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Popova-Labachevska M, Cvetanoski M, Ridova N, Trajkova S, Stojanovska-Jakimovska S, Mojsovska T, Stojanoski Z, Pivkova-Veljanovska A, Panovska-Stavridis I. Effectiveness of Ropeginterferon Alfa-2B in High-Risk Patients with Philadelphia Chromosome Negative Myeloproliferative Neoplasms- Evaluation of Clinicohaematologic Response, and Safety Profile: Single Centre Experience. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2023; 44:57-62. [PMID: 38109450 DOI: 10.2478/prilozi-2023-0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
Background: Treatment of Philadelphia chromosome negative myeloproliferative neoplasms (Ph - MPNs) requires individualized approach depending on multiple factors. Novel pegylated Interferon (IFN) formulations have become an attractive therapeutic option in young Ph- MPN patients associated with better patient compliance. Methods: In this retrospective observational study a total of 16 high-risk Ph- MPN patients treated off-label with ropeginterferon alfa-2b given twice monthly, were included. Median follow-up was 24 months. High-risk patients were defined using the IPSET score. Response to treatment was evaluated using ELN, IWG-MET EUMNET standardized criteria and occurrence of side effects was documented. Results: 11 patients were female (68.8%) and 5 male (31.2%); average age at diagnosis was 36 years (17-51); 12 patients (75%) had ET, one (6.2%) PV and three (18.8%) hypercellular phase of PMF. JAK2V617F mutation was detected in 10 patients (62.5%), CALR in three (18.8%), and three (18.7%) were triple-negative cases. In 7 patients (43.7%), ropeginterferon alfa-2b was used in first-line, and 9 (56.3%) were previously treated with HU and/or standard IFN. Among initially ropeginterferon alfa-2b treated patients, complete haematological response was observed in 4/7 (57.1%), partial in 2/7 (28.6%) and suboptimal in one (14.3%). Complete haematological response was observed in 8/9 (88.9%) among previously treated patients. Average time to blood count normalization was 8 weeks, at a dose ranging between 100mcg and 300mcg. Side effects were observed in one patient (6.2%). Conclusion: Our experience is in support of previous studies regarding ropeginterferon alfa-2b efficacy and safety profile in the treatment of young patients with Ph- MPNs.
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Affiliation(s)
- Marija Popova-Labachevska
- 1University clinic of hematology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, RN Macedonia
| | - Milche Cvetanoski
- 1University clinic of hematology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, RN Macedonia
| | - Nevenka Ridova
- 1University clinic of hematology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, RN Macedonia
| | - Sanja Trajkova
- 1University clinic of hematology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, RN Macedonia
| | | | - Tara Mojsovska
- 1University clinic of hematology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, RN Macedonia
| | - Zlate Stojanoski
- 1University clinic of hematology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, RN Macedonia
| | | | - Irina Panovska-Stavridis
- 1University clinic of hematology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, RN Macedonia
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2
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Mulas O, Mola B, Costa A, Pittau F, Mantovani D, Dessì S, Fronteddu A, La Nasa G, Caocci G. Renin-angiotensin inhibitors reduce thrombotic complications in Essential Thrombocythemia and Polycythemia Vera patients with arterial hypertension. Ann Hematol 2023; 102:2717-2723. [PMID: 37603060 PMCID: PMC10492873 DOI: 10.1007/s00277-023-05417-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 08/14/2023] [Indexed: 08/22/2023]
Abstract
Essential Thrombocythemia (ET) and Polycythemia Vera (PV) are chronic myeloproliferative neoplasms (MPNs) characterized by thrombotic and hemorrhagic complications, leading to a high risk of disability and mortality. Although arterial hypertension was found to be the most significant modifiable cardiovascular (CV) risk factor in the general population, little is known about its role in MPNs as well as a possible role of renin-angiotensin system inhibitors (RASi) in comparison with other anti-hypertensive treatments. We investigated a large cohort of 404 MPN adult patients, 133 diagnosed with PV and 271 with ET. Over half of the patients (53.7%) reported hypertension at MPN diagnosis. The 15-year cumulative incidence of thrombotic-adverse events (TAEs) was significantly higher in patients with hypertension (66.8 ± 10.3% vs 38.5 ± 8.4%; HR = 1.83; 95%CI 1.08-3.1). Multivariate analysis showed that PV diagnosis and hypertension were independently associated with a higher risk of developing TAEs (HR = 3.5; 95%CI 1.928-6.451, p < 0.001 and HR = 1.8; 95%CI 0.983-3.550, p = 0.05, respectively). In multivariate analysis, the diagnosis of PV confirmed a significant predictive role in developing TAEs (HR = 4.4; 95%CI 1.92-10.09, p < 0.01), also considering only MPN patients with hypertension. In addition, we found that the use of RASi showed a protective effect from TAEs both in the whole cohort of MPN with hypertension (HR = 0.46; 95%CI 0.21-0.98, p = 0.04) and in the subgroup of thrombotic high-risk score patients (HR = 0.49; 95%CI 0.24-1.01, p = 0.04). In particular, patients with ET and a high risk of thrombosis seem to benefit most from RASi treatment (HR = 0.27; 95%CI 0.07-1.01, p = 0.03). Hypertension in MPN patients represents a significant risk factor for TAEs and should be adequately treated.
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Affiliation(s)
- Olga Mulas
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
- Hematology Unit, Businco Hospital, ARNAS Brotzu Cagliari, Cagliari, Italy
| | - Brunella Mola
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Alessandro Costa
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Francesca Pittau
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Daniela Mantovani
- Hematology Unit, Businco Hospital, ARNAS Brotzu Cagliari, Cagliari, Italy
| | - Samuele Dessì
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Antonella Fronteddu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Giorgio La Nasa
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
- Hematology Unit, Businco Hospital, ARNAS Brotzu Cagliari, Cagliari, Italy
| | - Giovanni Caocci
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
- Hematology Unit, Businco Hospital, ARNAS Brotzu Cagliari, Cagliari, Italy.
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3
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Aini W, Xie L, Hu W, Tang Y, Peng H, Zhang G, Deng T. Exploration and identification of anoikis-related genes in polycythemia vera. Front Genet 2023; 14:1139351. [PMID: 36873934 PMCID: PMC9981965 DOI: 10.3389/fgene.2023.1139351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 02/09/2023] [Indexed: 02/19/2023] Open
Abstract
Background: Polycythemia Vera (PV) is a type of typical Myeloproliferative Neoplasms (MPNs) characterized with excessive erythropoiesis and thrombosis. Anoikis is a special programmed cell death mode induced by the adhesion disorder between cells and extracellular matrix (ECM) or adjacent cells facilitating cancer metastasis. However, few studies have focused on the role of anoikis in PV, especially on the development of PV. Methods: The microarray and RNA-seq results were screened from the Gene Expression Omnibus (GEO) database and the anoikis-related genes (ARGs) were downloaded from Genecards. The functional enrichment analysis of intersecting differentially expressed genes (DEGs) and protein-protein interaction (PPI) network analysis were performed to discover hub genes. The hub genes expression was tested in the training (GSE136335) and validation cohort (GSE145802), and RT-qPCR was performed to verify the gene expression in PV mice. Results: In the training GSE136335, a total of 1,195 DEGs was obtained from Myeloproliferative Neoplasm (MPN) patients compared with controls, among which 58 were anoikis-related DEGs. The significant enrichment of the apoptosis and cell adhesion pathways (i.e., cadherin binding) were shown in functional enrichment analysis. The PPI network was conducted to identify top five hub genes (CASP3, CYCS, HIF1A, IL1B, MCL1). The expression of CASP3 and IL1B were significantly upregulated both in validation cohort and PV mice and downregulated after treatment, suggesting that CASP3 and IL1B could be important indicators for disease surveillance. Conclusion: Our research revealed a relationship between anoikis and PV for the first time by combined analysis of gene level, protein interaction and functional enrichment, allowing novel insights into mechanisms of PV. Moreover, CASP3 and IL1B may become promising indicators of PV development and treatment.
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Affiliation(s)
- Wufuer Aini
- National Clinical Research Center for Metabolic Diseases, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.,Key Laboratory of Diabetes Immunology, Ministry of Education, and Metabolic Syndrome Research Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.,Clinical Immunology Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Limin Xie
- National Clinical Research Center for Metabolic Diseases, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.,Key Laboratory of Diabetes Immunology, Ministry of Education, and Metabolic Syndrome Research Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.,Clinical Immunology Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Wanyu Hu
- National Clinical Research Center for Metabolic Diseases, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.,Key Laboratory of Diabetes Immunology, Ministry of Education, and Metabolic Syndrome Research Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.,Clinical Immunology Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yuan Tang
- National Clinical Research Center for Metabolic Diseases, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.,Key Laboratory of Diabetes Immunology, Ministry of Education, and Metabolic Syndrome Research Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.,Clinical Immunology Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Hongling Peng
- Department of Hematology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.,Institute of Molecular Hematopathy, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.,Hunan Key Laboratory of Tumor Models and Individualized Medicine, Changsha, Hunan, China
| | - Guangsen Zhang
- Institute of Molecular Hematopathy, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Tuo Deng
- National Clinical Research Center for Metabolic Diseases, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.,Key Laboratory of Diabetes Immunology, Ministry of Education, and Metabolic Syndrome Research Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.,Clinical Immunology Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
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Vinogradova OY, Pankrashkina MM, Shikhbabaeva DI, Chernikov MV, Neverova AL, Ivanova VL, Nikitin EA, Usikova EV, Ptushkin VV. Possibilities of targeted therapy for myelofibrosis: Moscow experience. ONCOHEMATOLOGY 2022. [DOI: 10.17650/1818-8346-2022-17-4-94-105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Background. For many years the primary aim of treatment strategy for ph-negative myeloproliferative neoplasms has been to restrain disease progression, with lasting relief and management of symptoms to improve patients’ quality of life. Generally, this did not lead to a significant increase in life expectancy with primary myelofibrosis and didn’t decrease the risk of fibrosis in patients with polycythemia vera and essential thrombocythemia. To date a new class of targeted drugs has been developed, it is JAK2 inhibitors with pathogenetic effects. The results of clinical trials showed the high efficacy of the first registered drug of this its kind – ruxolitinib – that includes a faster reduction in the symptoms of tumor intoxication and in symptoms associated with the development of splenomegaly and increase in the overall survival rates. It is known that the data obtained during clinical trials of medicines may differ from the results obtained in routine clinical practice. In actual practice drugs are used in a much wider heterogeneous population of patients, less limited first of all by age and comorbid characteristics. It is possible to analyze cohorts of patients including a larger number of clinical cases with a longer follow-up period. In this regard of great interest is the actual clinical experience of long-term use of ruxolitinib in patients whose set is limited only by clinical contraindications for prescribing the drug.Aim. To present our own actual experience of targeted therapy of myelofibrosis and compare the results obtained with the data of clinical trials.Materials and methods. Our analysis includes data from 141 patients (67 (47.5 %) men and 74 (52.5 %) women) in a chronic phase myelofibrosis. All patients received ruxolitinib. Of these, 109 (69 %) patients had primary myelofibrosis, 26 (16 %) – postpolycythemia myelofibrosis, 6 (4 %) – postessential thrombocythemia myelofibrosis. The median age at the start of therapy was 62 (18–84) years. The median disease duration before ruxolitinib was prescribed – 79 (1–401) months. According to the dIpSS (dynamic International prognostic Scoring System) criteria, 13 % of patients were assigned to the low risk group, 38 % – to the intermediate-1, 36 % – to the intermediate-2, 13 % – to the high risk group. Most patients (52 %) had grade 3 bone marrow fibrosis.Results. The median duration of treatment was 18 (range from 1 to 115) months. Symptoms of intoxication were relieved 74 (81 %) of 91 patients, the spleen size decreased in 81 % of patients (the spleen size returned to normal in 25 % of patients). The increase in the median hemoglobin level was 15 %. The proportion of patients requiring blood transfusion decreased by 4 times (from 39 to 9 %). Mean platelet levels normalized in most patients with baseline high and low platelet levels. A complete clinical and hematological response was achieved in 16 % (n = 23) of cases, a partial response – in 26 % (n = 37) of cases, clinical improvement – in 21 % (n = 30), disease stabilization – in 33 % (n = 46) of cases. No response was received in 1 (1 %) patient and in 3 (3 %) cases there was progression of the disease. At the time of analysis, 81 (57 %) of 141 patients were continuing the ruxolitinib treatment. The fatal outcome in 33 (22 %) patients was associated with concomitant diseases, among which 20 (14 %) died from proven COvId-19 infection. Overall survival: 1-year 81 %, 2-year 73 %, 5-year 50 %. Overall survival excluding deaths due to COvId-19: 1-year 92 %, 2-year 85 %, 5-year 70 %. Massive splenomegaly and a high degree of fibrosis were unfavorable predictors of prognosis of overall survival.Conclusion. Target therapy with Janus kinase inhibitor ruxolitinib has demonstrated high efficacy in patients with myelofibrosis in routine clinical practice. The most rapid effect ruxolitinib had on the spleen size and the symptoms of intoxication. Tolerability of ruxolitinib therapy was generally satisfactory. The overall and progression-free survival rates in patients with myelofibrosis, receiving ruxolitinib in the clinical setting was consistent with the results of international multicenter clinical trials.
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Affiliation(s)
- O. Yu. Vinogradova
- Moscow City Hematology Center, S.P. Botkin City Clinical Hospital, Moscow Healthcare Department; Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Ministry of Health of Russia; N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia
| | - M. M. Pankrashkina
- Moscow City Hematology Center, S.P. Botkin City Clinical Hospital, Moscow Healthcare Department
| | - D. I. Shikhbabaeva
- Moscow City Hematology Center, S.P. Botkin City Clinical Hospital, Moscow Healthcare Department
| | - M. V. Chernikov
- Moscow City Hematology Center, S.P. Botkin City Clinical Hospital, Moscow Healthcare Department
| | - A. L. Neverova
- Moscow City Hematology Center, S.P. Botkin City Clinical Hospital, Moscow Healthcare Department
| | - V. L. Ivanova
- Moscow City Hematology Center, S.P. Botkin City Clinical Hospital, Moscow Healthcare Department
| | - E. A. Nikitin
- Moscow City Hematology Center, S.P. Botkin City Clinical Hospital, Moscow Healthcare Department
| | - E. V. Usikova
- Moscow City Hematology Center, S.P. Botkin City Clinical Hospital, Moscow Healthcare Department
| | - V. V. Ptushkin
- Moscow City Hematology Center, S.P. Botkin City Clinical Hospital, Moscow Healthcare Department; Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Ministry of Health of Russia; N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia
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Christensen SF, Svingel LS, Kjærsgaard A, Stenling A, Darvalics B, Paulsson B, Andersen CL, Christiansen CF, Stentoft J, Starklint J, Severinsen MT, Clausen MB, Hilsøe MH, Hasselbalch HC, Frederiksen H, Mikkelsen EM, Bak M. Healthcare resource utilization in patients with myeloproliferative neoplasms: A Danish nationwide matched cohort study. Eur J Haematol 2022; 109:526-541. [PMID: 35900040 PMCID: PMC9804288 DOI: 10.1111/ejh.13841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/15/2022] [Accepted: 07/19/2022] [Indexed: 01/05/2023]
Abstract
Few studies have assessed healthcare resource utilization (HRU) in patients with Philadelphia-negative myeloproliferative neoplasms (MPN) using a matched cohort design. Further, no detailed assessment of HRU in the years preceding an MPN diagnosis exists. We conducted a registry-based nationwide Danish cohort study, including patients with essential thrombocythemia, polycythemia vera, myelofibrosis, and unclassifiable MPN diagnosed between January 2010 and December 2016. HRU data were summarized annually from 2 years before MPN diagnosis until emigration, death, or end of study (December 2017). We included 3342 MPN patients and 32 737 comparisons without an MPN diagnosis, matched on sex, age, region of residence, and level of education. During the study period, the difference in HRU (rate ratio) between patients and matched comparisons ranged from 1.0 to 1.5 for general practitioner contacts, 0.9 to 2.2 for hospitalizations, 0.9 to 3.8 for inpatient days, 1.0 to 4.0 for outpatient visits, 1.3 to 2.1 for emergency department visits, and 1.0 to 4.1 for treatments/examinations. In conclusion, MPN patients had overall higher HRU than the matched comparisons throughout the follow-up period (maximum 8 years). Further, MPN patients had substantially increased HRU in both the primary and secondary healthcare sector in the 2 years preceding the diagnosis.
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Affiliation(s)
| | - Lise Skovgaard Svingel
- Department of Clinical Epidemiology, Department of Clinical MedicineAarhus University Hospital and Aarhus UniversityAarhusDenmark
| | - Anders Kjærsgaard
- Department of Clinical Epidemiology, Department of Clinical MedicineAarhus University Hospital and Aarhus UniversityAarhusDenmark
| | | | - Bianka Darvalics
- Department of Clinical Epidemiology, Department of Clinical MedicineAarhus University Hospital and Aarhus UniversityAarhusDenmark
| | | | - Christen Lykkegaard Andersen
- Department of HematologyCopenhagen University HospitalRigshospitaletDenmark,The Research Unit for General Practice and Section of General Practice, Department of Public HealthUniversity of CopenhagenCopenhagenDenmark
| | - Christian Fynbo Christiansen
- Department of Clinical Epidemiology, Department of Clinical MedicineAarhus University Hospital and Aarhus UniversityAarhusDenmark
| | - Jesper Stentoft
- Department of HematologyAarhus University HospitalAarhusDenmark
| | - Jørn Starklint
- Department of HematologyHolstebro HospitalHolstebroDenmark
| | | | - Mette Borg Clausen
- Department of HematologyCopenhagen University HospitalRigshospitaletDenmark
| | | | | | | | - Ellen Margrethe Mikkelsen
- Department of Clinical Epidemiology, Department of Clinical MedicineAarhus University Hospital and Aarhus UniversityAarhusDenmark
| | - Marie Bak
- Department of HematologyZealand University HospitalRoskildeDenmark,Department of HematologyCopenhagen University HospitalRigshospitaletDenmark
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Talarmain L, Clarke MA, Shorthouse D, Cabrera-Cosme L, Kent DG, Fisher J, Hall BA. HOXA9 has the hallmarks of a biological switch with implications in blood cancers. Nat Commun 2022; 13:5829. [PMID: 36192425 PMCID: PMC9530117 DOI: 10.1038/s41467-022-33189-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/07/2022] [Indexed: 11/09/2022] Open
Abstract
Blood malignancies arise from the dysregulation of haematopoiesis. The type of blood cell and the specific order of oncogenic events initiating abnormal growth ultimately determine the cancer subtype and subsequent clinical outcome. HOXA9 plays an important role in acute myeloid leukaemia (AML) prognosis by promoting blood cell expansion and altering differentiation; however, the function of HOXA9 in other blood malignancies is still unclear. Here, we highlight the biological switch and prognosis marker properties of HOXA9 in AML and chronic myeloproliferative neoplasms (MPN). First, we establish the ability of HOXA9 to stratify AML patients with distinct cellular and clinical outcomes. Then, through the use of a computational network model of MPN, we show that the self-activation of HOXA9 and its relationship to JAK2 and TET2 can explain the branching progression of JAK2/TET2 mutant MPN patients towards divergent clinical characteristics. Finally, we predict a connection between the RUNX1 and MYB genes and a suppressive role for the NOTCH pathway in MPN diseases.
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Affiliation(s)
- Laure Talarmain
- Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
| | - Matthew A Clarke
- UCL Cancer Institute, University College London, Paul O'Gorman Building, 72 Huntley Street, London, WC1E 6BT, United Kingdom
| | - David Shorthouse
- Department of Medical Physics and Biomedical Engineering, Malet Place Engineering Building, University College London, Gower Street, London, WC1E 6BT, United Kingdom
| | - Lilia Cabrera-Cosme
- York Biomedical Research Institute, Department of Biology, University of York, York, YO10 5DD, United Kingdom
| | - David G Kent
- York Biomedical Research Institute, Department of Biology, University of York, York, YO10 5DD, United Kingdom
| | - Jasmin Fisher
- UCL Cancer Institute, University College London, Paul O'Gorman Building, 72 Huntley Street, London, WC1E 6BT, United Kingdom
| | - Benjamin A Hall
- Department of Medical Physics and Biomedical Engineering, Malet Place Engineering Building, University College London, Gower Street, London, WC1E 6BT, United Kingdom.
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Tekin TO, Karis D, Ates Alkan F, Cetin G, Ercan AM. Evaluation of trace elements in essential thrombocytosis and reactive thrombocytosis. J Trace Elem Med Biol 2022; 73:127034. [PMID: 35839560 DOI: 10.1016/j.jtemb.2022.127034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 03/15/2022] [Accepted: 07/06/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Trace elements (TE) are vital for cellular mechanisms at biological, chemical and molecular levels. The effects of TE in diagnosis, progression and treatment of essential thrombocytosis (ET), which is one of the chronic myeloproliferative neoplasms is a rare clonal stem cell disease characterized by increased thrombocyte numbers with impaired function, have not been elucidated in detail yet. The aim of the present study was to investigate the effects of TE alterations in an ET model and the efficacy of TE in ET treatment protocol by means of a vast number of TE. METHODS Study groups were categorized as patients with ET diagnosis (ET group, n:30), patients with reactive thrombocytosis secondary to iron deficiency anemia (IDA-RT) (IDA-RT group, n:30) and healthy controls (HC group, n:30). Serum levels of copper (Cu), iron (Fe), cobalt (Co), chromium (Cr), aluminum (Al), silicon (Si), nickel (Ni), zinc (Zn), selenium (Se), manganese (Mn), boron (B) and magnesium (Mg) were analyzed utilizing inductively coupled plasma-optical emission spectrophotometer instrument (ICP-OES). Statistical analysis was evaluated using SPSS 23.0. RESULTS ET group had statistically higher serum levels of Co and Mg (p < 0.05), Ni and Mn (p < 0.001), and lower Si (p < 0.05) than IDA-RT group. ET group had statistically higher serum levels of Co and Mn (p < 0.05), and Ni (p < 0.001), and lower Al, Si and Se (p < 0.001) than HC group. Serum levels of Fe, Al and Se (p < 0.001), and Mg (p < 0.01), and Zn (p < 0.05) in IDA-RT group were significantly lower than HC group. CONCLUSION This novel study pointed out that alterations of many serum TE by means of both increment or decrement might have close relationship with mechanisms and complications of ET onset and follow-up. We consider that further research of TE would elucidate ethiopathogenesis and prognosis of ET. Thus, analysis of serum trace elements in essential thrombocytosis patients may be an important protocol by means of diagnosis, treatment and follow-up intervals.
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Affiliation(s)
- Tuba Ozkan Tekin
- Department of Hematology, Department of Internal Medicine, Faculty of Medicine, Bezmialem University, Fatih, Istanbul, Turkey
| | - Denizhan Karis
- Department of Biophysics, Faculty of Medicine, İstanbul University-Cerrahpasa, Fatih, Istanbul, Turkey.
| | - Fatma Ates Alkan
- Department of Biophysics, Faculty of Medicine, İstanbul University-Cerrahpasa, Fatih, Istanbul, Turkey
| | - Guven Cetin
- Department of Hematology, Department of Internal Medicine, Faculty of Medicine, Bezmialem University, Fatih, Istanbul, Turkey
| | - Alev Meltem Ercan
- Department of Biophysics, Faculty of Medicine, İstanbul University-Cerrahpasa, Fatih, Istanbul, Turkey
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Tiwari N, Singh A, Singh B, Verma SP, Tripathi AK. Ruxolitinib and tuberculosis: A case report with brief review. Indian J Tuberc 2022; 69:354-358. [PMID: 35760486 DOI: 10.1016/j.ijtb.2021.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 04/08/2021] [Accepted: 06/08/2021] [Indexed: 06/15/2023]
Abstract
JAK 2 inhibitors are widely used for the treatment of primary myelofibrosis. Ruxolitinib is the most commonly used JAK inhibitor in clinical practice. We report two cases of Primary Myelofibrosis who developed tuberculosis on active treatment with ruxolitinib. Our first case was a 48 year male who developed disseminated tuberculosis during fourth month of treatment and second case was a 50 year male developing tubercular lymphadenitis during second month of treatment respectively. These case reports indicate reactivation of underling tubercular infection as a very dreaded complication of this treatment. The prevalence of tuberculosis is much higher in India compared to the west. A thorough pretreatment evaluation should ideally be done using Mantoux test or interferon gamma release assay (IGRA) to rule out latent tuberculosis. Furthermore, the patients should be counselled regarding the possibility of reactivation of infections including tuberculosis. Also, proper follow up is the need of hour in all patients on any kind of immunomodulators.
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Affiliation(s)
- Neema Tiwari
- Department of Clinical Hematology, King George's Medical University, Lucknow, India
| | - Aparajita Singh
- Department of Clinical Hematology, King George's Medical University, Lucknow, India
| | - Bhupendra Singh
- Department of Clinical Hematology, King George's Medical University, Lucknow, India
| | | | - Anil Kumar Tripathi
- Department of Clinical Hematology, King George's Medical University, Lucknow, India
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9
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KAHRAMAN S, DEMİRKAN F. Assessment of relation between JAK2 gene and thrombosis in myeloproliferative neoplasms. TURKISH JOURNAL OF INTERNAL MEDICINE 2022. [DOI: 10.46310/tjim.1055305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background Thrombotic complications are the most considerable etiology causing morbidity and mortality in patients with philadelphia (Ph) negative myeloproliferative neoplasms (MPN). There are many studies evaluating the association of JAK2 mutation and risk of thrombosis in MPN with inconclusive results. We also investigated the relation between JAK2 mutation in all Ph negative MPN and thrombosis.
Material and Methods Thrombotic events and demographic features of 177 patients with Ph negative MPN were evaluated retrospectively.
Results JAK2 V617 F mutation was detected in 57% of patients with essential thrombocythemia (ET), %90.3 of pateints with polycythemia vera (PV), 100% of pateints with primary myelofibrosis (PMF). Thrombotic complications occured more frequently with JAK2 mutation in all MPN patients than without (p=0.014). In JAK 2 mutation positive groups, the median age, thrombosis risk scores and leucocyte values are higher, splenomegaly and arterial and/or venous thrombosis are detected more frequently (p
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10
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Masarova L, Bose P, Pemmaraju N, Daver NG, Sasaki K, Chifotides HT, Zhou L, Kantarjian HM, Estrov Z, Verstovsek S. Improved survival of patients with myelofibrosis in the last decade: Single‐center experience. Cancer 2022; 128:1658-1665. [DOI: 10.1002/cncr.34103] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/15/2021] [Accepted: 12/20/2021] [Indexed: 12/26/2022]
Affiliation(s)
- Lucia Masarova
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
| | - Prithviraj Bose
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
| | - Naveen Pemmaraju
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
| | - Naval G. Daver
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
| | - Koji Sasaki
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
| | - Helen T. Chifotides
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
| | - Lingsha Zhou
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
| | - Hagop M. Kantarjian
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
| | - Zeev Estrov
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
| | - Srdan Verstovsek
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas
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11
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Gou P, Zhang W, Giraudier S. Insights into the Potential Mechanisms of JAK2V617F Somatic Mutation Contributing Distinct Phenotypes in Myeloproliferative Neoplasms. Int J Mol Sci 2022; 23:ijms23031013. [PMID: 35162937 PMCID: PMC8835324 DOI: 10.3390/ijms23031013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/09/2022] [Accepted: 01/13/2022] [Indexed: 12/19/2022] Open
Abstract
Myeloproliferative neoplasms (MPN) are a group of blood cancers in which the bone marrow (BM) produces an overabundance of erythrocyte, white blood cells, or platelets. Philadelphia chromosome-negative MPN has three subtypes, including polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF). The over proliferation of blood cells is often associated with somatic mutations, such as JAK2, CALR, and MPL. JAK2V617F is present in 95% of PV and 50–60% of ET and PMF. Based on current molecular dynamics simulations of full JAK2 and the crystal structure of individual domains, it suggests that JAK2 maintains basal activity through self-inhibition, whereas other domains and linkers directly/indirectly enhance this self-inhibited state. Nevertheless, the JAK2V617F mutation is not the only determinant of MPN phenotype, as many normal individuals carry the JAK2V617F mutation without a disease phenotype. Here we review the major MPN phenotypes, JAK-STAT pathways, and mechanisms of development based on structural biology, while also describing the impact of other contributing factors such as gene mutation allele burden, JAK-STAT-related signaling pathways, epigenetic modifications, immune responses, and lifestyle on different MPN phenotypes. The cross-linking of these elements constitutes a complex network of interactions and generates differences in individual and cellular contexts that determine the phenotypic development of MPN.
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Affiliation(s)
- Panhong Gou
- Laboratoire UMRS-1131, Ecole doctorale 561, Université de Paris, 75010 Paris, France
- INSERM UMR-S1131, Hôpital Saint-Louis, 75010 Paris, France
- Correspondence: (P.G.); (S.G.)
| | - Wenchao Zhang
- BFA, UMR 8251, CNRS, Université de Paris, 75013 Paris, France;
| | - Stephane Giraudier
- Laboratoire UMRS-1131, Ecole doctorale 561, Université de Paris, 75010 Paris, France
- INSERM UMR-S1131, Hôpital Saint-Louis, 75010 Paris, France
- Service de Biologie Cellulaire, Hôpital Saint-Louis, AP-HP, 75010 Paris, France
- Correspondence: (P.G.); (S.G.)
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12
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Tan J, Chow YP, Zainul Abidin N, Chang KM, Selvaratnam V, Tumian NR, Poh YM, Veerakumarasivam A, Laffan MA, Wong CL. Analysis of genetic variants in myeloproliferative neoplasms using a 22-gene next-generation sequencing panel. BMC Med Genomics 2022; 15:10. [PMID: 35033063 PMCID: PMC8760696 DOI: 10.1186/s12920-021-01145-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 12/06/2021] [Indexed: 12/18/2022] Open
Abstract
Background The Philadelphia (Ph)-negative myeloproliferative neoplasms (MPNs), namely essential thrombocythaemia (ET), polycythaemia vera (PV) and primary myelofibrosis (PMF), are a group of chronic clonal haematopoietic disorders that have the propensity to advance into bone marrow failure or acute myeloid leukaemia; often resulting in fatality. Although driver mutations have been identified in these MPNs, subtype-specific markers of the disease have yet to be discovered. Next-generation sequencing (NGS) technology can potentially improve the clinical management of MPNs by allowing for the simultaneous screening of many disease-associated genes. Methods The performance of a custom, in-house designed 22-gene NGS panel was technically validated using reference standards across two independent replicate runs. The panel was subsequently used to screen a total of 10 clinical MPN samples (ET n = 3, PV n = 3, PMF n = 4). The resulting NGS data was then analysed via a bioinformatics pipeline. Results The custom NGS panel had a detection limit of 1% variant allele frequency (VAF). A total of 20 unique variants with VAFs above 5% (4 of which were putatively novel variants with potential biological significance) and one pathogenic variant with a VAF of between 1 and 5% were identified across all of the clinical MPN samples. All single nucleotide variants with VAFs ≥ 15% were confirmed via Sanger sequencing. Conclusions The high fidelity of the NGS analysis and the identification of known and novel variants in this study cohort support its potential clinical utility in the management of MPNs. However, further optimisation is needed to avoid false negatives in regions with low sequencing coverage, especially for the detection of driver mutations in MPL. Supplementary Information The online version contains supplementary material available at 10.1186/s12920-021-01145-0.
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Affiliation(s)
- Jaymi Tan
- Department of Biological Sciences, School of Medical and Life Sciences, Sunway University, Petaling Jaya, Selangor, Malaysia
| | - Yock Ping Chow
- Clinical Research Centre, Sunway Medical Centre, Petaling Jaya, Selangor Darul Ehsan, Malaysia
| | - Norziha Zainul Abidin
- Molecular Diagnostics Laboratory, Sunway Medical Centre, Petaling Jaya, Selangor Darul Ehsan, Malaysia
| | - Kian Meng Chang
- Haematology Unit, Department of Medicine, Sunway Medical Centre, Petaling Jaya, Selangor Darul Ehsan, Malaysia
| | | | - Nor Rafeah Tumian
- Haematology Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Yang Ming Poh
- School of Data Sciences, Perdana University, Serdang, Selangor, Malaysia
| | - Abhi Veerakumarasivam
- Department of Biological Sciences, School of Medical and Life Sciences, Sunway University, Petaling Jaya, Selangor, Malaysia
| | - Michael Arthur Laffan
- Centre for Haematology, Hammersmith Hospital, London, UK.,Faculty of Medicine, Imperial College London, London, UK
| | - Chieh Lee Wong
- Department of Biological Sciences, School of Medical and Life Sciences, Sunway University, Petaling Jaya, Selangor, Malaysia. .,Clinical Research Centre, Sunway Medical Centre, Petaling Jaya, Selangor Darul Ehsan, Malaysia. .,Molecular Diagnostics Laboratory, Sunway Medical Centre, Petaling Jaya, Selangor Darul Ehsan, Malaysia. .,Haematology Unit, Department of Medicine, Sunway Medical Centre, Petaling Jaya, Selangor Darul Ehsan, Malaysia. .,Centre for Haematology, Hammersmith Hospital, London, UK. .,Faculty of Medicine, Imperial College London, London, UK.
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13
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Güney T, Can F, Alkan A, Akıncı S, Dilek İ. The effects of plasma viscosity in thromboembolic events among patients with essential thrombocytosis: A case-control study. Clin Hemorheol Microcirc 2021; 80:233-240. [PMID: 34602461 DOI: 10.3233/ch-211137] [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: 11/15/2022]
Abstract
INTRODUCTION Essential thrombocythemia (ET) is an entity of classic Philadelphia chromosome-negative myeloproliferative neoplasms (MPNs), characterized by thrombocytosis with megakaryocytic hyperplasia where in the thrombocytes are increased with abnormal function.Thrombotic events are seen frequently and represent the main cause of morbidity and mortalityin patients with MPNs, mainly polycythemia vera and ET. This study has aimed to research the effects of clonally increased thrombocytes on plasma viscosity (PV) levels among patients with ET and the relationship between PV and thromboembolism history, according to the hypotheses about the effects of PV in thromboembolic events among patients with ET. METHODS A total of 55 patients were enrolled in the study group, 18 of who had been newly diagnosed with ET according to 2016 World Health Organization criteria and had not previously been treated. 37 of them had already been diagnosed with ET and had been treated. There were 47 healthy volunteers in the control group. 5 cc blood samples were taken from the patients into tubes including an anticoagulant to measure their PV levels. RESULTS PV of the control group was found to be lower than in the study group and both each patient groups (p < 0.05). No relationship was found between the patient groups in terms of PV (p = 0.404). The mean PV levels of the 16 patients with a history of thromboembolism and the 39 patients with no such history were 2.42±0.17 cP and 2.33±0.20 cP, respectively. The mean PV levels were found to be similar according to their history of thromboembolism in all patient groups and in treated patients (p = 0.572 vs p = 0.991). CONCLUSION We have found that PV levels were increased in clonally increased thrombocytes in patients with ET when compared with the control group. This is the first study in this field according to our knowledge.
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Affiliation(s)
- Tekin Güney
- Department of Hematology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Ferda Can
- Department of Hematology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Afra Alkan
- Department of Biostatistics and Medical Informatics, Ankara Yıldırım Beyazit University, Ankara, Turkey
| | - Sema Akıncı
- Department of Hematology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
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Kim J, Byun JM, Hong J, Koh Y, Shin DY, Kim I, Yoon SS, Park H, Bang SM. Incidence, characteristics and risk factors of thromboembolic events in East Asian patients with BCR-ABL1 negative myeloproliferative neoplasms. Sci Rep 2021; 11:17819. [PMID: 34497309 PMCID: PMC8426379 DOI: 10.1038/s41598-021-97464-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 08/25/2021] [Indexed: 01/14/2023] Open
Abstract
The vascular complications have been a major cause of morbidity and mortality among all subtypes of BCR-ABL1 negative myeloproliferative neoplasms (MPN), but the ethnicity-specific data was limited. We therefore conducted a multi-center retrospective, longitudinal cohort study to evaluate the incidence, characteristics and risk factors of thromboembolic events of MPN patients. Of 256 patients, 27.3% experienced thromboembolic events, majority of which occurred before or within 12 months of MPN diagnosis. The multivariable Cox proportional analyses identified leukocytosis (HR 2.67, 95% CI 1.36-5.24, q = 0.004) and history of thrombosis (HR 9.68, 95% CI 2.00-46.88, q = 0.005) as the risk factors for thromboembolism. In subgroup analysis of polycythemia vera and hemoglobin concentration (HR 1.97, 95% CI 1.28-3.04, q = 0.002) appeared to be a significant risk factor of thrombosis, along with age and thrombosis history. In essential thrombocythemia, severity of the established IPSET score was closely correlated with the frequency of thromboembolic events. In primary myelofibrosis, history of thrombosis was associated with thrombosis events (HR 13.85, 95% CI 1.2-159.5, q = 0.035). Overall survival was worse in patients who experienced thromboembolic events. Our study highlighted the importance of recognizing high risk patients and implementing personalized intervention.
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Affiliation(s)
- Jinyong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Ja Min Byun
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea. .,Cancer Research Institute, Seoul National University College of Medicine, Seoul, 110744, Korea. .,Center for Medical Innovation, Biomedical Research Institute, Seoul National University Hospital, Seoul, 110744, Korea.
| | - Junshik Hong
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, 110744, Korea.,Center for Medical Innovation, Biomedical Research Institute, Seoul National University Hospital, Seoul, 110744, Korea
| | - Youngil Koh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, 110744, Korea.,Center for Medical Innovation, Biomedical Research Institute, Seoul National University Hospital, Seoul, 110744, Korea
| | - Dong-Yeop Shin
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, 110744, Korea.,Center for Medical Innovation, Biomedical Research Institute, Seoul National University Hospital, Seoul, 110744, Korea
| | - Inho Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Sung-Soo Yoon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, 110744, Korea.,Center for Medical Innovation, Biomedical Research Institute, Seoul National University Hospital, Seoul, 110744, Korea
| | - Hyunkyung Park
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, 07061, Korea
| | - Soo-Mee Bang
- Department of Internal Medicine, Seoul Nationl University College of Medicine, Seoul National University Bundang Hospital, Seongnam, 463-707, Korea
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The Prognostic Role of Cytogenetics Analysis in Philadelphia Negative Myeloproliferative Neoplasms. ACTA ACUST UNITED AC 2021; 57:medicina57080813. [PMID: 34441019 PMCID: PMC8398709 DOI: 10.3390/medicina57080813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/03/2021] [Accepted: 08/06/2021] [Indexed: 11/16/2022]
Abstract
Myeloproliferative neoplasms (MPNs) are clonal stem cell disorders characterized collectively by clonal proliferation of myeloid cells with variable morphologic maturity and hematopoietic efficiency. Although the natural history of these neoplasms can be measured sometimes in decades more than years, the cytogenetics analysis can offer useful information regarding the prognosis. Cytogenetics has a well-established prognostic role in acute leukemias and in myelodysplastic syndromes, where it drives the clinical decisions. NGS techniques can find adverse mutations with clear prognostic value and are currently included in the prognostic evaluation of MPNs in scores such as MIPSS, GIPSS, MIPSS-PV, and MIPSS-ET. We suggest that cytogenetics (considering its availability and relative cost) has a role regarding prognostic and therapeutic decisions.
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Sayar Z, Nallamilli S, Efthymiou M, Lambert J, Cohen H. Coexistent antiphospholipid syndrome and myeloproliferative neoplasm. Lupus 2021; 30:1502-1508. [PMID: 34192956 DOI: 10.1177/09612033211021154] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Antiphospholipid syndrome (APS) and myeloproliferative neoplasms (MPN) are associated with an increased risk of thrombosis. The optimal management of patients with coexistent APS and MPN has not been defined. A single centre and systematic literature review of patients with coexistent APS and MPN was performed. Cases were divided into two groups based on whether they met international consensus criteria for APS. Of the 12 studies identified, eight were excluded (leaving five of a total 54 patients), as although antiphospholipid antibodies (aPL) were documented, the diagnosis of APS was not conclusively demonstrated. Another ten patients with definite APS were identified at our centre. Fifteen patients (ten females, five males) were therefore included in this analysis (eleven definite APS and four highly likely), median age 44 (range: 13-71) years. Nine had polycythaemia vera and six, essential thrombocythaemia. Thirteen of the 15 patients (86.7%) had thrombotic APS (seven with initial venous events and six arterial) and two (13.3%) had obstetric APS. Nine patients were single-positive, and six double-positive for aPL. None were triple aPL-positive. Four patients at our centre had recurrent thrombotic/obstetric events, including while on anticoagulation/antiplatelet treatment.
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Affiliation(s)
- Zara Sayar
- Haemostasis Research Unit, Department of Haematology, University College London, London, UK
| | - Susanna Nallamilli
- Haemostasis Research Unit, Department of Haematology, University College London, London, UK.,Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Maria Efthymiou
- Haemostasis Research Unit, Department of Haematology, University College London, London, UK.,Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Jonathan Lambert
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Hannah Cohen
- Haemostasis Research Unit, Department of Haematology, University College London, London, UK.,Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
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Kim SY, Bae SH, Bang SM, Eom KS, Hong J, Jang S, Jung CW, Kim HJ, Kim HY, Kim MK, Kim SJ, Mun YC, Nam SH, Park J, Won JH, Choi CW. The 2020 revision of the guidelines for the management of myeloproliferative neoplasms. Korean J Intern Med 2021; 36:45-62. [PMID: 33147902 PMCID: PMC7820646 DOI: 10.3904/kjim.2020.319] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 11/07/2020] [Indexed: 02/07/2023] Open
Abstract
In 2016, the World Health Organization revised the diagnostic criteria for myeloproliferative neoplasms (MPNs) based on the discovery of disease-driving genetic aberrations and extensive analysis of the clinical characteristics of patients with MPNs. Recent studies have suggested that additional somatic mutations have a clinical impact on the prognosis of patients harboring these genetic abnormalities. Treatment strategies have also advanced with the introduction of JAK inhibitors, one of which has been approved for the treatment of patients with myelofibrosis and those with hydroxyurea-resistant or intolerant polycythemia vera. Recently developed drugs aim to elicit hematologic responses, as well as symptomatic and molecular responses, and the response criteria were refined accordingly. Based on these changes, we have revised the guidelines and present the diagnosis, treatment, and risk stratification of MPNs encountered in Korea.
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Affiliation(s)
- Sung-Yong Kim
- Division of Hematology, Department of Internal Medicine, Konkuk University Medical Center, Seoul,
Korea
| | - Sung Hwa Bae
- Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu,
Korea
| | - Soo-Mee Bang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Ki-Seong Eom
- Department of Hematology, Seoul St. Mary’s Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Junshik Hong
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul,
Korea
| | - Seongsoo Jang
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Chul Won Jung
- Division of Hematology/Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Hee-Jin Kim
- Department of Laboratory Medicine & Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Ho Young Kim
- Department of Internal Medicine, Hallym University Medical Center, Anyang,
Korea
| | - Min Kyoung Kim
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu,
Korea
| | - Soo-Jeong Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul,
Korea
| | - Yeung-Chul Mun
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul,
Korea
| | - Seung-Hyun Nam
- Department of Internal Medicine, Veterans Health Service Medical Center, Seoul,
Korea
| | - Jinny Park
- Division of Hematology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon,
Korea
| | - Jong-Ho Won
- Division of Hematology-Oncology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul,
Korea
| | - Chul Won Choi
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University Guro Hospital, Seoul,
Korea
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Multimodality imaging beyond CLEM: Showcases of combined in-vivo preclinical imaging and ex-vivo microscopy to detect murine mural vascular lesions. Methods Cell Biol 2020; 162:389-415. [PMID: 33707020 DOI: 10.1016/bs.mcb.2020.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
In imaging, penetration depth comes at the expense of lateral resolution, which restricts the scope of 3D in-vivo imaging of small animals at micrometer resolution. Bioimaging will need to expand beyond correlative light and electron microscopy (CLEM) approaches to combine insights about in-vivo dynamics in a physiologically relevant 3D environment with ex-vivo information at micrometer resolution (or beyond) within the spatial, structural and biochemical contexts. Our report demonstrates the immense potential for biomedical discovery and diagnosis made available by bridging preclinical in-vivo imaging with ex-vivo biological microscopy to zoom in from the whole organism to individual structures and by adding localized spectroscopic information to structural and functional information. We showcase the use of two novel imaging pipelines to zoom into mural lesions (occlusions/hyperplasia and micro-calcifications) in murine vasculature in a truly correlative manner, that is using exactly the same animal for all integrated imaging modalities. This correlated multimodality imaging (CMI) approach includes well-established technologies such as Positron Emission Tomography (microPET), Autoradiography, Magnetic Resonance Imaging (microMRI) and Computed Tomography (microCT), and imaging approaches that are more novel in the biomedical setting, such as X-Ray Fluorescence Spectroscopy (microXRF) and High Resolution Episcopic Microscopy (HREM). Although the current pipelines are focused on mural lesions, they would also be beneficial in preclinical and clinical investigations of vascular diseases in general.
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Masarova L, Bose P, Verstovsek S. The Rationale for Immunotherapy in Myeloproliferative Neoplasms. Curr Hematol Malig Rep 2020; 14:310-327. [PMID: 31228096 DOI: 10.1007/s11899-019-00527-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW The classic, chronic Philadelphia chromosome negative myeloproliferative neoplasms (MPN)-essential thrombocythemia (ET), polycythemia vera (PV), and myelofibrosis (MF)-are clonal malignancies of hematopoietic stem cells and are associated with myeloproliferation, organomegaly, and constitutional symptoms. Expanding knowledge that chronic inflammation and a dysregulated immune system are central to the pathogenesis and progression of MPNs serves as a driving force for the development of agents affecting the immune system as therapy for MPN. This review describes the rationale and potential impact of anti-inflammatory, immunomodulatory, and targeted agents in MPNs. RECENT FINDINGS The advances in molecular insights, especially the discovery of the Janus kinase 2 (JAK2) V617F mutation and its role in JAK-STAT pathway dysregulation, led to the development of the JAK inhibitor ruxolitinib, which currently represents the cornerstone of medical therapy in MF and hydroxyurea-resistant/intolerant PV. However, there remain significant unmet needs in the treatment of these patients, and many agents continue to be investigated. Novel, more selective JAK inhibitors might offer reduced myelosuppression or even improvement of blood counts. The recent approval of a novel, long-acting interferon for PV patients in Europe, might eventually lead to its broader clinical use in all MPNs. Targeted immunotherapy involving monoclonal antibodies, checkpoint inhibitors, or therapeutic vaccines against selected MPN epitopes could further enhance tumor-specific immune responses. Immunotherapeutic approaches are expanding and hopefully will extend the therapeutic armamentarium in patients with myeloproliferative neoplasms.
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Affiliation(s)
- Lucia Masarova
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 0428, Houston, TX, 77030, USA.
| | - Prithviraj Bose
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 0428, Houston, TX, 77030, USA
| | - Srdan Verstovsek
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 0428, Houston, TX, 77030, USA
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20
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Differential cytokine network profile in polycythemia vera and secondary polycythemia. Sci Rep 2020; 10:7032. [PMID: 32341381 PMCID: PMC7468352 DOI: 10.1038/s41598-020-63680-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 03/30/2020] [Indexed: 11/13/2022] Open
Abstract
Polycythemia vera (PV) is a clonal disorder resulting from neoplastic transformation of hematopoietic stem cells, while secondary polycythemia (SP) is a disease characterized by increased absolute red blood cell mass caused by stimulation of red blood cell production. Although the physiopathology of SP and PV is distinct, patients with these diseases share similar symptoms. The early differential diagnosis may improve the quality of life and decrease the disease burden in PV patients, as well as enable curative treatment for SP patients. PV is considered an oncoinflammatory disease because PV patients exhibit augmented levels of several pro-inflammatory cytokines. In this sense, we examined whether analysis of the cytokine production profile of SP and PV patients would help to distinguish them, despite their clinical similarities. Here we reported that SP patients exhibited decreased plasma levels of, IL-17A, IFN-γ, IL-12p70 and TNF-α when compared with PV patients, suggesting that analysis of the cytokine production profile may be an useful diagnostic biomarker to distinguish PV from SP patients.
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Zaidi U, Sufaida G, Rashid M, Kaleem B, Maqsood S, Mukry SN, Khan RZA, Munzir S, Borhany M, Shamsi TS. A distinct molecular mutational profile and its clinical impact in essential thrombocythemia and primary myelofibrosis patients. BMC Cancer 2020; 20:205. [PMID: 32164591 PMCID: PMC7069043 DOI: 10.1186/s12885-020-6700-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 02/28/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Classical MPNs including ET and PMF have a chronic course and potential for leukaemic transformation. Timely diagnosis is obligatory to ensure appropriate management and positive outcomes. The aim of this study was to determine the mutational profile, clinical characteristics and outcome of ET and PMF patients in Pakistani population. METHODS This was a prospective observational study conducted between 2012 and 2017 at NIBD. Patients were diagnosed and risk stratified according to international recommendations. Response to treatment was assessed by IWG criteria. RESULTS Of the total 137 patients analysed, 75 were ET and 62 were PMF. JAK2 positivity was seen in 51 cases (37.2%), CALR in 41 cases (29.9%), while triple-negative in 17 (12.4%) cases. None of the patients in the present study were MPL positive. Overall survival for patients with ET and PMF was 92.5 and 86.0% respectively and leukaemia free survival was 100 and 91.6% respectively, at a median follow-up of 12 months. Leukaemic transformation occurred in 6.5% of MF patients; among them, JAK2 mutation was frequently found. Molecular mutations did not influence the OS in ET whereas in PMF, OS was shortest in the triple-negative PMF group as compared to the JAK2 and CALR positive patient groups. CONCLUSION This study shows a different spectrum of molecular mutations in ET and PMF patients in Pakistani population as compared to other Asian countries. Similarly, the risk of leukaemic transformation in ET and PMF is relatively lower in our population of patients. The factors responsible for these phenotypic and genotypic differences need to be analysed in large scale studies with longer follow-up of patients.
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Affiliation(s)
- Uzma Zaidi
- Department of Clinical Hematology, National Institute of Blood Diseases & Bone Marrow Transplantation, Karachi, Pakistan.
| | - Gul Sufaida
- Department of Molecular Medicine, National Institute of Blood Diseases & Bone Marrow Transplantation, Karachi, Pakistan
| | - Munazza Rashid
- Department of Molecular Medicine, National Institute of Blood Diseases & Bone Marrow Transplantation, Karachi, Pakistan
| | - Bushra Kaleem
- Department of Clinical Research, National Institute of Blood Diseases & Bone Marrow Transplantation, Karachi, Pakistan
| | - Sidra Maqsood
- Department of Clinical Research, National Institute of Blood Diseases & Bone Marrow Transplantation, Karachi, Pakistan
| | - Samina Naz Mukry
- Department of Molecular Medicine, National Institute of Blood Diseases & Bone Marrow Transplantation, Karachi, Pakistan
| | - Rifat Zubair Ahmed Khan
- Department of Molecular Medicine, National Institute of Blood Diseases & Bone Marrow Transplantation, Karachi, Pakistan
| | - Saima Munzir
- Department of Clinical Hematology, National Institute of Blood Diseases & Bone Marrow Transplantation, Karachi, Pakistan
| | - Munira Borhany
- Department of Clinical Hematology, National Institute of Blood Diseases & Bone Marrow Transplantation, Karachi, Pakistan
| | - Tahir Sultan Shamsi
- Department of Clinical Hematology, National Institute of Blood Diseases & Bone Marrow Transplantation, Karachi, Pakistan
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Schain F, Vago E, Song C, He J, Liwing J, Löfgren C, Björkholm M. Survival outcomes in myelofibrosis patients treated with ruxolitinib: A population-based cohort study in Sweden and Norway. Eur J Haematol 2019; 103:614-619. [PMID: 31536656 PMCID: PMC6899943 DOI: 10.1111/ejh.13330] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 09/10/2019] [Accepted: 09/11/2019] [Indexed: 12/12/2022]
Abstract
Objective To estimate survival in Swedish and Norwegian myelofibrosis (MF) patients who received ruxolitinib. Methods Swedish and Norwegian patients with MF diagnosis in the National Cancer Registries (Sweden: 2001‐2015; Norway: 2002‐2016) and ≥1 record of ruxolitinib in the Prescribed Drug Registries (2013‐2017) were included. Patients were followed from ruxolitinib initiation until death or end of follow‐up; those who discontinued ruxolitinib were followed from ruxolitinib discontinuation. Relative survival (RS) and excess mortality rate ratios (EMRRs) were calculated vs a matched general population. Average loss in life expectancy (LEL) was predicted using flexible parametric models. Results Among patients who initiated ruxolitinib (n = 190), 1‐ and 4‐year RS were 0.80 (95% confidence interval [CI]: 0.74, 0.86) and 0.52 (95% CI: 0.42, 0.64), respectively, and LEL was 11 years. EMRR was greater in patients aged >70 vs <60 years (3.16; 95% CI: 1.34‐7.40). Among patients who discontinued ruxolitinib (n = 71), median RS was 16.0 months (95% CI: 6.3, NE), and LEL was 12 years. After ruxolitinib treatment discontinuation, Swedish patients (n = 37) received glucocorticoids, hydroxyurea, busulfan, danazol and lenalidomide. Conclusion Swedish and Norwegian MF patients who discontinued ruxolitinib had dismal survival outcomes and limited subsequent treatment options, highlighting the need for improved therapies.
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Affiliation(s)
- Frida Schain
- Janssen Global Services, Solna, Sweden.,Division of Hematology, Department of Medicine, Karolinska University Hospital Solna and Karolinska Institutet, Stockholm, Sweden
| | | | - Ci Song
- Janssen Global Services, Solna, Sweden
| | - Jianming He
- Janssen Pharmaceuticals LLC, Raritan, NJ, USA
| | | | | | - Magnus Björkholm
- Division of Hematology, Department of Medicine, Karolinska University Hospital Solna and Karolinska Institutet, Stockholm, Sweden
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Szuber N, Mudireddy M, Nicolosi M, Penna D, Vallapureddy RR, Lasho TL, Finke C, Begna KH, Elliott MA, Hook CC, Wolanskyj AP, Patnaik MM, Hanson CA, Ketterling RP, Sirhan S, Pardanani A, Gangat N, Busque L, Tefferi A. 3023 Mayo Clinic Patients With Myeloproliferative Neoplasms: Risk-Stratified Comparison of Survival and Outcomes Data Among Disease Subgroups. Mayo Clin Proc 2019; 94:599-610. [PMID: 30824279 DOI: 10.1016/j.mayocp.2018.08.022] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 07/16/2018] [Accepted: 08/06/2018] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To document the Mayo Clinic decades-long experience with myeloproliferative neoplasms (MPNs) and provide mature risk-stratified survival data and disease complication estimates. PATIENTS AND METHODS All Mayo Clinic patients with World Health Organization-defined MPNs constituted the core study group and included those with polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF). RESULTS A total of 3023 consecutive patients (median age, 62 years; range, 18-96 years) were considered: 665 PV, 1076 ET, and 1282 PMF. From October 27, 1967, through December 29, 2017, 1631 deaths (54%), 183 leukemic transformations (6%), 244 fibrotic progressions (14%), and 516 thrombotic events (17%) were recorded. Median overall survival (OS) was 18 years for ET, 15 years for PV, and 4.4 years for PMF (P<.05 for all intergroup comparisons). Inferior survival was documented in patients with ET diagnosed more recently (post-1990) (P<.001), whereas survival data were time independent in PV and PMF. After conventional risk stratification, OS in low-risk ET and low-risk PV were superimposed (P=.89) but each differed significantly from that of age- and sex-matched controls (P<.001). Leukemia-free survival was similar for ET and PV (P=.22) and significantly worse with PMF (P<.001). Compared with ET, PV was associated with higher risk of fibrotic progression (P<.001). Thrombosis risk after diagnosis was highest in PV and lowest in PMF (P=.002 for PV vs ET; P=.56 for ET vs PMF; and P=.001 for PV vs PMF). CONCLUSION This study provides the most mature survival and outcomes data in MPNs and highlights MPN subgroup risk categorization as key in appraising disease natural history. The OS was only marginally better in ET compared with PV, and PV displayed a higher risk of thrombosis and fibrotic progression.
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Affiliation(s)
- Natasha Szuber
- Division of Hematology, Department of Internal and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Mythri Mudireddy
- Division of Hematology, Department of Internal and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Maura Nicolosi
- Division of Hematology, Department of Internal and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Domenico Penna
- Division of Hematology, Department of Internal and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Rangit R Vallapureddy
- Division of Hematology, Department of Internal and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Terra L Lasho
- Division of Hematology, Department of Internal and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Christy Finke
- Division of Hematology, Department of Internal and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Kebede H Begna
- Division of Hematology, Department of Internal and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Michelle A Elliott
- Division of Hematology, Department of Internal and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - C Christopher Hook
- Division of Hematology, Department of Internal and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Alexandra P Wolanskyj
- Division of Hematology, Department of Internal and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Mrinal M Patnaik
- Division of Hematology, Department of Internal and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Curtis A Hanson
- Division of Hematopathology, Department of Internal and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Rhett P Ketterling
- Division of Laboratory Genetics and Genomics, Department of Internal and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Shireen Sirhan
- Division of Hematology, Jewish General Hospital, Montréal, Québec, Canada; Chronic Myeloid Leukemia and Myeloproliferative Neoplasms Quebec Research Group
| | - Animesh Pardanani
- Division of Hematology, Department of Internal and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Naseema Gangat
- Division of Hematology, Department of Internal and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Lambert Busque
- Chronic Myeloid Leukemia and Myeloproliferative Neoplasms Quebec Research Group; Department of Laboratory Hematology, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada
| | - Ayalew Tefferi
- Division of Hematology, Department of Internal and Laboratory Medicine, Mayo Clinic, Rochester, MN.
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Yang N, Park S, Cho MS, Lee M, Hong KS, Mun YC, Seong CM, Huh HJ, Huh J. GATA1 Expression in BCR/ABL1-negative Myeloproliferative Neoplasms. Ann Lab Med 2018; 38:296-305. [PMID: 29611379 PMCID: PMC5895858 DOI: 10.3343/alm.2018.38.4.296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 09/19/2017] [Accepted: 02/20/2018] [Indexed: 12/21/2022] Open
Abstract
Background This study aimed to determine GATA1 expression levels to better characterize subgroups in BCR/ABL1-negative myeloproliferative neoplasms (MPNs). Methods This study enrolled 49 patients diagnosed as having BCR/ABL1-negative MPN on the basis of the 2016 World Health Organization classification : nine polycythemia vera (PV), 17 essential thrombocythemia (ET), 12 prefibrotic primary myelofibrosis (prePMF), and 11 overt primary myelofibrosis (PMF). Relevant clinical and laboratory data were retrieved from the medical records. The molecular analysis of CALR and MPL mutations and quantification of JAK2 V617F allele burden were performed. GATA1 expression was assessed by an immunohistochemical assay on bone marrow biopsy. GATA1 expression was analyzed serially in 18 patients. Results GATA1 expression decreased significantly in PMF compared with that in other subtypes, while no statistical difference was identified between ET and prePMF. GATA1 expression did not differ according to the mutation profiles or the allele burden of JAK2 V617F, but it decreased significantly in patients with overt fibrosis or leukemic transformation. Conclusions Our results suggest that GATA1 expression is significantly low in PMF and decreases with progressive fibrosis and possibly with leukemic transformation, although our attempt to accurately distinguish between subgroups using GATA1 immunohistochemical approach did not achieve statistical significance. A large patient cohort with long term follow-up is required to evaluate the prognostic value of GATA1 expression.
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Affiliation(s)
- Naery Yang
- Department of Laboratory Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Sholhui Park
- Department of Laboratory Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Min Sun Cho
- Department of Pathology, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Miae Lee
- Department of Laboratory Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Ki Sook Hong
- Department of Laboratory Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Yeung Chul Mun
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Chu Myong Seong
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Hee Jin Huh
- Department of Laboratory Medicine, Dongguk University Ilsan Hospital, Goyang, Korea.
| | - Jungwon Huh
- Department of Laboratory Medicine, College of Medicine, Ewha Womans University, Seoul, Korea.
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25
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Takenaka K, Shimoda K, Akashi K. Recent advances in the diagnosis and management of primary myelofibrosis. Korean J Intern Med 2018; 33:679-690. [PMID: 29665657 PMCID: PMC6030412 DOI: 10.3904/kjim.2018.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 03/07/2018] [Indexed: 12/13/2022] Open
Abstract
Primary myelofibrosis (PMF) is a myeloproliferative neoplasm (MPN) in which dysregulation of the Janus kinase/signal transducers and activators of transcription (JAK/STAT) signaling pathways is the major pathogenic mechanism. Most patients with PMF carry a driver mutation in the JAK2, MPL (myeloproliferative leukemia), or CALR (calreticulin) genes. Mutations in epigenetic regulators and RNA splicing genes may also occur, and play critical roles in PMF disease progression. Based on revised World Health Organization diagnostic criteria for MPNs, both screening for driver mutations and bone marrow biopsy are required for a specific diagnosis. Clinical trials of JAK2 inhibitors for PMF have revealed significant efficacy for improving splenomegaly and constitutional symptoms. However, the currently available drug therapies for PMF do not improve survival. Although allogeneic stem cell transplantation is potentially curative, it is associated with substantial treatment-related morbidity and mortality. PMF is a heterogeneous disorder and decisions regarding treatments are often complicated, necessitating the use of prognostic models to determine the management of treatments for individual patients. This review focuses on the clinical aspects and outcomes of a cohort of Japanese patients with PMF, including discussion of recent advances in the management of PMF.
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Affiliation(s)
- Katsuto Takenaka
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
- Correspondence to Katsuto Takenaka, M.D. Division of Hematology, Oncology & Cardiovascular Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan Tel: +81-92-642-5230 Fax: +81-92-642-5247 E-mail:
| | - Kazuya Shimoda
- Department of Gastroenterology and Hematology, University of Miyazaki Faculty of Medicine, Miyazaki, Japan
| | - Koichi Akashi
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
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26
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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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27
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Assessment of risk factors affecting thrombosis in patients with Essential Thrombocytosis in our clinic. JOURNAL OF SURGERY AND MEDICINE 2018. [DOI: 10.28982/josam.396881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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28
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Zhou A, Afzal A, Oh ST. Prognostication in Philadelphia Chromosome Negative Myeloproliferative Neoplasms: a Review of the Recent Literature. Curr Hematol Malig Rep 2018; 12:397-405. [PMID: 28948488 DOI: 10.1007/s11899-017-0401-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE OF REVIEW The prognosis for patients with Philadelphia chromosome (Ph)-negative myeloproliferative neoplasms (MPNs) is highly variable. All Ph-negative MPNs carry an increased risk for thrombotic complications, bleeding, and leukemic transformation. Several clinical, biological, and molecular prognostic factors have been identified in recent years, which provide important information in guiding management of patients with Ph-negative MPNs. In this review, we critically evaluate the recent published literature and discuss important new developments in clinical and molecular factors that impact survival, disease transformation, and thrombosis in patients with polycythemia vera, essential thrombocythemia, and primary myelofibrosis. RECENT FINDINGS Recent studies have identified several clinical factors and non-driver mutations to have prognostic impact on Ph-negative MPNs independent of conventional risk stratification and prognostic models. In polycythemia vera (PV), leukocytosis, abnormal karyotype, phlebotomy requirement on hydroxyurea, increased bone marrow fibrosis, and mutations in ASXL1, SRSF2, and IDH2 were identified as additional adverse prognostic factors. In essential thrombocythemia (ET), JAK2 V617F mutation, splenomegaly, and mutations in SH2B3, SF3B1, U2AF1, TP53, IDH2, and EZH2 were found to be additional negative prognostic factors. Bone marrow fibrosis and mutations in ASXL1, SRSF2, EZH2, and IDH1/2 have been found to be additional prognostic factors in primary myelofibrosis (PMF). CALR mutations appear to be a favorable prognostic factor in PMF, which has not been clearly demonstrated in ET. The prognosis for patients with PV, ET, and PMF is dependent upon the presence or absence of several clinical, biological, and molecular risk factors. The significance of additional risk factors identified in these recent studies will need further validation in prospective studies to determine how they may be best utilized in the management of these disorders.
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Affiliation(s)
- Amy Zhou
- Division of Hematology, Washington University in St. Louis School of Medicine, 660 S. Euclid Ave, Campus Box 8125, St. Louis, MO, 63110, USA
| | - Amber Afzal
- Division of Hematology, Washington University in St. Louis School of Medicine, 660 S. Euclid Ave, Campus Box 8125, St. Louis, MO, 63110, USA
| | - Stephen T Oh
- Division of Hematology, Washington University in St. Louis School of Medicine, 660 S. Euclid Ave, Campus Box 8125, St. Louis, MO, 63110, USA.
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29
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Herborg LL, Nederby L, Hasselbalch HC, Aggerholm A, Roug AS. Distinguishing myelofibrosis from polycythemia vera and essential thrombocythemia: The utility of enumerating circulating stem cells with aberrant hMICL expression by flow cytometry. Int J Lab Hematol 2018; 40:320-325. [PMID: 29427319 DOI: 10.1111/ijlh.12787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 01/10/2018] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Diagnosing BCR-ABL negative myeloproliferative neoplasms (MPN) may be challenging due to overlapping features and lack of robust discriminatory parameters, especially between essential thrombocythemia (ET) and prefibrotic myelofibrosis (MF). Circulating immature hematopoietic cells are variably present in polycythemia vera (PV), ET, and MF. The C-type lectin hMICL is aberrantly expressed on hematopoietic stem cells in the majority of acute myeloid leukemia patients. However, the hMICL expression in MPN, having varying propensity of leukemic transformation, is unsettled. We hypothesized that enumeration of immature cells by flow cytometry (FCM) could be a discriminatory tool in MPN diagnostics. METHODS By FCM, we quantified circulating stem cells with aberrant hMICL expression in 39 MPN patients, 10 age-matched controls, and in leukapheresis products from 10 patients with lymphoproliferative neoplasms. The utility of the FCM assay for discriminating MPN entities was evaluated by applying ROC curve analysis. RESULTS While hMICL was absent in control samples, MF patients had significantly more hMICL+ stem cells (median 15.2%) than PV and ET (0.0%, P = .001 and 0.0%, P = .002, respectively). By ROC curve analysis, the presence of hMICL+ stem cells (>0 cells) in peripheral blood reliably discriminates MF from ET and PV with a sensitivity of 80% and a specificity of 97%. CONCLUSION Enumeration of circulating hMICL+ stem cells by FCM can discriminate between MPN phenotypes and holds potential for monitoring disease evolution.
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Affiliation(s)
- L L Herborg
- Department of Hematology, Aarhus University Hospital, Aarhus C, Denmark
| | - L Nederby
- Department of Hematology, Aarhus University Hospital, Aarhus C, Denmark.,Department of Clinical Immunology and Biochemistry, Lillebaelt Hospital, Vejle, Denmark
| | - H C Hasselbalch
- Department of Hematology, Roskilde University Hospital, Roskilde, Denmark
| | - A Aggerholm
- Department of Hematology, Aarhus University Hospital, Aarhus C, Denmark
| | - A S Roug
- Department of Hematology, Aarhus University Hospital, Aarhus C, Denmark
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30
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Hernández-Boluda JC, Pereira A, Correa JG, Alvarez-Larrán A, Ferrer-Marín F, Raya JM, Martínez-López J, Velez P, Pérez-Encinas M, Estrada N, García-Gutiérrez V, Fox ML, Payer A, Kerguelen A, Cuevas B, Durán MA, Ramírez MJ, Gómez-Casares MT, Mata-Vázquez MI, Mora E, Gómez M, Cervantes F. Prognostic risk models for transplant decision-making in myelofibrosis. Ann Hematol 2018; 97:813-820. [DOI: 10.1007/s00277-018-3240-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 01/04/2018] [Indexed: 12/15/2022]
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31
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Phosphatidylserine-exposing blood and endothelial cells contribute to the hypercoagulable state in essential thrombocythemia patients. Ann Hematol 2018; 97:605-616. [PMID: 29332224 DOI: 10.1007/s00277-018-3228-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 12/28/2017] [Indexed: 12/27/2022]
Abstract
The mechanisms of thrombogenicity in essential thrombocythemia (ET) are complex and not well defined. Our objective was to explore whether phosphatidylserine (PS) exposure on blood cells and endothelial cells (ECs) can account for the increased thrombosis and distinct thrombotic risks among mutational subtypes in ET. Using flow cytometry and confocal microscopy, we found that the levels of PS-exposing erythrocytes, platelets, leukocytes, and serum-cultured ECs were significantly higher in each ET group [JAK2, CALR, and triple-negative (TN) (all P < 0.001)] than those in controls. Among ET patients, those with JAK2 mutations showed higher levels of PS-positive erythrocytes, platelets, neutrophils, and serum-cultured ECs than TN patients or those with CALR mutations, which show similar levels. Coagulation function assays showed that higher levels of PS-positive blood cells and serum-cultured ECs led to markedly shortened coagulation time and dramatically increased levels of FXa, thrombin, and fibrin production. This procoagulant activity could be largely blocked by addition of lactadherin (approx. 70% inhibition). Confocal microscopy showed that the FVa/FXa complex and fibrin fibrils colocalized with PS on ET serum-cultured ECs. Additionally, we found a relationship between D-dimer, prothrombin fragment F1 + 2, and PS exposure. Our study reveals a previously unrecognized link between hypercoagulability and exposed PS on cells, which might also be associated with distinct thrombotic risks among mutational subtypes in ET. Thus, blocking PS-binding sites may represent a new therapeutic target for preventing thrombosis in ET.
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Bose P, Verstovsek S. Prognosis of Primary Myelofibrosis in the Genomic Era. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017; 16 Suppl:S105-13. [PMID: 27521306 DOI: 10.1016/j.clml.2016.02.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 02/09/2016] [Indexed: 02/07/2023]
Abstract
Currently, prognostication in primary myelofibrosis (PMF) relies on the International Prognostic Scoring System (IPSS), dynamic IPSS (DIPSS), and DIPSS-plus, which incorporate age, blood counts, constitutional symptoms, circulating blasts, red cell transfusion need, and karyotype. Although the JAK2 V617F mutation was discovered a decade ago and MPL mutations shortly thereafter, it was the recent discovery of CALR mutations in the vast majority of JAK2/MPL-unmutated patients and recognition of the powerful impact of CALR mutations and triple-negative (JAK2/MPL/CALR-negative) status on outcome that set the stage for revision of traditional prognostic models to include molecular information. Additionally, the advent of next-generation sequencing has identified a host of previously unrecognized somatic mutations across hematologic malignancies. As in the myelodysplastic syndromes, the majority of common and prognostically informative mutations in PMF affect epigenetic regulation and mRNA splicing. Thus, a need has arisen to incorporate mutational information on genes such as ASXL1 and SRSF2 into risk stratification systems. Mutations in yet other genes appear to be important players in leukemic transformation, and new insights into disease pathogenesis are emerging. Finally, the number of prognostically detrimental mutations may affect both survival and response to ruxolitinib, which has significant implications for clinical decision making. In this review, we briefly summarize the prognostic models in use today and discuss in detail the somatic mutations commonly encountered in patients with PMF, along with their prognostic implications and role in leukemic transformation. Emerging prognostic models that incorporate new molecular information into existing systems or exclude clinical variables are also presented.
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Affiliation(s)
- Prithviraj Bose
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Srdan Verstovsek
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX
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33
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Zaidi U, Shahid S, Fatima N, Ahmed S, Sufaida G, Nadeem M, Shamsi T. Genomic profile of a patient with triple negative essential thrombocythemia, unresponsive to therapy: A case report and literature review. J Adv Res 2017; 8:375-378. [PMID: 28560052 PMCID: PMC5435578 DOI: 10.1016/j.jare.2017.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 04/12/2017] [Accepted: 04/14/2017] [Indexed: 11/15/2022] Open
Abstract
Clonal analysis of patients with triple negative myeloproliferative neoplasm (MPN) has provided evidence of additional aberrations, including epigenetic alterations. To discover such novel genetic aberrations, patients were screened through next-generation sequencing using a myeloid sequencing panel of 54 genes using a genetic analyser. Genetic variants in 28 genes, including TET2, BCOR, BCR, and ABL1 were identified in a triple negative essential thrombocythemia (ET) patient. The individual role of some of these variants in disease pathogenesis has yet to be studied. Somatic mutations in the same genes have been reported with variable frequencies in myeloid malignancies. However, no pathogenic impact of these variants could be found; therefore, long-term follow up of patients with genetic analysis of a large cohort and the use of whole genome sequencing is required to assess the effects of these variants.
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Affiliation(s)
- Uzma Zaidi
- Department of Clinical Haematology, National Institute of Blood Diseases and Bone Marrow Transplantation, P.O. Box 75300, Pakistan
| | - Saba Shahid
- Department of Genomics, National Institute of Blood Diseases and Bone Marrow Transplantation, P.O. Box 75300, Pakistan
- Corresponding author.
| | - Naveen Fatima
- Department of Research & Molecular Medicine, National Institute of Blood Diseases and Bone Marrow Transplantation, P.O. Box 75300, Pakistan
| | - Shariq Ahmed
- Department of Genomics, National Institute of Blood Diseases and Bone Marrow Transplantation, P.O. Box 75300, Pakistan
| | - Gul Sufaida
- Department of Genomics, National Institute of Blood Diseases and Bone Marrow Transplantation, P.O. Box 75300, Pakistan
| | - Muhammad Nadeem
- Department of Genomics, National Institute of Blood Diseases and Bone Marrow Transplantation, P.O. Box 75300, Pakistan
| | - Tahir Shamsi
- Department of Clinical Haematology, National Institute of Blood Diseases and Bone Marrow Transplantation, P.O. Box 75300, Pakistan
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Barraco D, Cerquozzi S, Hanson CA, Ketterling RP, Pardanani A, Gangat N, Tefferi A. Prognostic impact of bone marrow fibrosis in polycythemia vera: validation of the IWG-MRT study and additional observations. Blood Cancer J 2017; 7:e538. [PMID: 28282034 PMCID: PMC5380902 DOI: 10.1038/bcj.2017.17] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 01/25/2017] [Indexed: 01/22/2023] Open
Abstract
In 2012, the International Working Group for Myeloproliferative Neoplasms (MPN) Research and Treatment (IWG-MRT) reported an associations between mild bone marrow (BM) fibrosis (⩾grade 1) in polycythemia vera (PV) and a lower incidence of thrombosis during the clinical course and a higher risk of fibrotic progression. The objective in the current study of 262 patients with PV was to validate these observations and also identify other risk factors for myelofibrosis-free survival (MFFS). About 127 (48%) patients displayed ⩾grade 1 reticulin fibrosis at the time of diagnosis; presenting clinical and laboratory features were not significantly different between patients with or without BM fibrosis. In univariate analysis, BM fibrosis had no significant impact on overall, leukemia-free or thrombosis-free survival, whereas a significant association was noted for MFFS (P=0.009, hazard ratio 2.9; 95% confidence interval 1.32–6.78); other risk factors for MFFS included leukocytosis ⩾15 × 109/l, presence of palpable splenomegaly and abnormal karyotype. During multivariable analysis, leukocytosis ⩾15 × 109/l, palpable splenomegaly and ⩾grade 1 BM reticulin fibrosis remained significant. The current study validates the previously observed association between ⩾grade 1 BM reticulin fibrosis in PV and subsequent fibrotic progression, and identifies leukocytosis and palpable splenomegaly as additional risk factors for fibrotic progression; additional studies are required to clarify the impact of BM fibrosis on thrombosis and that of abnormal karyotype on MFFS.
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Affiliation(s)
- D Barraco
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - S Cerquozzi
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - C A Hanson
- Department of Laboratory and Pathology, Mayo Clinic, Rochester, MN, USA
| | - R P Ketterling
- Department of Laboratory and Pathology, Mayo Clinic, Rochester, MN, USA
| | - A Pardanani
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - N Gangat
- 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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Pieri L, Paoli C, Arena U, Marra F, Mori F, Zucchini M, Colagrande S, Castellani A, Masciulli A, Rosti V, De Stefano V, Betti S, Finazzi G, Ferrari ML, Rumi E, Ruggeri M, Nichele I, Guglielmelli P, Fjerza R, Mannarelli C, Fanelli T, Merli L, Corbizi Fattori G, Massa M, Cimino G, Rambaldi A, Barosi G, Cazzola M, Barbui T, Vannucchi AM. Safety and efficacy of ruxolitinib in splanchnic vein thrombosis associated with myeloproliferative neoplasms. Am J Hematol 2017; 92:187-195. [PMID: 27880982 DOI: 10.1002/ajh.24614] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 11/19/2016] [Accepted: 11/21/2016] [Indexed: 12/19/2022]
Abstract
Splanchnic vein thrombosis (SVT) is one of the vascular complications of myeloproliferative neoplasms (MPN). We designed a phase 2 clinical trial to evaluate safety and efficacy of ruxolitinib in reducing splenomegaly and improving disease-related symptoms in patients with MPN-associated SVT. Patients diagnosed with myelofibrosis (12 cases), polycythemia vera (5 cases) and essential thrombocythemia (4 cases) received ruxolitinib for 24 weeks in the core study period. Spleen volume was assessed by magnetic resonance imaging (MRI) and splanchnic vein circulation by echo-Doppler analysis. Nineteen patients carried JAK2V617F, one had MPLW515L, and one CALRL367fs*46 mutation. Eighteen patients had spleno-portal-mesenteric thrombosis, two had Budd-Chiari syndrome, and one had both sites involved; 16 patients had esophageal varices. Ruxolitinib was well tolerated with hematological toxicities consistent with those of patients without SVT and no hemorrhagic adverse events were recorded. After 24 weeks of treatment, spleen volume reduction ≥35% by MRI was achieved by 6/21 (29%) patients, and a ≥50% spleen length reduction by palpation at any time up to week 24 was obtained by 13/21 (62%) patients. At week 72, 8 of the 13 (62%) patients maintained the spleen response by palpation. No significant effect of treatment on esophageal varices or in splanchnic circulation was observed. MPN-related symptoms, evaluated by MPN-symptom assessment form (SAF) TSS questionnaire, improved significantly during the first 4 weeks and remained stable up to week 24. In conclusion, this trial shows that ruxolitinib is safe in patients with MPN-associated SVT, and effective in reducing spleen size and disease-related symptoms.
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Affiliation(s)
- Lisa Pieri
- CRIMM-Centro Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera-Universitaria Careggi; Florence Italy
- DenoThe Excellence Center; Florence Italy
- Department of Experimental and Clinical Medicine; University of Florence; Florence Italy
| | - Chiara Paoli
- CRIMM-Centro Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera-Universitaria Careggi; Florence Italy
- DenoThe Excellence Center; Florence Italy
- Department of Experimental and Clinical Medicine; University of Florence; Florence Italy
| | - Umberto Arena
- Internal Medicine and Hepatology; Azienda Ospedaliera-Universitaria Careggi; Florence Italy
| | - Fabio Marra
- Department of Experimental and Clinical Medicine; University of Florence; Florence Italy
| | - Fabio Mori
- Department of Cardiology; Azienda Ospedaliera-Universitaria Careggi; Florence Italy
| | - Mery Zucchini
- Department of Cardiology; Azienda Ospedaliera-Universitaria Careggi; Florence Italy
| | - Stefano Colagrande
- Department of Experimental and Clinical Biomedical Sciences; University of Florence - Azienda Ospedaliera-Universitaria Careggi; Florence Italy
| | - Alessandro Castellani
- Department of Experimental and Clinical Biomedical Sciences; University of Florence - Azienda Ospedaliera-Universitaria Careggi; Florence Italy
| | - Arianna Masciulli
- Department of Hematology; Hospital Papa Giovanni XXIII; Bergamo Italy
| | - Vittorio Rosti
- IRCCS Policlinico San Matteo Foundation; Center for the Study of Myelofibrosis, Biotechnology Research Area; Pavia Italy
| | | | - Silvia Betti
- Institute of Hematology, Catholic University; Rome Italy
| | - Guido Finazzi
- Department of Hematology; Hospital Papa Giovanni XXIII; Bergamo Italy
| | | | - Elisa Rumi
- Department of Hematology Oncology; IRCCS Policlinico San Matteo Foundation; Pavia Italy
| | - Marco Ruggeri
- Department of Hematology; San Bortolo Hospital; Vicenza Italy
| | - Ilaria Nichele
- Department of Hematology; San Bortolo Hospital; Vicenza Italy
| | - Paola Guglielmelli
- CRIMM-Centro Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera-Universitaria Careggi; Florence Italy
- DenoThe Excellence Center; Florence Italy
- Department of Experimental and Clinical Medicine; University of Florence; Florence Italy
| | - Rajmonda Fjerza
- CRIMM-Centro Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera-Universitaria Careggi; Florence Italy
- DenoThe Excellence Center; Florence Italy
- Department of Experimental and Clinical Medicine; University of Florence; Florence Italy
| | - Carmela Mannarelli
- CRIMM-Centro Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera-Universitaria Careggi; Florence Italy
- DenoThe Excellence Center; Florence Italy
- Department of Experimental and Clinical Medicine; University of Florence; Florence Italy
| | - Tiziana Fanelli
- CRIMM-Centro Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera-Universitaria Careggi; Florence Italy
- DenoThe Excellence Center; Florence Italy
- Department of Experimental and Clinical Medicine; University of Florence; Florence Italy
- University of Siena; Siena Italy
| | - Lucia Merli
- CRIMM-Centro Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera-Universitaria Careggi; Florence Italy
- DenoThe Excellence Center; Florence Italy
- Department of Experimental and Clinical Medicine; University of Florence; Florence Italy
| | - Giuditta Corbizi Fattori
- CRIMM-Centro Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera-Universitaria Careggi; Florence Italy
- DenoThe Excellence Center; Florence Italy
- Department of Experimental and Clinical Medicine; University of Florence; Florence Italy
- University of Siena; Siena Italy
| | - Margherita Massa
- IRCCS Policlinico San Matteo Foundation; Biotechnology Research Area; Pavia Italy
| | - Giuseppe Cimino
- Department of Cellular Biotechnology and Hematology; University “La Sapienza”; Rome Italy
| | | | - Giovanni Barosi
- IRCCS Policlinico San Matteo Foundation; Center for the Study of Myelofibrosis, Biotechnology Research Area; Pavia Italy
| | - Mario Cazzola
- Department of Hematology Oncology; IRCCS Policlinico San Matteo Foundation; Pavia Italy
| | - Tiziano Barbui
- Hospital Papa Giovanni XXIII and Research Foundation; Bergamo Italy
| | - Alessandro M. Vannucchi
- CRIMM-Centro Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera-Universitaria Careggi; Florence Italy
- DenoThe Excellence Center; Florence Italy
- Department of Experimental and Clinical Medicine; University of Florence; Florence Italy
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Mesa RA, Passamonti F. Individualizing Care for Patients With Myeloproliferative Neoplasms: Integrating Genetics, Evolving Therapies, and Patient-Specific Disease Burden. Am Soc Clin Oncol Educ Book 2017; 35:e324-35. [PMID: 27249739 DOI: 10.1200/edbk_159322] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Individualized medicine is important for patients with myeloproliferative neoplasms (MPNs), including essential thrombocythemia, polycythemia vera, and myelofibrosis, which are heterogeneous in terms of genetic mutation profile, prognosis, disease burden, and symptoms. Status of MPN driver mutations in JAK2, CALR, and MPL (or lack of one of these mutations) and other myeloid mutations (ASXL1, SRSF2, CBL, and IDH1/2, among others) affects diagnosis and prognosis. Management begins with estimating the prognosis, disease burden including MPN symptoms, and prevention of vascular events. Allogeneic stem cell transplantation is the definitive therapy in a subset of patients with myelofibrosis, the majority of whom receive JAK inhibition with ruxolitinib to relieve splenomegaly and symptoms and to prolong survival. Ruxolitinib is now a second-line therapy in polycythemia vera, with pegylated interferon being evaluated as a potential front-line therapy compared with hydroxyurea. The therapeutic landscape is evolving to include new JAK inhibitors, which may affect cytopenias (pacritinib and momelotinib), combination therapies including ruxolitinib, and novel targets such as pentraxin and telomerase. Assessing the therapeutic efficacy (including symptom impact) and toxicity of these new approaches is necessary to determine longitudinal management of MPNs in clinical practice and is a key component of "individualizing" care for patients with MPNs.
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Affiliation(s)
- Ruben A Mesa
- From the Mayo Clinic Cancer Center, Phoenix, AZ; Division of Hematology, Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
| | - Francesco Passamonti
- From the Mayo Clinic Cancer Center, Phoenix, AZ; Division of Hematology, Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
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Abstract
Venous thromboembolism, usually entailing deep vein thrombosis, pulmonary embolism, or both, is a complex and multifactorial disorder, in which a number of putative conditions interplay and finally contribute to propel the individual risk over a certain degree, so ultimately culminating in the development of venous occlusive disorders. Thrombophilia is commonly defined as a propensity to develop venous thromboembolism on the basis of an underlying hypercoagulable state attributable to inherited or acquired disorders of blood coagulation or fibrinolysis. The thrombophilic conditions are conventionally classified as inherited (or genetically determined) and acquired. The former include deficiencies of natural anticoagulants such as antithrombin, protein C, protein S, increased values of clotting factors (especially factor VIII), as well as prothrombotic polymorphisms in genes encoding for factor V (i.e., factor V Leiden) and prothrombin. The latter conditions mainly entail antiphospholipid antibody syndrome, malignancy, acquired elevations of coagulation factors or acquired reduction of natural inhibitors, or hyperhomocysteinemia. Deepened knowledge of all potential risk factors, as well as the clear understanding of their role in the pathophysiology of venous thrombosis, are both essential to help achieve a faster and more efficient diagnosis of this condition as well as a more effective prophylaxis of patients at higher risk and treatment of those with manifest disease.
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Affiliation(s)
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Elisa Danese
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
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Komatsu N, Kirito K, Shimoda K, Ishikawa T, Ohishi K, Ohyashiki K, Takahashi N, Okada H, Amagasaki T, Yonezu T, Akashi K. Assessing the safety and efficacy of ruxolitinib in a multicenter, open-label study in Japanese patients with myelofibrosis. Int J Hematol 2016; 105:309-317. [DOI: 10.1007/s12185-016-2130-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 11/01/2016] [Accepted: 11/02/2016] [Indexed: 01/19/2023]
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Takenaka K, Shimoda K, Uchida N, Shimomura T, Nagafuji K, Kondo T, Shibayama H, Mori T, Usuki K, Azuma T, Tsutsumi Y, Tanaka J, Dairaku H, Matsuo K, Ozawa K, Kurokawa M, Arai S, Akashi K. Clinical features and outcomes of patients with primary myelofibrosis in Japan: report of a 17-year nationwide survey by the Idiopathic Disorders of Hematopoietic Organs Research Committee of Japan. Int J Hematol 2016; 105:59-69. [PMID: 27761702 DOI: 10.1007/s12185-016-2102-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 09/20/2016] [Accepted: 09/26/2016] [Indexed: 11/25/2022]
Abstract
We conducted a 17-year nationwide survey (1999-2015) to elucidate the clinical outcomes of patients with primary myelofibrosis (PMF) in Japan. Questionnaires were sent annually to approximately 500 hematology departments. Newly diagnosed patients with PMF were enrolled in this study, and were followed up annually to collect prognostic information. Approximately 50 patients were enrolled per year, yielding a total of 780 patients with PMF included in this study. The median age at diagnosis was 66 years. At the time of analysis, the median survival duration was 47 months, and the 3-year overall survival rate was 59 %. Infection and disease transformation into acute leukemia were the most frequent causes of death. Of the proposed prognostic models for predicting the outcomes of PMF patients in Japan, the Dynamic International Prognostic Scoring System of PMF plus model was the most feasible. Forty-three patients received allogeneic hematopoietic stem cell transplantation (alloSCT) at a median of 343 days after diagnosis. This treatment significantly prolonged the survival of PMF patients, and the 3-year overall survival rate after first alloSCT was 84 %. A long-term registration study is required for further evaluation of prognosis and the impact of treatments on survival.
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Affiliation(s)
- Katsuto Takenaka
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kazuya Shimoda
- Department of Gastroenterology and Hematology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Naoyuki Uchida
- Department of Hematology, Toranomon Hospital, Tokyo, Japan
| | - Taizo Shimomura
- Department of Hematology, Kumamoto Shinto General Hospital, Kumamoto, Japan
| | - Koji Nagafuji
- Division of Hematology and Oncology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Tadakazu Kondo
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hirohiko Shibayama
- Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takehiko Mori
- Division of Hematology, Department of Medicine, Keio University, Tokyo, Japan
| | - Kensuke Usuki
- Department of Hematology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Taichi Azuma
- Department of Hematology, Clinical Immunology, and Infectious Diseases, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Yutaka Tsutsumi
- Department of Hematology, Hakodate Municipal Hospital, Hokkaido, Japan
| | - Junji Tanaka
- Department of Hematology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hitomi Dairaku
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Keitaro Matsuo
- Division of Molecular Medicine, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Keiya Ozawa
- The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Mineo Kurokawa
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shunya Arai
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Koichi Akashi
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
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Nazha A, Khoury JD, Verstovsek S, Daver N. Second line therapies in polycythemia vera: What is the optimal strategy after hydroxyurea failure? Crit Rev Oncol Hematol 2016; 105:112-7. [PMID: 27401783 DOI: 10.1016/j.critrevonc.2016.06.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 06/06/2016] [Accepted: 06/16/2016] [Indexed: 01/08/2023] Open
Abstract
Cytoreductive therapies have traditionally been the standard treatment for older patients with polycythemia vera (PV) or those with a history of prior thrombosis. Hydroxyurea (HU) is the most frequently used cytoreductive agent in PV. However, approximately 24% of patients treated with HU will eventually develop resistance or intolerance and patients who fail HU have an increased risk of death, transformation to myelofibrosis or acute myeloid leukemia. Interferon-alpha has been used in younger PV patients and is capable of inducing a complete hematologic response and significant reductions, or even eradication, of JAK2 V617F mutation allele burdens in a small but notable subset of PV patients. The potential toxicities of interferon-alpha must be weighed against the disease control benefit in a case-by-case fashion. Recently JAK2 inhibitor, ruxolitinib, demonstrated significant improvement in controlling the hematocrit and splenomegaly versus best available therapy in patients with PV who failed or are intolerant to HU and currently is FDA-approved in this setting. In this review, we will discuss novel emerging therapies for PV with a special focus on the currently available and upcoming treatment options for patients who fail HU.
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Affiliation(s)
- Aziz Nazha
- Leukemia Program, Department of Hematology and Medical Oncology, Cleveland, OH, USA.
| | - Joseph D Khoury
- Departments of Hematopathology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Srdan Verstovsek
- Leukemia Department, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Naval Daver
- Leukemia Department, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
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Health care setting and severity, symptom burden, and complications in patients with Philadelphia-negative myeloproliferative neoplasms (MPN): a comparison between university hospitals, community hospitals, and office-based physicians. Ann Hematol 2016; 95:1399-410. [PMID: 27334946 DOI: 10.1007/s00277-016-2730-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 06/15/2016] [Indexed: 10/21/2022]
Abstract
Philadelphia-negative myeloproliferative neoplasms (MPN) comprise a heterogeneous group of chronic hematological malignancies with significant variations in clinical characteristics. Due to the long survival and the feasibility of oral or subcutaneous therapy, these patients are frequently treated outside of larger academic centers. This analysis was performed to elucidate differences in MPN patients in three different health care settings: university hospitals (UH), community hospitals (CH), and office-based physicians (OBP). The MPN registry of the Study Alliance Leukemia is a non-interventional prospective study including adult patients with an MPN according to WHO criteria (2008). For statistical analysis, descriptive methods and tests for significant differences were used. Besides a different distribution of MPN subtypes between the settings, patients contributed by UH showed an impaired medical condition, a higher comorbidity burden, and more vascular complications. In the risk group analyses, the majority of polycythemia vera (PV) and essential thrombocythemia (ET) patients from UH were classified into the high-risk category due to previous vascular events, while for PV and ET patients in the CH and OBP settings, age was the major parameter for a high-risk categorization. Regarding MPN-directed therapy, PV patients from the UH setting were more likely to receive ruxolitinib within the framework of a clinical trial. In summary, the characteristics and management of patients differed significantly between the three health care settings with a higher burden of vascular events and comorbidities in patients contributed by UH. These differences need to be taken into account for further analyses and design of clinical trials.
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Khan I, Shergill A, Saraf SL, Chen YF, Patel PR, Quigley JG, Peace D, Gordeuk VR, Hoffman R, Rondelli D. Outcome Disparities in Caucasian and Non-Caucasian Patients With Myeloproliferative Neoplasms. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2016; 16:350-7. [DOI: 10.1016/j.clml.2016.02.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 01/14/2016] [Accepted: 02/18/2016] [Indexed: 01/12/2023]
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Chow V, Weissman A, O'Connell CL, Mehrvar A, Akhtari M. Emerging treatment options for myelofibrosis: focus on pacritinib. Onco Targets Ther 2016; 9:2655-65. [PMID: 27226728 PMCID: PMC4863690 DOI: 10.2147/ott.s93875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Myelofibrosis (MF) is a myeloid malignancy associated with a heavy symptomatic burden that decreases quality of life and presents a risk for leukemic transformation. While there are limited curative treatments, the recent discovery of the Janus kinase/signal transducer and activator of transcription (JAK/STAT) pathway dysregulation has led to many clinical investigations for new treatment approaches. This review provides practical knowledge on the disease state, an overview of treatment options, and specifically focuses on the efficacy and safety of pacritinib in the management of MF. Pacritinib is a novel selective inhibitor of JAK2 and FMS-related tyrosine kinase 3 (FLT3) currently in Phase III trials for the treatment of MF. Thus far, studies have demonstrated clinical efficacy in reducing splenomegaly and constitutional symptoms. Common adverse events were gastrointestinal in nature, while hematologic toxicity was limited. However, it was announced that all ongoing clinical trials on pacritinib have been placed on hold by the US Food and Drug Administration in February 2016, due to concerns for increased intracranial hemorrhage and cardiac events. With comprehensive risk-benefit analysis of clinical trial data, the utility of pacritinib in the management of MF may be more clearly defined.
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Affiliation(s)
- Vivian Chow
- Department of Clinical Pharmacy and Pharmaceutical Economics and Policy, University of Southern California, Los Angeles, CA, USA
| | - Ashley Weissman
- Department of Pharmacy, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Casey Lee O'Connell
- Jane Anne Nohl Division of Hematology and Center for the Study of Blood Diseases, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Azim Mehrvar
- Mahak Children's Cancer Treatment and Research Center, Tehran, Iran
| | - Mojtaba Akhtari
- Jane Anne Nohl Division of Hematology and Center for the Study of Blood Diseases, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA, USA
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Sultan S, Irfan SM, Murad S. Clinico-Epidemiological Profile of Patients with Polycythaemia Rubra Vera - a Five Year Experience from a Tertiary Care Center. Asian Pac J Cancer Prev 2016; 17:1531-3. [PMID: 27039801 DOI: 10.7314/apjcp.2016.17.3.1531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Polycythaemia rubra vera (PV) is a Philadelphia chromosome negative myeloproliferative neoplasm characterized by increased red cell production, independent of the mechanisms that regulate normal erythropoiesis. The aim of this study was to analyze the clinico-epidemiological profile of Pakistani patients with PV. MATERIALS AND METHODS In this retrospective cross sectional study, 26 patients with PV were enrolled from January 2010 to December 2014. They were diagnosed based on WHO criteria. RESULTS The mean age was 53.4±9.31 years (range 36-72) and the male to female ratio was 2:1. Overall 30.7% of patients were asymptomatic. In symptomatic patients, major complaints were headache (30.8%), abdominal discomfort (23.1%), blurred vision (15.3%), pruritus (11.5%) and vascular incidents (11.5%). Physical examination revealed plethoric face and splenomegaly as predominant findings, detected in 34.6% and 30.7%, respectively, with the mean splenic span of 15.9±2.04cm. The mean hemoglobin was 18.1±1.9 g/dl with the mean hematocrit of 55.6±8.3%. The mean total leukocyte count was 12.8±7.1x109/l and the platelet count 511±341.9x109/l. Mean erythrocyte sedimentation rate was 3.5±1.22mm/hr. Serum lactate dehydrogenase, serum creatinine and uric acid were 552.7±309.2, 0.8±0.17 and 6.60±1.89 respectively. CONCLUSIONS PV in Pakistani patients, unlike in the West, is seen in a moderately young population. The disease is frequently seen in male gender and primarily patients present with symptoms related to hyperviscosity.
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Affiliation(s)
- Sadia Sultan
- Department of Hematology and Blood bank, Liaquat National Hospital and Medical College, Karachi, Pakistan E-mail :
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Nazha A, Gerds AT. Where to Turn for Second-Line Cytoreduction After Hydroxyurea in Polycythemia Vera? Oncologist 2016; 21:475-80. [PMID: 26975864 DOI: 10.1634/theoncologist.2015-0380] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 01/22/2016] [Indexed: 01/14/2023] Open
Abstract
UNLABELLED The goals of therapy in patients with polycythemia vera (PV) are to improve disease-related symptoms, prevent the incidence or recurrence of thrombosis, and possibly delay or prevent the transformation into myelofibrosis or acute myeloid leukemia (AML). Cytoreductive therapies have been used in older patients and those with a history of thrombosis to achieve these goals. Hydroxyurea (HU) remains the first-line cytoreductive choice; however, up to one in four patients treated with HU over time will develop resistance or intolerance to HU. More importantly, patients who fail HU have a 5.6-fold increase in mortality and a 6.8-fold increase risk of transformation to myelofibrosis or AML; therefore, alternative therapies are needed for these patients. Interferon-α has been used in PV and has shown significant activity in achieving hematologic responses and decreasing JAK2 V617F mutation allele burden. JAK inhibition has also been investigated and recently garnered regulatory approval for this indication. In this review, we will discuss the current treatment options that are available for patients after HU and the novel therapies that are currently under investigation. IMPLICATIONS FOR PRACTICE The outcomes of PV patients who fail or who are intolerant of hydroxyurea are poor. Although pegylated interferon can be considered in younger patients, currently, ruxolitinib is the only U.S. Food and Drug Administration-approved agent in this setting, representing a viable option, leading to hematocrit control and a reduction in spleen size and constitutional symptoms. Although a small number of patients will achieve a molecular response with continuous treatment, the implications of such response on the clinical outcomes are still unknown. Patients whose disease is not adequately controlled with ruxolitinib, or who lose their response, can be treated with low-dose busulfan or pipobroman; however, they should be encouraged to participate in trials with novel therapies.
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Affiliation(s)
- Aziz Nazha
- Leukemia Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Aaron T Gerds
- Leukemia Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Ipek YH, Fehmi H, Meliha N. Hairy cell leukemia followed by polycythemia vera: report of the first case. Oxf Med Case Reports 2016; 2016:28-30. [PMID: 26941958 PMCID: PMC4773848 DOI: 10.1093/omcr/omw005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 01/19/2016] [Accepted: 01/21/2016] [Indexed: 11/23/2022] Open
Affiliation(s)
- Yonal-Hindilerden Ipek
- Istanbul University Istanbul Medical Faculty, Department of Internal Medicine, Division of Hematology, Istanbul , Turkey
| | - Hindilerden Fehmi
- Istanbul Bakırkoy Sadi Konuk Training and Research Hospital , Hematology Clinic , Istanbul , Turkey
| | - Nalcaci Meliha
- Istanbul University Istanbul Medical Faculty, Department of Internal Medicine, Division of Hematology, Istanbul , Turkey
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Kaifie A, Kirschner M, Wolf D, Maintz C, Hänel M, Gattermann N, Gökkurt E, Platzbecker U, Hollburg W, Göthert JR, Parmentier S, Lang F, Hansen R, Isfort S, Schmitt K, Jost E, Serve H, Ehninger G, Berdel WE, Brümmendorf TH, Koschmieder S. Bleeding, thrombosis, and anticoagulation in myeloproliferative neoplasms (MPN): analysis from the German SAL-MPN-registry. J Hematol Oncol 2016; 9:18. [PMID: 26944254 PMCID: PMC4779229 DOI: 10.1186/s13045-016-0242-9] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 02/10/2016] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Patients with Ph-negative myeloproliferative neoplasms (MPN), such as polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF), are at increased risk for thrombosis/thromboembolism and major bleeding. Due to the morbidity and mortality of these events, antiplatelet and/or anticoagulant agents are commonly employed as primary and/or secondary prophylaxis. On the other hand, disease-related bleeding complications (i.e., from esophageal varices) are common in patients with MPN. This analysis was performed to define the frequency of such events, identify risk factors, and assess antiplatelet/anticoagulant therapy in a cohort of patients with MPN. METHODS The MPN registry of the Study Alliance Leukemia is a non-interventional prospective study including adult patients with an MPN according to WHO criteria (2008). For statistical analysis, descriptive methods and tests for significant differences as well as contingency tables were used to identify the odds of potential risk factors for vascular events. RESULTS MPN subgroups significantly differed in sex distribution, age at diagnosis, blood counts, LDH levels, JAK2V617F positivity, and spleen size (length). While most thromboembolic events occurred around the time of MPN diagnosis, one third of these events occurred after that date. Splanchnic vein thrombosis was most frequent in post-PV-MF and MPN-U patients. The chance of developing a thromboembolic event was significantly elevated if patients suffered from post-PV-MF (OR 3.43; 95% CI = 1.39-8.48) and splenomegaly (OR 1.76; 95% CI = 1.15-2.71). Significant odds for major bleeding were previous thromboembolic events (OR = 2.71; 95% CI = 1.36-5.40), splenomegaly (OR = 2.22; 95% CI 1.01-4.89), and the administration of heparin (OR = 5.64; 95% CI = 1.84-17.34). Major bleeding episodes were significantly less frequent in ET patients compared to other MPN subgroups. CONCLUSIONS Together, this report on an unselected "real-world" cohort of German MPN patients reveals important data on the prevalence, diagnosis, and treatment of thromboembolic and major bleeding complications of MPN.
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Affiliation(s)
- A. Kaifie
- Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
| | - M. Kirschner
- Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
| | - D. Wolf
- Internal Medicine 3, Oncology, Hematology and Rheumatology, University Clinic Bonn (UKB), Bonn, Germany
| | - C. Maintz
- Practice for Hematology and Oncology, Wuerselen, Germany
| | - M. Hänel
- Department for Hematology, Oncology, Stem Cell Transplantation, Hospital Chemnitz, Chemnitz, Germany
| | - N. Gattermann
- Department for Hematology, Oncology and Clinical Immunology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - E. Gökkurt
- Practice for Hematology-Oncology Eppendorf, Hamburg, Germany
| | - U. Platzbecker
- Department for Hematology, University Hospital Dresden, Dresden, Germany
| | - W. Hollburg
- Practice for Hematology and Oncology Altona, Hamburg, Germany
| | - J. R. Göthert
- Department for Hematology, University Hospital Essen, Essen, Germany
| | - S. Parmentier
- Department for Hematology, Oncology and Palliative Care, Rems-Murr-Hospitals, Winnenden, Germany
| | - F. Lang
- Department for Hematology and Oncology, University Hospital Frankfurt/Main, Frankfurt/Main, Germany
| | - R. Hansen
- Practice for Hematology and Oncology, Kaiserslautern, Germany
| | - S. Isfort
- Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
| | - K. Schmitt
- Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
| | - E. Jost
- Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
| | - H. Serve
- Department for Hematology and Oncology, University Hospital Frankfurt/Main, Frankfurt/Main, Germany
| | - G. Ehninger
- Department for Hematology, University Hospital Dresden, Dresden, Germany
| | - W. E. Berdel
- Department of Medicine A, University Hospital Münster, Münster, Germany
| | - T. H. Brümmendorf
- Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
| | - S. Koschmieder
- Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
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Reiter A, Harrison C. How We Identify and Manage Patients with Inadequately Controlled Polycythemia Vera. Curr Hematol Malig Rep 2016; 11:356-67. [DOI: 10.1007/s11899-016-0311-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Ito S, Tsutsumi Y, Ohigashi H, Shiratori S, Teshima T. Determination of prognosis of Philadelphia chromosome-negative myeloproliferative neoplasms with a simple clinical examination: Retrospective analysis of 71 patients in a single institution. Mol Clin Oncol 2016; 4:51-57. [PMID: 26870357 DOI: 10.3892/mco.2015.652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 09/18/2015] [Indexed: 11/05/2022] Open
Abstract
Philadelphia chromosome-negative myeloproliferative neoplasms (MPNs), including polycythemia vera (PV), essential thrombocytosis (ET) and primary myelofibrosis (PMF), are clonal hematopoietic diseases. A single-institution retrospective analysis was performed, including 71 MPN patients diagnosed at the Hakodate Municipal Hospital between April, 2001 and April, 2014, and certain clinical characteristics were identified as effective prognostic factors. The patients were categorized by risk factor scoring based on age, number of abnormal blood cell lineages and splenomegaly at diagnosis, and the association between this categorization and prognosis was analyzed using a statistical procedure. The effect of Janus kinase 2 (JAK2) V617F mutation on prognosis was also investigated. The MPN patients were consolidated into three risk groups based on the margin of intergroup survival differences: i) Score 1-2 (n=23), ii) score 3 (n=24) and iii) score 4-5 (n=24). MPN patients with scores of 4 or 5 exhibited poorer overall survival (OS) compared with those with lower scores (P<0.001). In addition, there were significant differences in event-free survival (EFS) among scoring groups (P=0.0059). PV and ET had a better prognosis compared with PMF, although this analysis suggested that PV and ET patients with scores of 4 or 5 may have a poorer prognosis in terms of OS (P=0.0052) and EFS (P=0.022) and should be closely followed up. We observed no significant prognostic effect of the JAK2V167F mutation for OS (P=0.28) or EFS (P=0.17). Our results suggested that a simple scoring system based on age, blood cell counts and presence of splenomegaly at diagnosis may be used for the long-term prognosis of MPN patients.
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Affiliation(s)
- Shinichi Ito
- Department of Hematology, Hakodate Municipal Hospital, Hakodate, Hokkaido 041-8680, Japan
| | - Yutaka Tsutsumi
- Department of Hematology, Hakodate Municipal Hospital, Hakodate, Hokkaido 041-8680, Japan
| | - Hiroyuki Ohigashi
- Department of Hematology, Hakodate Municipal Hospital, Hakodate, Hokkaido 041-8680, Japan
| | - Souichi Shiratori
- Department of Hematology, Hakodate Municipal Hospital, Hakodate, Hokkaido 041-8680, Japan; Department of Hematology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido 060-8638, Japan
| | - Takanori Teshima
- Department of Hematology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido 060-8638, Japan
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Pemmaraju N, Moliterno AR. From Philadelphia-Negative to JAK2-Positive: Effect of Genetic Discovery on Risk Stratification and Management. Am Soc Clin Oncol Educ Book 2016:139-45. [PMID: 25993152 DOI: 10.14694/edbook_am.2015.35.139] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The 2005 discovery of the JAK2 mutation redefined the diagnosis and natural history of myeloproliferative neoplasms (MPNs). Most importantly, this improvement in the pathobiologic conceptualization has focused our evolution of this field from being defined as what it is not (e.g., Philadelphia [Ph]-negative) to what it is (e.g., JAK2-positive, CALR-positive) in the majority of MPN cases. In the ensuing 10 years, the field has experienced a paradigm shift in terms of understanding of the biologic basis of the development of MPNs, an explosion of knowledge of the genetics of MPNs, and has translated disease knowledge into effective targeted therapies. With greater uniformity and agreement on the diagnosis and differences among the individual MPNs, augmented by improved cytogenetic and molecular classification, attention has turned now to addressing the need for uniformity in risk stratification of patients in the clinic for both disease complications and disease transformation. This article will highlight the developments in the field with regard to risk stratification and prognostication in MPNs with focus on the clinical aspects of the patient who presents with either essential thrombocytosis (ET), polycythemia vera (PV), or myelofibrosis (MF).
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Affiliation(s)
- Naveen Pemmaraju
- From the Department of Medicine, The Johns Hopkins Hospital, Baltimore, MD; the Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Alison R Moliterno
- From the Department of Medicine, The Johns Hopkins Hospital, Baltimore, MD; the Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
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