenzo M, Grille S, Stevenazzi M. Emergence of BCR-ABL1 Chronic Myeloid Leukemia in a JAK2-V617F Polycythemia Vera. J Hematol 2020; 9:23-29. [PMID: 32362982 PMCID: PMC7188376 DOI: 10.14740/jh591] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 02/27/2020] [Indexed: 12/15/2022] Open
Abstract
Emergence of a new chronic myeloid neoplasm in the setting of a previous one, or their concomitant appearance seems to be a rare event, but plenty of cases have been reported. We describe the case of a patient with JAK2-V617F polycythemia vera, which looses JAK2 clone and develops overt BCR-ABL1 chronic myeloid leukemia after 6 years. Once treatment with tyrosine kinase inhibitors controls BCR-ABL1 clone, JAK2 clone arises again. In this report, we review the literature and discuss the clonal relationship of this event in light of the new molecular data.
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Affiliation(s)
- Mariana Lorenzo
- Catedra de Hematologia, Hospital de Clinicas, Montevideo 11300, Uruguay
| | - Sofia Grille
- Catedra de Hematologia, Hospital de Clinicas, Montevideo 11300, Uruguay.,Departamento Basico de Medicina, Hospital de Clinicas, Montevideo 11300, Uruguay
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Myeloproliferative neoplasms with concurrent BCR-ABL1 translocation and JAK2 V617F mutation: a multi-institutional study from the bone marrow pathology group. Mod Pathol 2018; 31:690-704. [PMID: 29327708 PMCID: PMC6008160 DOI: 10.1038/modpathol.2017.182] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 10/22/2017] [Accepted: 10/26/2017] [Indexed: 11/08/2022]
Abstract
Myeloproliferative neoplasms arise from hematopoietic stem cells with somatically altered tyrosine kinase signaling. Classification of myeloproliferative neoplasms is based on hematologic, histopathologic and molecular characteristics including the presence of the BCR-ABL1 and JAK2 V617F. Although thought to be mutually exclusive, a number of cases with co-occurring BCR-ABL1 and JAK2 V617F have been identified. To characterize the clinicopathologic features of myeloproliferative neoplasms with concomitant BCR-ABL1 and JAK2 V617F, and define the frequency of co-occurrence, we conducted a retrospective multi-institutional study. Cases were identified using a search of electronic databases over a decade at six major institutions. Of 1570 patients who were tested for both BCR-ABL1 and JAK2 V617F, six were positive for both. An additional five patients were identified via clinical records providing a total of 11 cases for detailed evaluation. For each case, clinical variables, hematologic and genetic data, and bone marrow histomorphologic features were analyzed. The sequence of identification of the genetic abnormalities varied: five patients were initially diagnosed with a JAK2 V617F+ myeloproliferative neoplasm, one patient initially had BCR-ABL1+ chronic myeloid leukemia, while both alterations were identified simultaneously in five patients. Classification of the BCR-ABL1-negative myeloproliferative neoplasms varied, and in some cases, features only became apparent following tyrosine kinase inhibitor therapy. Seven of the 11 patients showed myelofibrosis, in some cases before identification of the second genetic alteration. Our data, reflecting the largest reported study comprehensively detailing clinicopathologic features and response to therapy, show that the co-occurrence of BCR-ABL1 and JAK2 V617F is rare, with an estimated frequency of 0.4%, and most often reflects two distinct ('composite') myeloproliferative neoplasms. Although uncommon, it is important to be aware of this potentially confounding genetic combination, lest these features be misinterpreted to reflect resistance to therapy or disease progression, considerations that could lead to inappropriate management.
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Pagnano KBB, Delamain MT, Magnus MM, Vassallo J, DE Souza CA, DE Almeida D, Lorand-Metze I. Concomitant essential thrombocythemia with JAK2 V617F mutation in a patient with chronic myeloid leukemia with major molecular response with imatinib and long-term follow-up. Oncol Lett 2016; 12:485-487. [PMID: 27347169 PMCID: PMC4906713 DOI: 10.3892/ol.2016.4631] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 01/22/2016] [Indexed: 12/30/2022] Open
Abstract
The association of chronic myeloid leukemia (CML) with other myeloproliferative neoplasms (MPNs), in particular with the V617F mutation in the Janus kinase 2 (JAK2) gene, is very uncommon, and there are only a few cases reported in the literature. In the present study, the case of a 73-year-old man with CML and persistent thrombocytosis, is reported. The patient achieved a complete cytogenetic response and major molecular response (MR) with imatinib. The patient presented JAK2 V617F mutation, and bone marrow morphology was consistent with essential thrombocythemia. The patient was treated with imatinib and hydroxyurea to control the platelet count, and maintains complete MR with imatinib upon 10 years of follow-up. Although rare, the association of breakpoint cluster region-Abelson rearrangement and JAK2 V617F mutation should be investigated in patients with MPN, since both genetic anomalies may be present at diagnosis or may emerge during treatment, and require different therapeutic approaches.
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Affiliation(s)
| | - Márcia Torresan Delamain
- Hematology and Hemotherapy Center, University of Campinas, Campinas, São Paulo, SP 13083-868, Brazil
| | - Mariana Munari Magnus
- Hematology and Hemotherapy Center, University of Campinas, Campinas, São Paulo, SP 13083-868, Brazil
| | - José Vassallo
- Department of Pathological Anatomy, University of Campinas, Campinas, São Paulo, SP 13083-868, Brazil
| | - Carmino Antonio DE Souza
- Hematology and Hemotherapy Center, University of Campinas, Campinas, São Paulo, SP 13083-868, Brazil
| | - Daiane DE Almeida
- Hematology and Hemotherapy Center, University of Campinas, Campinas, São Paulo, SP 13083-868, Brazil
| | - Irene Lorand-Metze
- Hematology and Hemotherapy Center, University of Campinas, Campinas, São Paulo, SP 13083-868, Brazil
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Qin YW, Yang YN, Li S, Wang C. Coexistence of JAK2V617F Mutation and BCR-ABL Translocation in a Pregnant Woman with Essential Thrombocythemia. Indian J Hematol Blood Transfus 2014; 30:331-4. [PMID: 25332611 DOI: 10.1007/s12288-014-0385-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 03/30/2014] [Indexed: 02/05/2023] Open
Abstract
In 2012, a 25-years-old pregnant woman presented with thromocytosis for 4 months, blood counts showed platelets 701 × 10(9)/L. Bone marrow examination disclosed a feature of hypercellular marrow in erythrocytic,granulocytic and megakaryocytic series. Cytogenetic analysis showed t(9;22)(q34;q11) in 100 % of metaphase. The percentage of BCR-ABL-positive FISH signals was 37 % in the peripheral blood. Molecular analysis showed the presence of the JAK2V617F mutation and BCR-ABL mRNA b3a2 transcript. A diagnosis of concomitant presence of essential thrombocythemia and chronic myelocytic leukemia was made. Based on this case and literatures reported before, it might be necessary to detect JAK2-V617F mutation and BCR-ABL fusion gene concomitantly in myeloproliferative neoplasms patients.
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Affiliation(s)
- You-Wen Qin
- Department of Hematology, Shanghai First People's Hospital, Medical College, Shanghai JiaoTong University, Shanghai, People's Republic of China
| | - Yi-Ning Yang
- Department of Hematology, Shanghai First People's Hospital, Medical College, Shanghai JiaoTong University, Shanghai, People's Republic of China
| | - Su Li
- Department of Hematology, Shanghai First People's Hospital, Medical College, Shanghai JiaoTong University, Shanghai, People's Republic of China
| | - Chun Wang
- Department of Hematology, Shanghai First People's Hospital, Medical College, Shanghai JiaoTong University, Shanghai, People's Republic of China
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Lee YJ, Moon JH, Shin HC, Seo JW, Han SA, Seo SK, Sohn SK. Two CML patients who subsequently developed features of essential thrombocythemia with JAK2-V617F mutation while in complete cytogenetic remission after treatment with imatinib mesylate. Int J Hematol 2013; 97:804-7. [PMID: 23613267 DOI: 10.1007/s12185-013-1326-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 04/04/2013] [Accepted: 04/05/2013] [Indexed: 10/26/2022]
Abstract
The present report describes two chronic myelogenous leukemia (CML) patients with the JAK2-V617F mutation who were in complete hematologic and cytogenetic remission and subsequently developed clinical features of essential thrombocythemia under treatment with tyrosine kinase inhibitors. In light of the findings from previous reports, screening for the JAK2-V617F mutation should be considered for any Ph(+) CML patients with thrombocytosis, leukocytosis, or erythrocytosis at diagnosis and for patients who subsequently develop thrombocytosis, leukocytosis, or erythrocytosis during follow-up, even for CML patients in complete cytogenetic response and major molecular response.
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Affiliation(s)
- Yoo Jin Lee
- Department of Hematology/Oncology, Kyungpook National University Hospital, Kyungpook National University School of Medicine, 130 Dongduk-Ro, Jung-Gu, Daegu, Korea.
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Harrison CN, Butt N, Campbell P, Conneally E, Drummond M, Green AR, Murrin R, Radia DH, Reilly JT, McMullin MF. Diagnostic pathway for the investigation of thrombocytosis. Br J Haematol 2013; 161:604-6. [DOI: 10.1111/bjh.12283] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Claire N. Harrison
- Department of Haematology; Guy's and St Thomas, Hospitals' NHS Foundation Trust; London UK
| | - Nauman Butt
- Department of Haematology; Arrowe Park Hospital; Wirral UK
| | - Peter Campbell
- Welcome Trust Sanger Institute; Welcome Trust Genome Campus; Hinxton Cambridge UK
| | | | - Mark Drummond
- Department of Haematology; Beatson Oncology Centre; Glasgow UK
| | - Anthony R. Green
- Department of Haematology; Cambridge Institute for Medical Research; Cambridge UK
| | | | - Deepti H. Radia
- Department of Haematology; Guy's and St Thomas, Hospitals' NHS Foundation Trust; London UK
| | | | - Mary F. McMullin
- Department of Haematology; CCRCB; Queen's University; Belfast UK
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Michieli M, Peccatori FA, Lleshi A, Del Pup L, Valente D, Rupolo M, Tirelli U, Berretta M. Antiblastic treatment of haematological malignancies during pregnancy: a crucial decision. Int J Immunopathol Pharmacol 2013; 25:21S-32S. [PMID: 23092517 DOI: 10.1177/03946320120250s202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Antiblastic treatment of hematological malignancies during pregnancy poses a number of issues related to the curability of the maternal disease, the need of a prompt treatment and the potential toxicity of chemotherapy for the fetus. Here we report the results of a systematic literature search about the management of the most frequent hematological malignancies that may occur during pregnancy, focusing on specific issues related to gestational age at diagnosis, fetal toxicity and efficacy on the maternal side. The standard approach in non-pregnant women is illustrated as reference.
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Affiliation(s)
- M Michieli
- Department of Medical Oncology, National Cancer Institute, Aviano (PN), Italy.
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Ng AP. On the origin of clones: learning from concurrent or sequential Philadelphia negative and positive myeloproliferative neoplasms. Leuk Lymphoma 2013; 54:1569-70. [PMID: 23289358 DOI: 10.3109/10428194.2012.756106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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