1
|
Almanaseer A, Chin-Yee B, Ho J, Lazo-Langner A, Schenkel L, Bhai P, Sadikovic B, Chin-Yee IH, Hsia CC. An Approach to the Investigation of Thrombocytosis: Differentiating between Essential Thrombocythemia and Secondary Thrombocytosis. Adv Hematol 2024; 2024:3056216. [PMID: 38375212 PMCID: PMC10876298 DOI: 10.1155/2024/3056216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/24/2024] [Accepted: 02/05/2024] [Indexed: 02/21/2024] Open
Abstract
Background Thrombocytosis is a common reason for referral to Hematology. Differentiating between secondary causes of thrombocytosis and essential thrombocythemia (ET) is often clinically challenging. A practical diagnostic approach to identify secondary thrombocytosis could reduce overinvestigation such as next generation sequencing (NGS) panel. Methods and Results All adult patients with thrombocytosis (≥450 × 109/L) who underwent molecular testing at a single tertiary care centre between January 1, 2018 and May 31, 2021 were evaluated. Clinical and laboratory variables were compared between patients with secondary thrombocytosis vs. ET. Clinical variables included smoking, thrombosis, splenectomy, active malignancy, chronic inflammatory disease, and iron deficiency anemia. Laboratory variables included complete blood count (CBC), ferritin, and myeloid mutations detected by NGS. The overall yield of molecular testing was 52.4%; 92.1% of which were mutations in JAK2, CALR, and/or MPL. Clinical factors predictive of ET included history of arterial thrombosis (p < 0.05); active malignancy, chronic inflammatory disease, splenectomy, and iron deficiency were associated with secondary thrombocytosis (p < 0.05). A diagnosis of ET was associated with higher hemoglobin, mean corpuscular volume (MCV), red cell distribution width (RDW), and mean platelet volume (MPV), while secondary thrombocytosis was associated with higher body mass index, white blood cells, and neutrophils (p < 0.01). Conclusion A practical approach to investigating patients with persistent thrombocytosis based on clinical characteristics such as active malignancy, chronic inflammatory disease, splenectomy, and iron deficiency may assist in accurately identifying patients more likely to have secondary causes of thrombocytosis and reduce overinvestigation, particularly costly molecular testing.
Collapse
Affiliation(s)
- Ala Almanaseer
- Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Benjamin Chin-Yee
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Jenny Ho
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Alejandro Lazo-Langner
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Laila Schenkel
- Molecular Diagnostic Division, Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Pratibha Bhai
- Molecular Diagnostic Division, Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Bekim Sadikovic
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Ian H. Chin-Yee
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Cyrus C. Hsia
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| |
Collapse
|
2
|
Cochard B, De Marco G, Bazin L, Vazquez O, Di Laura Frattura G, Steiger CN, Dayer R, Ceroni D. Biological Predictors of Osteoarticular Infection Due to K. kingae-A Retrospective Cohort Study of 247 Cases. Microorganisms 2023; 11:2130. [PMID: 37763974 PMCID: PMC10534464 DOI: 10.3390/microorganisms11092130] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023] Open
Abstract
Pediatric osteoarticular infections (OAIs) are serious conditions that can lead to severe septic complications, prolonged morbidity with long-term impaired function, and perturbed subsequent bone development. Kingella kingae (K. kingae) is currently accepted as the predominant pathogen in pediatric OAIs, especially among 6-48 month olds. The present study aimed to identify clinical and biological markers that would refine the detection of patients with an OAI due to K. kingae. We retrospectively studied every consecutive case of pediatric OAI admitted to our institution over 17 years. Medical records were examined for patient characteristics such as temperature at admission, affected segment, and biological parameters such as white blood cell (WBC) count, left shift, platelet count (PLT), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). The 247 patients included 52.2% males and 47.8% females and mean age was 18.5 ± 10 months old. Four patients were older than 48 months; none were younger than 6 months old. Mean temperature at admission was 37.4 ± 0.9 °C. Regarding biological parameters, mean WBC count was 12,700 ± 4180/mm3, left shift was only present in one patient, mean PLT was 419,000 ± 123,000/mm3, mean CRP was 26.6 ± 27.8 mg/L, and mean ESR was 35.0 ± 18.9 mm/h. Compared to the modified predictors of OAI defined by Kocher and Caird, 17.2% of our cases were above their cut-off values for temperature, 52.3% were above the WBC cut-off, 33.5% were above the ESR cut-off, and 46.4% were above the CRP cut-off. OAIs due to K. kingae frequently remain undetected using the classic biological parameters for investigating bacterial infections. As an addition to the predictors normally used (°C, WBC, CRP, and ESR), this study found that elevated platelet count was frequently present during OAIs caused by K. kingae. Although this biological characteristic was inconstant, its presence was highly significant and very suggestive of an invasive infection due to K. kingae.
Collapse
Affiliation(s)
- Blaise Cochard
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals, CH-1211 Geneva, Switzerland; (B.C.); (L.B.); (O.V.); (G.D.L.F.); (R.D.)
- Division of Orthopedics and Trauma Surgery, Geneva University Hospitals, CH-1211 Geneva, Switzerland
| | - Giacomo De Marco
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals, CH-1211 Geneva, Switzerland; (B.C.); (L.B.); (O.V.); (G.D.L.F.); (R.D.)
| | - Ludmilla Bazin
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals, CH-1211 Geneva, Switzerland; (B.C.); (L.B.); (O.V.); (G.D.L.F.); (R.D.)
| | - Oscar Vazquez
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals, CH-1211 Geneva, Switzerland; (B.C.); (L.B.); (O.V.); (G.D.L.F.); (R.D.)
- Division of Orthopedics and Trauma Surgery, Geneva University Hospitals, CH-1211 Geneva, Switzerland
| | - Giorgio Di Laura Frattura
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals, CH-1211 Geneva, Switzerland; (B.C.); (L.B.); (O.V.); (G.D.L.F.); (R.D.)
| | - Christina N. Steiger
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals, CH-1211 Geneva, Switzerland; (B.C.); (L.B.); (O.V.); (G.D.L.F.); (R.D.)
| | - Romain Dayer
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals, CH-1211 Geneva, Switzerland; (B.C.); (L.B.); (O.V.); (G.D.L.F.); (R.D.)
| | - Dimitri Ceroni
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals, CH-1211 Geneva, Switzerland; (B.C.); (L.B.); (O.V.); (G.D.L.F.); (R.D.)
| |
Collapse
|
3
|
Combaluzier S, Quessada J, Abbou N, Arcani R, Tichadou A, Gabert J, Costello R, Loosveld M, Venton G, Berda-Haddad Y. Cytological Diagnosis of Classic Myeloproliferative Neoplasms at the Age of Molecular Biology. Cells 2023; 12:cells12060946. [PMID: 36980287 PMCID: PMC10047531 DOI: 10.3390/cells12060946] [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: 02/22/2023] [Revised: 03/14/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
Myeloproliferative neoplasms (MPN) are clonal hematopoietic stem cell-derived disorders characterized by uncontrolled proliferation of differentiated myeloid cells. Two main groups of MPN, BCR::ABL1-positive (Chronic Myeloid Leukemia) and BCR::ABL1-negative (Polycythemia Vera, Essential Thrombocytosis, Primary Myelofibrosis) are distinguished. For many years, cytomorphologic and histologic features were the only proof of MPN and attempted to distinguish the different entities of the subgroup BCR::ABL1-negative MPN. World Health Organization (WHO) classification of myeloid neoplasms evolves over the years and increasingly considers molecular abnormalities to prove the clonal hematopoiesis. In addition to morphological clues, the detection of JAK2, MPL and CALR mutations are considered driver events belonging to the major diagnostic criteria of BCR::ABL1-negative MPN. This highlights the preponderant place of molecular features in the MPN diagnosis. Moreover, the advent of next-generation sequencing (NGS) allowed the identification of additional somatic mutations involved in clonal hematopoiesis and playing a role in the prognosis of MPN. Nowadays, careful cytomorphology and molecular biology are inseparable and complementary to provide a specific diagnosis and to permit the best follow-up of these diseases.
Collapse
Affiliation(s)
- Sophie Combaluzier
- Hematology Laboratory, Timone University Hospital, 13005 Marseille, France
| | - Julie Quessada
- Hematological Cytogenetics Laboratory, Timone University Hospital, 13005 Marseille, France
- CNRS, INSERM, CIML, Luminy Campus, Aix-Marseille University, 13009 Marseille, France
| | - Norman Abbou
- Molecular Biology Laboratory, North University Hospital, 13015 Marseille, France
- INSERM, INRAE, C2VN, Luminy Campus, Aix-Marseille University, 13005 Marseille, France
| | - Robin Arcani
- INSERM, INRAE, C2VN, Luminy Campus, Aix-Marseille University, 13005 Marseille, France
- Department of Internal Medicine, Timone University Hospital, 13005 Marseille, France
| | - Antoine Tichadou
- Hematology and Cellular Therapy Department, Conception University Hospital, 13005 Marseille, France
| | - Jean Gabert
- Molecular Biology Laboratory, North University Hospital, 13015 Marseille, France
| | - Régis Costello
- INSERM, INRAE, C2VN, Luminy Campus, Aix-Marseille University, 13005 Marseille, France
- Hematology and Cellular Therapy Department, Conception University Hospital, 13005 Marseille, France
- TAGC, INSERM, UMR1090, Luminy Campus, Aix-Marseille University, 13005 Marseille, France
| | - Marie Loosveld
- Hematology Laboratory, Timone University Hospital, 13005 Marseille, France
- Hematological Cytogenetics Laboratory, Timone University Hospital, 13005 Marseille, France
- CNRS, INSERM, CIML, Luminy Campus, Aix-Marseille University, 13009 Marseille, France
| | - Geoffroy Venton
- INSERM, INRAE, C2VN, Luminy Campus, Aix-Marseille University, 13005 Marseille, France
- Hematology and Cellular Therapy Department, Conception University Hospital, 13005 Marseille, France
- TAGC, INSERM, UMR1090, Luminy Campus, Aix-Marseille University, 13005 Marseille, France
| | - Yaël Berda-Haddad
- Hematology Laboratory, Timone University Hospital, 13005 Marseille, France
| |
Collapse
|
4
|
Kiladjian JJ, Cassinat B. Myeloproliferative neoplasms and splanchnic vein thrombosis: Contemporary diagnostic and therapeutic strategies. Am J Hematol 2023; 98:794-800. [PMID: 36869873 DOI: 10.1002/ajh.26896] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 02/15/2023] [Accepted: 02/20/2023] [Indexed: 03/05/2023]
Abstract
Myeloproliferative neoplasms (MPNs) are the most common etiologies of primary splanchnic vein thrombosis, present in almost forty percent of patients with Budd-Chiari syndrome or portal vein thrombosis. Diagnosis of MPNs can be difficult in these patients because key characteristics, such as elevated blood cell counts and splenomegaly, are confounded by portal hypertension or bleeding complications. In recent years, diagnostic tools have improved to provide more accurate diagnosis and classification of MPNs. Although bone marrow biopsy findings remain a major diagnostic criterion, molecular markers are playing an increasing role not only in diagnosis but also in better estimating prognosis. Therefore, though screening for JAK2V617F mutation should be the starting point of the diagnostic workup performed in all patients with splanchnic vein thrombosis, a multidisciplinary approach is needed to accurately diagnose the subtype of myeloproliferative neoplasm, recommend the useful additional tests (bone marrow biopsy, search for an additional mutation using targeted next-generation sequencing), and suggest the best treatment strategy. Indeed, providing a specific expert care pathway for patients with splanchnic vein thrombosis and underlying myeloproliferative neoplasm is crucial to determine the optimal management to reduce the risk of both hematological and hepatic complications.
Collapse
Affiliation(s)
- Jean-Jacques Kiladjian
- Centre d'Investigations Cliniques, Université Paris Cité, AP-HP, Hôpital Saint-Louis, Paris, France.,INSERM UMR 1131, Institut de Recherche Saint-Louis, Paris, France
| | - Bruno Cassinat
- INSERM UMR 1131, Institut de Recherche Saint-Louis, Paris, France.,Laboratoire de Biologie Cellulaire, AP-HP, Hôpital Saint-Louis, Paris, France
| |
Collapse
|
5
|
Li WW, Sui XF, Fan S, Xu H, Wang CL, Wang FY, Mo XD. Transformation from polycythemia vera to acute promyelocytic leukemia: Case report and literature review. Medicine (Baltimore) 2022; 101:e30064. [PMID: 35960050 PMCID: PMC9371556 DOI: 10.1097/md.0000000000030064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Transformation from chronic myeloproliferative neoplasm to acute leukemia is a feature of myeloproliferative neoplasm; however, the rate is not high. Transformation to acute promyelocytic leukemia is rare. Here, we report a case of transformation of polycythemia vera to acute promyelocytic leukemia and describe a process of clonal evolution that has not yet been reported. PATIENT CONCERNS In this case, a 51-year-old woman was diagnosed with polycythemia vera and concomitant JAK2/V617F mutations in July 2019. She underwent intermittent phlebotomy and oral hydroxyurea irregularly. After 2 years, the patient complained of fatigue and poor sleep quality for 2 months. DIAGNOSIS Further examination revealed marked hypercellularity and grade 1 bone marrow fibrosis with the PML/RARαV variant (23.85% mutation load), WT1-Exon1 (37.8%), WT1-Exon9 (4.1%), JAK3-Exon7 (49.3%), and RELN-Exon55 (45.8%). According to the World Health Organization classification of tumors of hematopoietic and lymphoid tissues, the patient was ultimately diagnosed with a rare transformation of polycythemia vera to acute promyelocytic leukemia. INTERVENTIONS The patient underwent dual induction therapy with all-trans-retinoic acid and arsenic trioxide. OUTCOMES After 28 days of induction therapy, the patient achieved complete remission, was compliant and the treatment was well tolerated. CONCLUSION Polycythemia vera can transform into acute promyelocytic leukemia; therefore, it is important to review bone aspiration and other tests to perform a comprehensive assessment and monitor the disease status, to detect disease progression and intervene early when it transforms into acute promyelocytic leukemia.
Collapse
Affiliation(s)
- Wen-Wen Li
- Qingdao Women and Children’s Hospital, Department of Hematology, Qingdao, China
| | - Xiu-Fang Sui
- Qingdao Women and Children’s Hospital, Department of Hematology, Qingdao, China
| | - Shuang Fan
- Peking University People’s Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Hong Xu
- The Affiliated Hospital of Qingdao University, Department of Hematology, Qingdao, China
| | - Cheng-Lei Wang
- Qingdao Women and Children’s Hospital, Department of Hematology, Qingdao, China
| | - Fei-Ying Wang
- Qingdao Women and Children’s Hospital, Department of Hematology, Qingdao, China
| | - Xiao-Dong Mo
- Peking University People’s Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
- Research Unit of Key Technique for Diagnosis and Treatments of Hematologic Malignancies, Chinese Academy of Medical Sciences, Beijing, China
- *Correspondence: Xiao-Dong Mo, Peking University People’s Hospital, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Xicheng District, Beijing 100044, China (e-mail: )
| |
Collapse
|
6
|
Bhuria V, Baldauf CK, Schraven B, Fischer T. Thromboinflammation in Myeloproliferative Neoplasms (MPN)-A Puzzle Still to Be Solved. Int J Mol Sci 2022; 23:ijms23063206. [PMID: 35328626 PMCID: PMC8954909 DOI: 10.3390/ijms23063206] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/11/2022] [Accepted: 03/15/2022] [Indexed: 02/04/2023] Open
Abstract
Myeloproliferative neoplasms (MPNs), a group of malignant hematological disorders, occur as a consequence of somatic mutations in the hematopoietic stem cell compartment and show excessive accumulation of mature myeloid cells in the blood. A major cause of morbidity and mortality in these patients is the marked prothrombotic state leading to venous and arterial thrombosis, including myocardial infarction (MI), deep vein thrombosis (DVT), and strokes. Additionally, many MPN patients suffer from inflammation-mediated constitutional symptoms, such as fever, night sweats, fatigue, and cachexia. The chronic inflammatory syndrome in MPNs is associated with the up-regulation of various inflammatory cytokines in patients and is involved in the formation of the so-called MPN thromboinflammation. JAK2-V617F, the most prevalent mutation in MPNs, has been shown to activate a number of integrins on mature myeloid cells, including granulocytes and erythrocytes, which increase adhesion and drive venous thrombosis in murine knock-in/out models. This review aims to shed light on the current understanding of thromboinflammation, involvement of neutrophils in the prothrombotic state, plausible molecular mechanisms triggering the process of thrombosis, and potential novel therapeutic targets for developing effective strategies to reduce the MPN disease burden.
Collapse
Affiliation(s)
- Vikas Bhuria
- Institute of Molecular and Clinical Immunology, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany; (V.B.); (C.K.B.); (T.F.)
- Health-Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany
- Center for Health and Medical Prevention—ChaMP, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany
| | - Conny K. Baldauf
- Institute of Molecular and Clinical Immunology, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany; (V.B.); (C.K.B.); (T.F.)
- Health-Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany
| | - Burkhart Schraven
- Institute of Molecular and Clinical Immunology, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany; (V.B.); (C.K.B.); (T.F.)
- Health-Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany
- Center for Health and Medical Prevention—ChaMP, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany
- Correspondence: ; Tel.: +49-391-67-15338; Fax: +49-391-67-15852
| | - Thomas Fischer
- Institute of Molecular and Clinical Immunology, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany; (V.B.); (C.K.B.); (T.F.)
- Health-Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany
- Center for Health and Medical Prevention—ChaMP, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany
| |
Collapse
|
7
|
Bhuria V, Baldauf CK, Schraven B, Fischer T. Thromboinflammation in Myeloproliferative Neoplasms (MPN)-A Puzzle Still to Be Solved. Int J Mol Sci 2022. [PMID: 35328626 DOI: 10.3390/ijms23063206.pmid:35328626;pmcid:pmc8954909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Abstract
Myeloproliferative neoplasms (MPNs), a group of malignant hematological disorders, occur as a consequence of somatic mutations in the hematopoietic stem cell compartment and show excessive accumulation of mature myeloid cells in the blood. A major cause of morbidity and mortality in these patients is the marked prothrombotic state leading to venous and arterial thrombosis, including myocardial infarction (MI), deep vein thrombosis (DVT), and strokes. Additionally, many MPN patients suffer from inflammation-mediated constitutional symptoms, such as fever, night sweats, fatigue, and cachexia. The chronic inflammatory syndrome in MPNs is associated with the up-regulation of various inflammatory cytokines in patients and is involved in the formation of the so-called MPN thromboinflammation. JAK2-V617F, the most prevalent mutation in MPNs, has been shown to activate a number of integrins on mature myeloid cells, including granulocytes and erythrocytes, which increase adhesion and drive venous thrombosis in murine knock-in/out models. This review aims to shed light on the current understanding of thromboinflammation, involvement of neutrophils in the prothrombotic state, plausible molecular mechanisms triggering the process of thrombosis, and potential novel therapeutic targets for developing effective strategies to reduce the MPN disease burden.
Collapse
Affiliation(s)
- Vikas Bhuria
- Institute of Molecular and Clinical Immunology, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany
- Health-Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany
- Center for Health and Medical Prevention-ChaMP, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany
| | - Conny K Baldauf
- Institute of Molecular and Clinical Immunology, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany
- Health-Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany
| | - Burkhart Schraven
- Institute of Molecular and Clinical Immunology, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany
- Health-Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany
- Center for Health and Medical Prevention-ChaMP, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany
| | - Thomas Fischer
- Institute of Molecular and Clinical Immunology, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany
- Health-Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany
- Center for Health and Medical Prevention-ChaMP, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany
| |
Collapse
|
8
|
Chen H, Xu X, Li P, Xu Z. Imipenem–cilastatin-induced thrombocytosis: A probable rare case report. EUR J INFLAMM 2022. [DOI: 10.1177/1721727x221078719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Drug-induced thrombocytosis is difficult to identify and is rarely reported. Here, we report a probable rare case of imipenem–cilastatin-induced thrombocytosis in a 51-year-old female. The patient received imipenem–cilastatin treatment because of an intra-abdominal infection, following which the platelet count increased to a peak value of 1058×109 cells/L in 14 days. When imipenem–cilastatin was replaced by levofloxacin and amikacin, the platelet count decreased progressively and remained within the normal range until the 6-month follow-up. Moreover, platelet counts were independent of the infection. Thrombocytosis was probably attributable to imipenem–cilastatin with a Naranjo score of seven. This is a probable rare case in which the thrombocytosis was likely an adverse reaction induced by imipenem–cilastatin. We suggest that clinicians need to be vigilant concerning the impact of imipenem–cilastatin on platelet count in patients with thrombocytosis.
Collapse
Affiliation(s)
- Huadong Chen
- Pharmacy Department, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, China
| | - Xing’e Xu
- Pharmacy Department, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, China
| | - Piaopiao Li
- Pharmacy Department, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, China
| | - Zhenglin Xu
- Urinary Surgery, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, China
| |
Collapse
|
9
|
Spivak JL. Advances in polycythemia vera and lessons for acute leukemia. Best Pract Res Clin Haematol 2021; 34:101330. [PMID: 34865702 DOI: 10.1016/j.beha.2021.101330] [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: 10/20/2022]
Abstract
The myeloproliferative neoplasms (MPN), polycythemia vera (PV), essential thrombocytosis and primary myelofibrosis, are an unusual group of myeloid neoplasms, which arise in a pluripotent hematopoietic stem cell (HSC) due to gain of function driver mutations in the JAK2, CALR and MPL genes that constitutively activate JAK2, the cognate tyrosine kinase of the type 1 hematopoietic growth factor (HGF) receptors. PV is the ultimate phenotypic expression of constitutive JAK2 activation since it alone of the three MPN is characterized by overproduction of normal red cells, white cells and platelets. Paradoxically, however, although PV is a panmyelopathy involving myeloid, erythroid and megakaryocytic progenitor cells, pluripotent HSC only express a single type of HGF receptor, the thrombopoietin receptor, MPL. In this review, the basis for how a pluripotent HSC with one type of HGF can give rise to three separate types of myeloid cells will be explained and it will be demonstrated that PV is actually a hormone-sensitive disorder, characterized by elevated thrombopoietin levels. Finally, it will be shown that the most common form of acute leukemia in PV is due to the inappropriate use of chemotherapy, including hydroxyurea, which facilitates expansion of DNA-damaged, mutated HSC at the expense of their normal counterparts.
Collapse
Affiliation(s)
- Jerry L Spivak
- Division of Hematology, Johns Hopkins University School of Medicine, Traylor 924, 720 Rutland Avenue, Baltimore, MD, 20037, USA.
| |
Collapse
|
10
|
Pizzi M, Croci GA, Ruggeri M, Tabano S, Dei Tos AP, Sabattini E, Gianelli U. The Classification of Myeloproliferative Neoplasms: Rationale, Historical Background and Future Perspectives with Focus on Unclassifiable Cases. Cancers (Basel) 2021; 13:5666. [PMID: 34830822 PMCID: PMC8616346 DOI: 10.3390/cancers13225666] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/04/2021] [Accepted: 11/04/2021] [Indexed: 01/11/2023] Open
Abstract
Myeloproliferative neoplasms (MPNs) are a heterogeneous group of clonal hematopoietic stem cell disorders, characterized by increased proliferation of one or more myeloid lineages in the bone marrow. The classification and diagnostic criteria of MPNs have undergone relevant changes over the years, reflecting the increased awareness on these conditions and a better understanding of their biological and clinical-pathological features. The current World Health Organization (WHO) Classification acknowledges four main sub-groups of MPNs: (i) Chronic Myeloid Leukemia; (ii) classical Philadelphia-negative MPNs (Polycythemia Vera; Essential Thrombocythemia; Primary Myelofibrosis); (iii) non-classical Philadelphia-negative MPNs (Chronic Neutrophilic Leukemia; Chronic Eosinophilic Leukemia); and (iv) MPNs, unclassifiable (MPN-U). The latter are currently defined as MPNs with clinical-pathological findings not fulfilling the diagnostic criteria for any other entity. The MPN-U spectrum traditionally encompasses early phase MPNs, terminal (i.e., advanced fibrotic) MPNs, and cases associated with inflammatory or neoplastic disorders that obscure the clinical-histological picture. Several lines of evidence and clinical practice suggest the existence of additional myeloid neoplasms that may expand the spectrum of MPN-U. To gain insight into such disorders, this review addresses the history of MPN classification, the evolution of their diagnostic criteria and the complex clinical-pathological and biological features of MPN-U.
Collapse
Affiliation(s)
- Marco Pizzi
- Surgical Pathology and Cytopathology Unit, Department of Medicine—DIMED, University of Padua, 35128 Padua, Italy;
| | - Giorgio Alberto Croci
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy; (G.A.C.); (U.G.)
- Division of Pathology, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Marco Ruggeri
- Department of Hematology, San Bortolo Hospital, 36100 Vicenza, Italy;
| | - Silvia Tabano
- Laboratory of Medical Genetics, Foundation IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Angelo Paolo Dei Tos
- Surgical Pathology and Cytopathology Unit, Department of Medicine—DIMED, University of Padua, 35128 Padua, Italy;
| | - Elena Sabattini
- Haematopathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Umberto Gianelli
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy; (G.A.C.); (U.G.)
- Division of Pathology, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
| |
Collapse
|
11
|
Pandravada S, Sandler S. The Role of Navitoclax in Myelofibrosis. Cureus 2021; 13:e17976. [PMID: 34667663 PMCID: PMC8516617 DOI: 10.7759/cureus.17976] [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] [Accepted: 09/14/2021] [Indexed: 11/05/2022] Open
Abstract
Primary myelofibrosis (PMF) is the most aggressive type of chronic myeloproliferative neoplasm, characterized by a disarray of hematopoietic stem cells and bone marrow fibrosis. The estimated incidence is 1.5 per 100,000 individuals per year with a median survival of less than six years. This statistic can vary by risk category, primarily based on clinical and cytogenetic features. Death can result from many causes, including leukemic transformation, cachexia, vascular events, and infection. Currently, allogeneic hematopoietic cell transplant is the only curative method for those at high risk. Unfortunately, only about 10% are eligible for this therapy. JAK2 kinase inhibitors are commonly used for high-risk patients with symptomatic splenomegaly or systemic symptoms from PMF. In clinical trials, the major endpoint is a reduction of spleen size by 35%. Secondary endpoints have included amelioration of symptomatic PMF and overall survival, which can be difficult to determine because of frequent co-morbid conditions. Current Food and Drug Administration (FDA)-approved JAK2 inhibitors have not shown increased survival or reduced risk of leukemic transformation. In relapsed or refractory disease, there is currently no standard of care. In this paper, we discuss the role of a new anti-apoptotic B cell leukemia 2 (Bcl-2) inhibitor, Navitoclax, for the treatment of myelofibrosis. The clinical data thus far for Navitoclax, especially in synergistic combination with traditional JAK2 inhibitors, have been promising for those with a refractory or relapsing disease on prior therapies. Following the encouraging results of phase II trials, ongoing phase III trials will primarily evaluate splenic size reduction versus the standard of care and evaluate secondary endpoints such as symptom reduction and overall survival. These studies may establish a new standard of care for refractory or relapsed myelofibrosis.
Collapse
Affiliation(s)
| | - Steven Sandler
- Hematology/Oncology, NorthShore University HealthSystem, Skokie, USA
| |
Collapse
|
12
|
Abstract
Background Enoxaparin is an anticoagulant that falls in the class of medications called low molecular weight heparins (LMWHs), and is used to prevent or treat patients with deep vein thrombosis (DVT) and pulmonary embolism. Enoxaparin is the most widely used LMWH for DVT prophylaxis following knee or hip replacement surgery. Common side effects of enoxaparin include bleeding, petechiae at the injection site, and thrombocytopenia. However, reactive thrombocytosis is a rarely reported adverse reaction. We managed a patient who developed enoxaparin-associated thrombocytosis, which was completely resolved after treatment cessation. Case presentation A 78-year-old female was hospitalized for post-hip replacement rehabilitation. Low molecular weight heparin 40 mg/day was administered subcutaneously to prevent deep venous thrombosis (DVT). At admission, her platelet count was normal (228 × 109/L) and her white blood cell count was slightly elevated (12.91 × 109/L). Seven days after admission, the patient developed thrombocytosis, which peaked on the 14th day (836 × 109/L), while her white blood cell count had returned to normal (8.86 × 109/L). Her therapeutic regimen was reviewed, and enoxaparin was identified as a potentially reversible cause of reactive thrombocytosis. Switching from enoxaparin to rivaroxaban lead to a gradual decrease in the patient’s platelet count, which eventually returned to normal levels 16 days after enoxaparin was discontinued. No complications secondary to thrombocytosis was observed, and no conclusion was reached on the use of small doses of aspirin for antithrombotic therapy under these circumstances. Conclusion Enoxaparin-induced reactive thrombocytosis should be suspected in patients with thrombocytosis following enoxaparin administration as an anticoagulant to prevent certain complications.
Collapse
|
13
|
Benmalek R, Mechal H, Zahidi H, Mounaouir K, Arous S, Benouna MEG, Drighil A, Habbal R. Combined venous and arterial thrombosis revealing underlying myeloproliferative disorder in a young patient: a case report. J Med Case Rep 2021; 15:76. [PMID: 33593422 PMCID: PMC7885597 DOI: 10.1186/s13256-020-02593-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 11/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Myeloproliferative neoplasms (MPNs) such as polycythemia Vera (PV) and Essential Thrombocythemia (ET) can be associated with a high risk of both venous and arterial thrombosis. However, the co-existence between these two complications is very rare and has never been described before, especially in young adults with no known history of MPNs. CASE PRESENTATION We report the case of a 39 year-old Caucasian Moroccan male patient without cardiovascular risk factors (CVRF), who presented with acute chest pain. He also suffered from a severe headache since 2 weeks. Electrocardiogram (ECG) showed ST segment elevation myocardial infarction in the posterolateral leads. Cerebral Computed Tomography (CT) scan revealed subarachnoid hemorrhage (SAH), and cerebral Magnetic Resonance Angiography (MRA) found a Superior Sagittal Sinus Thrombosis (SSST). Routine blood tests showed raised hemoglobin and hematocrit in addition to leukocytosis and thrombocythemia. His coronary angiography revealed a thrombus in the ostial left circumflex artery (LCX). Further testing revealed positive Janus kinase 2 (JAK2) V617F mutation and low erythropoietin level, confirming the diagnosis of PV according to the 2008 World Health Organization (WHO) criteria. Antithrombotic and anti-ischemic treatments, in addition to myelosuppressive therapy with hydroxyurea, were initiated with a good clinical and biological evolution. CONCLUSION This case shows that MPNs are an important cause of thrombosis, especially in young patients with no other risk factors. Early diagnosis and appropriate management are fundamental before the occurrence of life-threatening complications that can sometimes present in unusual forms associating arterial and venous thrombotic events.
Collapse
Affiliation(s)
- Rime Benmalek
- Cardiology department, Hospital University Center Ibn Rochd, Casablanca, Morocco.
| | - Hanane Mechal
- Cardiology department, Hospital University Center Ibn Rochd, Casablanca, Morocco
| | - Hatim Zahidi
- Cardiology department, Hospital University Center Ibn Rochd, Casablanca, Morocco
| | - Karim Mounaouir
- Cardiology department, Hospital University Center Ibn Rochd, Casablanca, Morocco
| | - Salim Arous
- Cardiology department, Hospital University Center Ibn Rochd, Casablanca, Morocco
| | | | - Abdenasser Drighil
- Cardiology department, Hospital University Center Ibn Rochd, Casablanca, Morocco
| | - Rachida Habbal
- Cardiology department, Hospital University Center Ibn Rochd, Casablanca, Morocco
| |
Collapse
|
14
|
Current management strategies for polycythemia vera and essential thrombocythemia. Blood Rev 2020; 42:100714. [DOI: 10.1016/j.blre.2020.100714] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/02/2019] [Accepted: 05/11/2020] [Indexed: 02/06/2023]
|
15
|
Hasselbalch HC. Time for revival of the red blood cell count and red cell mass in the differential diagnosis between essential thrombocythemia and polycythemia vera? Haematologica 2020; 104:2119-2125. [PMID: 31666340 DOI: 10.3324/haematol.2019.229039] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
|
16
|
Lupak O, Han X, Xie P, Mahmood S, Mohammed H, Donthireddy V. The role of a low erythropoietin level for the polycythemia vera diagnosis. Blood Cells Mol Dis 2020; 80:102355. [DOI: 10.1016/j.bcmd.2019.102355] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 08/27/2019] [Accepted: 08/28/2019] [Indexed: 01/14/2023]
|
17
|
Nersesjan V, Zervides KA, Sørensen AL, Kjaer L, Skov V, Hasselbalch HC. The red blood cell count and the erythrocyte sedimentation rate in the diagnosis of polycythaemia vera. Eur J Haematol 2019; 104:46-54. [PMID: 31584701 DOI: 10.1111/ejh.13334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 09/12/2019] [Accepted: 09/17/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND Iron deficiency in polycythaemia vera (PV) may impact the validity of the haematocrit (HCT), since HCT is red blood cell count (RBC) × mean corpuscular volume (MCV). OBJECTIVES To investigate (a) the effect of microcytosis on HCT, (b) the erythrocyte sedimentation rate (ESR) as a possible additional diagnostic marker for PV. MATERIAL AND METHODS This study included 182 subjects: 39 with PV, 27 with essential thrombocythemia (ET) and 116 suspected of myeloproliferative neoplasm (MPN) with a secondary cause for either thrombocytosis or erythrocytosis. RESULTS Patients with PV had significantly lower ratio of MCV and serum ferritin compared to MPN suspects. A good correlation of RBC versus HCT was found for PV and MPN subjects when individuals with microcytosis were excluded (R2 = .87 in PV and R2 = .82 in MPN suspects). We found a specificity of 98% and a sensitivity of 37% for ESR <2 mm in the diagnosis of PV. CONCLUSION The RBC may more precisely reflect the total red cell mass and accordingly the hypercoagulable state of the PV patient, which is integrated in the ESR. A combination of RBC and ESR is proposed as a novel tool to substitute the Hb concentration and the HCT in the diagnosis of PV.
Collapse
Affiliation(s)
- Vardan Nersesjan
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kristoffer A Zervides
- Department of Clinical Sciences, Rheumatology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Anders L Sørensen
- Department of Hematology, Zealand University Hospital, Roskilde, Denmark.,Institute for Inflammation Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lasse Kjaer
- Department of Hematology, Zealand University Hospital, Roskilde, Denmark
| | - Vibe Skov
- Department of Hematology, Zealand University Hospital, Roskilde, Denmark
| | - Hans C Hasselbalch
- Department of Hematology, Zealand University Hospital, Roskilde, Denmark
| |
Collapse
|
18
|
Abstract
Since its discovery, polycythemia vera (PV) has challenged clinicians responsible for its diagnosis and management and scientists investigating its pathogenesis. As a clonal hematopoietic stem cell (HSC) disorder, PV is a neoplasm but its driver mutations result in overproduction of morphologically and functionally normal blood cells. PV arises in an HSC but it can present initially as isolated erythrocytosis, leukocytosis, thrombocytosis, or any combination of these together with splenomegaly or myelofibrosis, and it can take years for a true panmyelopathy to appear. PV shares the same JAK2 mutation as essential thrombocytosis and primary myelofibrosis, but erythrocytosis only occurs in PV. However, unlike secondary causes of erythrocytosis, in PV, the plasma volume is frequently expanded, masking the erythrocytosis and making diagnosis difficult if this essential fact is ignored. PV is not a monolithic disorder: female patients deregulate fewer genes and clinically behave differently than their male counterparts, while some PV patients are genetically predisposed to an aggressive clinical course. Nevertheless, based on what we have learned over the past century, most PV patients can lead long and productive lives. In this review, using clinical examples, I describe how I diagnose and manage PV in an evidence-based manner without relying on chemotherapy.
Collapse
|
19
|
Abstract
OBJECTIVES The purpose of this article is to review the current literature on drug-induced thrombocytosis with the goal of critically assessing causality and providing a comprehensive review of the topic. Thrombopoietic growth factors, such as thrombopoietin-receptor agonists (romiplostim and eltrombopag) and erythropoietin are not included in our review. DATA SOURCES The literature search included published articles limited to the English language and humans in MEDLINE, EMBASE, and Web of Science databases. MEDLINE/PubMed (1966 to September 2018) was searched using the MeSH terms thrombocytosis/chemically-induced and thrombocytosis/etiology. EMBASE (1980 to September 2018) was searched using the EMTAGS thrombocytosis/side effect. Web of Science (1970 to September 2018) was searched using the search term thrombocytosis. References of all relevant articles were reviewed for additional citations and information. STUDY SELECTION AND DATA EXTRACTION Review articles, clinical trials, background data, case series, and case reports of drug-induced thrombocytosis were collected, and case reports were assessed for causality using a modified Naranjo nomogram. DATA SYNTHESIS Drug-induced thrombocytosis, a form of reactive thrombocytosis cannot be easily differentiated from more common etiologies of reactive thrombocytosis. In all, 43 case reports of drug-induced thrombocytosis from a wide variety of drugs and drug classes were reviewed using a modified Naranjo probability scale that included criteria specific for thrombocytosis. CONCLUSIONS Drug-induced thrombocytosis is a relatively rare adverse drug reaction. The strongest evidence of causality supports low-molecular-weight heparins and neonatal drug withdrawal. Weaker evidence exists for all-trans retinoic acid, antibiotics, clozapine, epinephrine, gemcitabine, and vinca alkaloids.
Collapse
Affiliation(s)
- Quyen T Vo
- 1 Southwestern Oklahoma State University, Weatherford, OK, USA
| | | |
Collapse
|
20
|
Lugito NPH, Kurniawan A, Kurniawan YC, Yacobus E, Halim E. Essential thrombocythemia, hemolytic anemia and hepatic cirrhosis: Could there be an association? Hematol Rep 2018; 10:7394. [PMID: 30344986 PMCID: PMC6176381 DOI: 10.4081/hr.2018.7394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 06/24/2018] [Indexed: 12/29/2022] Open
Abstract
Vascular events are the most common clinical complication of essential thrombocythemia, leading to sign and symptoms of this disease. There are various sign and symptoms of essential thrombocythemia, such as thrombosis in artery or vein, and enlarged spleen. Portal hypertension and hepatic cirrhosis could be caused by essential thrombocythemia via intrahepatic thrombus. Anemia in essential thrombocythemia patient treated with hydroxyurea could be the side effect of bone marrow supression and also hydroxyurea induced hemolytic anemia. Association betweeen autoimmune hemolytic anemia and primary biliary cirrhosis or hepatic cirrhosis has been discussed. This case report presented an patient diagnosed with essential thrombocythemia. He later developed hepatic cirrhosis possibly caused by intra hepatic thrombus in the setting of hypercoagulabuility in myeloproliverative disorders. He also sufferred from anemia due to hydroxyurea induced hemolytic anemia. Association between autoimmune hepatic cirrhosis and autoimmune hemolytic anemia should also be considered in this patient.
Collapse
Affiliation(s)
| | - Andree Kurniawan
- Department of Internal Medicine, Faculty of Medicine, Pelita Harapan University
| | | | - Enny Yacobus
- Faculty of Medicine, Pelita Harapan University, Tangerang, Banten, Indonesia
| | - Edwin Halim
- Faculty of Medicine, Pelita Harapan University, Tangerang, Banten, Indonesia
| |
Collapse
|
21
|
Coexistent Breast Cancer and Essential Thrombocythemia: How We Addressed the Therapeutic Challenges. Case Rep Hematol 2018; 2018:2080185. [PMID: 30159181 PMCID: PMC6109582 DOI: 10.1155/2018/2080185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 05/11/2018] [Accepted: 07/19/2018] [Indexed: 01/30/2023] Open
Abstract
Essential thrombocythemia (ET) occurring with breast cancer is uncommon; the therapeutic approach varies and poses a challenge. A 65-year-old female presented to us after being diagnosed with hormone positive, HER2-negative infiltrating ductal carcinoma. She had a platelet count of 600 thou/cu mm. Her JAK2 mutation was positive. Bone marrow biopsy showed increased megakaryocytes. She was diagnosed with ET in the setting of breast cancer. She underwent breast conservation surgery after which aspirin was resumed. Anticipating thrombocytopenia during chemotherapy and given the absence of data combining hydroxyurea with standard chemotherapy used for breast cancer, we felt it prudent to delay cytoreductive therapy for her ET until after completion of breast cancer treatment. Her average platelet count during chemotherapy was 480 thou/cu mm with the lowest being 377 thou/cu mm. Her platelet count remained at goal between 300 and 350 thou/cu mm after four months of hydroxyurea.
Collapse
|
22
|
Jakovic L, Gotic M, Gisslinger H, Soldatovic I, Sefer D, Tirnanic M, Lekovic D, Jovanovic MP, Schalling M, Gisslinger B, Beham-Schmid C, Simonitsch-Klupp I, Thiele J. The WHO diagnostic criteria for polycythemia vera—role of red cell mass versus hemoglobin/hematocrit level and morphology. Ann Hematol 2018; 97:1581-1590. [DOI: 10.1007/s00277-018-3344-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 04/22/2018] [Indexed: 11/24/2022]
|
23
|
|
24
|
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.
Collapse
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
| |
Collapse
|
25
|
Gadomska G, Bartoszewska-Kubiak A, Boinska J, Matiakowska K, Ziołkowska K, Haus O, Rość D. Selected Parameters of Angiogenesis and the JAK2, CALR, and MPL Mutations in Patients With Essential Thrombocythemia. Clin Appl Thromb Hemost 2018; 24:1056-1060. [PMID: 29390868 PMCID: PMC6714737 DOI: 10.1177/1076029617740222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The aim of the study was to evaluate selected angiogenic factors in patients with essential thrombocythemia (ET) depending on JAK2V617F, calreticulin gene (CALR) and myeloproliferative leukemia virus oncogene (MPL) mutations. Sixty ET patients and 20 healthy volunteers were enrolled in the study. The following tests were performed: vascular endothelial growth factor- A (VEGF-A), soluble vascular endothelial growth factor receptor-1 (sVEGFR-1),soluble vascular endothelial growth factor receptor-2 (sVEGFR-2), platelet-derived growth factor( PDGF-BB), and stromal-derived factor-1α (SDF-1α). We observed an increased PDGF-BB level in patients with ET compared to the controls. Patients with CALR mutation had significantly higher concentration of PDGF-BB and lower concentration of SDF-1α than patients with JAK2V617F mutation. High concentration of PDGF-BB and low concentration of SDF-1α in patients with CALR(+) ET may indicate a contribution of these chemokines in disturbed Ca2+ metabolism in platelets.
Collapse
Affiliation(s)
- Grażyna Gadomska
- 1 Department of Hematology and Malignant Diseases of Hematopoietic System, Faculty of Medicine, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Alicja Bartoszewska-Kubiak
- 2 Department of Clinical Genetics, Faculty of Medicine, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Joanna Boinska
- 3 Department of Pathophysiology, Faculty of Pharmacy, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Karolina Matiakowska
- 2 Department of Clinical Genetics, Faculty of Medicine, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Katarzyna Ziołkowska
- 3 Department of Pathophysiology, Faculty of Pharmacy, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Olga Haus
- 2 Department of Clinical Genetics, Faculty of Medicine, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Danuta Rość
- 3 Department of Pathophysiology, Faculty of Pharmacy, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| |
Collapse
|
26
|
Kvasnicka HM, Orazi A, Thiele J, Barosi G, Bueso-Ramos CE, Vannucchi AM, Hasserjian RP, Kiladjian JJ, Gianelli U, Silver R, Mughal TI, Barbui T. European LeukemiaNet study on the reproducibility of bone marrow features in masked polycythemia vera and differentiation from essential thrombocythemia. Am J Hematol 2017; 92:1062-1067. [PMID: 28685840 DOI: 10.1002/ajh.24837] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 06/26/2017] [Indexed: 01/24/2023]
Abstract
The purpose of the study was to assess consensus and interobserver agreement among an international panel of six hematopathologists regarding characterization and reproducibility of bone marrow (BM) histologic features used to diagnose early stage myeloproliferative neoplasms, in particular differentiation of so-called masked/prodromal polycythemia vera (mPV) from JAK2-mutated essential thrombocythemia (ET). The six members of the hematopathology panel evaluated 98 BM specimens independently and in a blinded fashion without knowledge of clinical data. The specimens included 48 cases of mPV according to the originally published hemoglobin threshold values for this entity (male: 16.0-18.4 g/dL, female: 15.0-16.4 g/dL), 31 cases with overt PV according to the updated 2016 WHO criteria, and 19 control cases. The latter group included cases of JAK2-mutated ET, primary myelofibrosis, myelodysplastic syndrome, and various reactive conditions. Inter-rater agreement between the panelists was very high (overall agreement 92.6%, kappa 0.812), particularly with respect to separating mPV from ET. Virtually all cases of mPV were correctly classified as PV according to their BM morphology. In conclusion, a central blinded review of histology slides by six hematopathologists demonstrated that highly reproducible specific histological pattern characterize PV and confirmed the notion that there are no significant differences between mPV and overt PV in relation to BM morphology.
Collapse
Affiliation(s)
| | - Attilio Orazi
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY
| | - Juergen Thiele
- Institute of Pathology, University of Cologne, Cologne, Germany
| | - Giovanni Barosi
- Center for the Study of Myelofibrosis, Biotechnology Research Area, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico S. Matteo Foundation, Pavia, Italy
| | | | - Alessandro M Vannucchi
- Dipartimento di Medicina Sperimentale e Clinica, University of Florence, Florence, Italy
| | | | | | - Umberto Gianelli
- Pathology Unit, University of Milan Medical School, Fondazione IRCCS Cà Granda, Ospedale, Italy
| | | | | | - Tiziano Barbui
- Division of Hematology and Research Foundation, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| |
Collapse
|
27
|
Hassan OA, Moey MYY, Papageorgiou CN. From anemia to polycythemia in 4 weeks. Clin Case Rep 2017; 5:1526-1530. [PMID: 28878919 PMCID: PMC5582235 DOI: 10.1002/ccr3.879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 09/11/2016] [Accepted: 01/20/2017] [Indexed: 11/29/2022] Open
Abstract
Primary polycythemia (PCV) may coexist in otherwise asymptomatic patients particularly in the presence of unsuspecting conditions such as Thrombotic thrombocytopenic purpura (TTP). In presumed “idiopathic TTP,” autoimmune conditions such as rheumatoid arthritis (RA) should be investigated as a possible etiology for TTP. Standardization of targeted therapy with immunomodulatory agents may be recommended for this subset of patients.
Collapse
Affiliation(s)
- Omer A Hassan
- Saba University School of Medicine The Bottom Saba Dutch Caribbean The Netherlands.,Present address: Department of Pathology Wake Forest School of Medicine Medical Center Boulevard Winston-Salem North Carolina 27157 USA
| | - Melissa Y Y Moey
- Saba University School of Medicine The Bottom Saba Dutch Caribbean The Netherlands.,Present address: Department of Internal Medicine Vidant Medical Center/East Carolina University 600 Moye Blvd Greenville North Carolina 27834 USA
| | - Christos N Papageorgiou
- SSM Cancer Care St. Mary's Health Center St. Louis Missouri USA.,Division of Hematology and Oncology Department of Internal Medicine Saint Louis University School of Medicine St. Louis Missouri USA
| |
Collapse
|
28
|
Goel S, Sokhal AK, Singh BP, Aggarwal A. Priapism due to essential thrombocythaemia: a rare causation. BMJ Case Rep 2017; 2017:bcr-2017-221116. [PMID: 28824001 DOI: 10.1136/bcr-2017-221116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Priapism is rarely caused by essential thrombocytosis, a disorder characterised by increased number of megakaryocytes. We report a case of a 21-year-old man who presented with priapism and on investigation was found to have essential thrombocytosis as the cause.
Collapse
Affiliation(s)
- Sunny Goel
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Ashok Kumar Sokhal
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Bhupendra Pal Singh
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Ajay Aggarwal
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| |
Collapse
|
29
|
Nielsen HM, Andersen CL, Westman M, Kristensen LS, Asmar F, Kruse TA, Thomassen M, Larsen TS, Skov V, Hansen LL, Bjerrum OW, Hasselbalch HC, Punj V, Grønbæk K. Epigenetic changes in myelofibrosis: Distinct methylation changes in the myeloid compartments and in cases with ASXL1 mutations. Sci Rep 2017; 7:6774. [PMID: 28754985 PMCID: PMC5533802 DOI: 10.1038/s41598-017-07057-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 06/26/2017] [Indexed: 02/07/2023] Open
Abstract
This is the first study to compare genome-wide DNA methylation profiles of sorted blood cells from myelofibrosis (MF) patients and healthy controls. We found that differentially methylated CpG sites located to genes involved in 'cancer' and 'embryonic development' in MF CD34+ cells, in 'inflammatory disease' in MF mononuclear cells, and in 'immunological diseases' in MF granulocytes. Only few differentially methylated CpG sites were common among the three cell populations. Mutations in the epigenetic regulators ASXL1 (47%) and TET2 (20%) were not associated with a specific DNA methylation pattern using an unsupervised approach. However, in a supervised analysis of ASXL1 mutated versus wild-type cases, differentially methylated CpG sites were enriched in regions marked by histone H3K4me1, histone H3K27me3, and the bivalent histone mark H3K27me3 + H3K4me3 in human CD34+ cells. Hypermethylation of selected CpG sites was confirmed in a separate validation cohort of 30 MF patients by pyrosequencing. Altogether, we show that individual MF cell populations have distinct differentially methylated genes relative to their normal counterparts, which likely contribute to the phenotypic characteristics of MF. Furthermore, differentially methylated CpG sites in ASXL1 mutated MF cases are found in regulatory regions that could be associated with aberrant gene expression of ASXL1 target genes.
Collapse
Affiliation(s)
- Helene Myrtue Nielsen
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Biomedicine, Aarhus University, Aarhus, Denmark.,Danish Stem Cell Centre (DanStem) Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christen Lykkegaard Andersen
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Hematology, Roskilde Hospital, Roskilde, Denmark
| | - Maj Westman
- Department of Clinical Genetics, Rigshospitalet, Copenhagen, Denmark
| | - Lasse Sommer Kristensen
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Fazila Asmar
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Torben Arvid Kruse
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | - Mads Thomassen
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | | | - Vibe Skov
- Department of Hematology, Roskilde Hospital, Roskilde, Denmark
| | | | - Ole Weis Bjerrum
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Vasu Punj
- Division of Hematology, Keck School of Medicine, University of Southern California, Los Angeles, United States
| | - Kirsten Grønbæk
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. .,Danish Stem Cell Centre (DanStem) Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
| |
Collapse
|
30
|
Nangalia J, Grinfeld J, Green AR. Pathogenesis of Myeloproliferative Disorders. ANNUAL REVIEW OF PATHOLOGY-MECHANISMS OF DISEASE 2017; 11:101-26. [PMID: 27193452 DOI: 10.1146/annurev-pathol-012615-044454] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Myeloproliferative neoplasms (MPNs) are a set of chronic hematopoietic neoplasms with overlapping clinical and molecular features. Recent years have witnessed considerable advances in our understanding of their pathogenetic basis. Due to their protracted clinical course, the evolution to advanced hematological malignancies, and the accessibility of neoplastic tissue, the study of MPNs has provided a window into the earliest stages of tumorigenesis. With the discovery of mutations in CALR, the majority of MPN patients now bear an identifiable marker of clonal disease; however, the mechanism by which mutated CALR perturbs megakaryopoiesis is currently unresolved. We are beginning to understand better the role of JAK2(V617F) homozygosity, the function of comutations in epigenetic regulators and spliceosome components, and how these mutations cooperate with JAK2(V617F) to modulate MPN phenotype.
Collapse
Affiliation(s)
- Jyoti Nangalia
- Department of Haematology, Cambridge Institute for Medical Research and Wellcome Trust/MRC Stem Cell Institute, University of Cambridge, Cambridge CB2 0XY, United Kingdom; .,Department of Haematology, Addenbrooke's Hospital, Cambridge CB2 2QR, United Kingdom
| | - Jacob Grinfeld
- Department of Haematology, Cambridge Institute for Medical Research and Wellcome Trust/MRC Stem Cell Institute, University of Cambridge, Cambridge CB2 0XY, United Kingdom; .,Department of Haematology, Addenbrooke's Hospital, Cambridge CB2 2QR, United Kingdom
| | - Anthony R Green
- Department of Haematology, Cambridge Institute for Medical Research and Wellcome Trust/MRC Stem Cell Institute, University of Cambridge, Cambridge CB2 0XY, United Kingdom; .,Department of Haematology, Addenbrooke's Hospital, Cambridge CB2 2QR, United Kingdom
| |
Collapse
|
31
|
Mailankody S, Prasad V. Pharmaceutical Marketing for Rare Diseases: Regulating Drug Company Promotion in an Era of Unprecedented Advertisement. JAMA 2017; 317:2479-2480. [PMID: 28520871 DOI: 10.1001/jama.2017.5784] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Sham Mailankody
- Myeloma Service, Division of Hematologic Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Vinay Prasad
- Knight Cancer Institute, Division of Hematology Oncology, Oregon Health & Science University, Portland3Department of Public Health and Preventive Medicine and Center for Health Care Ethics, Oregon Health & Science University, Portland
| |
Collapse
|
32
|
Affiliation(s)
- Jerry L Spivak
- From the Hematology Division, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore
| |
Collapse
|
33
|
Grinfeld J, Godfrey AL. After 10 years of JAK2V617F: Disease biology and current management strategies in polycythaemia vera. Blood Rev 2017; 31:101-118. [DOI: 10.1016/j.blre.2016.11.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 11/08/2016] [Accepted: 11/14/2016] [Indexed: 12/12/2022]
|
34
|
Abstract
Myeloproliferative neoplasms (MPNs) are diseases of excess cell proliferation from bone marrow precursors. Two classic MPNs, polycythemia vera (PV) and essential thrombocytosis (ET), are conditions of excess proliferation of red blood cells and platelets, respectively. Although PV and ET involve different cells in the myeloid lineage, their clinical presentations have shared features, consistent with overlapping mutations in growth factor signaling. The management of both diseases involves minimizing the risk of thrombotic and hemorrhagic complications. Both PV and ET can progress to myelofibrosis or acute myeloid leukemia, portending a poor prognosis. MPNs can also present as primary myelofibrosis.
Collapse
Affiliation(s)
- Aric Parnes
- Division of Hematology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA.
| | - Arvind Ravi
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA
| |
Collapse
|
35
|
Shi ZX, Xiao ZJ. [Interpretation of the Chinese expert consensus on the diagnosis and treatment of polycythemia vera(2016)]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2016; 37:852-857. [PMID: 27801313 PMCID: PMC7364883 DOI: 10.3760/cma.j.issn.0253-2727.2016.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Indexed: 04/03/2023]
Affiliation(s)
- Z X Shi
- Institute of Hematology and Blood Diseases Hospital, State Key Laboratory of Experimental Hematology, CAMS & PUMC, Tianjin 300020, China
| | | |
Collapse
|
36
|
Korkmaz S, Kulakoglu S, Gorkem H, Aygun B, Cetinkaya A. Coexistence of chronic lymphocytic leukemia and polycythemia vera: a case report and review of the literature. Ann Saudi Med 2016; 36:364-366. [PMID: 27710990 PMCID: PMC6074321 DOI: 10.5144/0256-4947.2016.364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
UNLABELLED Polycythemia vera is a Philadelphia chromosome-negative myeloproliferative neoplasm. Chronic lymphocytic leukemia is a monoclonal expansion of a CD5+ CD19+ B lymphocytes. Chronic myeloproliferative neoplasms may coexist with indolent B-cell malignant lymphomas of various types. The association of chronic lymphocytic leukemia with polycythemia vera is a rare event with only a few cases of coexistence ever reported. We report a 56-year-old man in whom these two disorders were diagnosed concomitantly. Possible etiopathogenic relationships between both disorders are discussed in this case report. SIMILAR CASES PUBLISHED 6.
Collapse
Affiliation(s)
- Serdal Korkmaz
- Associated Professor Serdal Korkmaz MD, Division of Hematology,, Kayseri Education and Research Hospital 38100,, Kayseri, Turkey, T: +90 352 336 88 84,, Fax: +90 352 320 73 13, , ORCID: orcid.org/0000-0001-8521-7513
| | | | | | | | | |
Collapse
|
37
|
Inoue S, Okiyama N, Okune M, Shiraki N, Kessoku R, Fujimoto M. Clinical and histological characteristics of livedo racemosa in essential thrombocythemia: A report of two cases and review of the published works. J Dermatol 2016; 44:84-87. [DOI: 10.1111/1346-8138.13561] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 07/18/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Sae Inoue
- Department of Dermatology; Faculty of Medicine; University of Tsukuba; Tsukuba Japan
| | - Naoko Okiyama
- Department of Dermatology; Faculty of Medicine; University of Tsukuba; Tsukuba Japan
| | - Mari Okune
- Department of Dermatology; Faculty of Medicine; University of Tsukuba; Tsukuba Japan
| | - Nagisa Shiraki
- Department of Dermatology; Faculty of Medicine; University of Tsukuba; Tsukuba Japan
| | - Reiko Kessoku
- Department of Dermatology; Faculty of Medicine; University of Tsukuba; Tsukuba Japan
| | - Manabu Fujimoto
- Department of Dermatology; Faculty of Medicine; University of Tsukuba; Tsukuba Japan
| |
Collapse
|
38
|
Geyer JT, Orazi A. Myeloproliferative neoplasms (BCR-ABL1 negative) and myelodysplastic/myeloproliferative neoplasms: current diagnostic principles and upcoming updates. Int J Lab Hematol 2016; 38 Suppl 1:12-9. [PMID: 27161873 DOI: 10.1111/ijlh.12509] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 05/04/2016] [Indexed: 01/24/2023]
Abstract
Since the publication of the latest World Health Organization (WHO) classification in 2008, there has been a significant effort for clarification of unresolved questions, especially with the help of the rapidly developing field of molecular genetic studies, next-generation sequencing in particular. Numerous entities within the WHO categories of myeloproliferative neoplasms (MPNs) and myelodysplastic (MDS)/MPNs have been extensively studied, with large published series attempting to characterize and better define their morphologic and molecular genetic features. This emerging genetic landscape maintains a robust correlation with the various disease entities recognized by the WHO classification scheme based on a careful integration of detailed clinical information, bone marrow and peripheral blood morphology, immunohistology, and genomics. This brief review summarizes the current guidelines as they apply to diagnosing both the classical BCR-ABL1 negative MPN (polycythemia vera, essential thrombocythemia, and primary myelofibrosis) and the more common subtypes of MDS/MPN overlap syndromes. The more important recent molecular updates as well as the upcoming changes to the current WHO classification, expected to be published in late 2016, will also be briefly reviewed.
Collapse
Affiliation(s)
- J T Geyer
- Division of Hematopathology, Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA
| | - A Orazi
- Division of Hematopathology, Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA
| |
Collapse
|
39
|
Melikyan AL, Sukhanova GA, Vakhrusheva MV, Subortseva IN, Orel EB. [Experience in treating portal thromboses in patients with chronic myeloproliferative diseases]. TERAPEVT ARKH 2016; 88:89-95. [PMID: 26978616 DOI: 10.17116/terarkh201688189-95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patients with myeloproliferative diseases (MPD) are noted to be at high risk for portal thromboses. This problem gives rise to disability if it is untimely treated or resistant to therapy. The paper gives the experience of the Outpatient Department of the Hematology Research Center, Ministry of Health of the Russian Federation, in using antithrombin III in MPD patients (3 patients with primary myelofibrosis, 3 with essential thrombocythemia) and acute and subacute portal vein thromboses resistant to therapy with direct anticoagulants. In all 5 cases, the use of antithrombin III in combination with low-molecular-weight heparin showed a positive clinical effect as rapid relief of pain syndrome and comparatively early (3-week to 1.5-2-month) recanalization of thrombosed vessels. Three clinical cases are described in detail.
Collapse
Affiliation(s)
- A L Melikyan
- Hematology Research Center, Ministry of Health of Russia, Moscow, Russia
| | - G A Sukhanova
- M.V. Lomonosov Moscow State University, Moscow, Russia
| | - M V Vakhrusheva
- Hematology Research Center, Ministry of Health of Russia, Moscow, Russia
| | - I N Subortseva
- Hematology Research Center, Ministry of Health of Russia, Moscow, Russia
| | - E B Orel
- Hematology Research Center, Ministry of Health of Russia, Moscow, Russia
| |
Collapse
|
40
|
Stein BL, Gotlib J, Arcasoy M, Nguyen MH, Shah N, Moliterno A, Jamieson C, Pollyea DA, Scott B, Wadleigh M, Levine R, Komrokji R, Klisovic R, Gundabolu K, Kropf P, Wetzler M, Oh ST, Ribeiro R, Paschal R, Mohan S, Podoltsev N, Prchal J, Talpaz M, Snyder D, Verstovsek S, Mesa RA. Historical views, conventional approaches, and evolving management strategies for myeloproliferative neoplasms. J Natl Compr Canc Netw 2016; 13:424-34. [PMID: 25870379 DOI: 10.6004/jnccn.2015.0058] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The classical Philadelphia chromosome-negative myeloproliferative neoplasms (MPN), which include essential thrombocythemia, polycythemia vera, and myelofibrosis (MF), are in a new era of molecular diagnosis, ushered in by the identification of the JAK2(V617F) and cMPL mutations in 2005 and 2006, respectively, and the CALR mutations in 2013. Coupled with increased knowledge of disease pathogenesis and refined diagnostic criteria and prognostic scoring systems, a more nuanced appreciation has emerged of the burden of MPN in the United States, including the prevalence, symptom burden, and impact on quality of life. Biological advances in MPN have translated into the rapid development of novel therapeutics, culminating in the approval of the first treatment for MF, the JAK1/JAK2 inhibitor ruxolitinib. However, certain practical aspects of care, such as those regarding diagnosis, prevention of vascular events, choice of cytoreductive agent, and planning for therapies, present challenges for hematologists/oncologists, and are discussed in this article.
Collapse
Affiliation(s)
- Brady L Stein
- From Northwestern University Feinberg School of Medicine, Chicago, Illinois; Stanford Cancer Institute, Stanford University, Stanford, California; Duke Cancer Institute, Duke University, Durham, North Carolina; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; University of California, San Francisco, San Francisco, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; Moores Cancer Center, UC San Diego, San Diego, California; University of Colorado Cancer Center, Aurora, Colorado; Fred Hutchinson Cancer Research Center, Seattle, Washington; Dana Farber Cancer Institute, Boston, Massachusetts; Memorial Sloan Kettering Cancer Center, New York; New York; Moffitt Cancer Center and Research Institute, Tampa, Florida; The Ohio State University, Columbus, Ohio; Fred & Pamela Buffett Cancer Center, Omaha, Nebraska; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Roswell Park Cancer Institute, Buffalo, New York; Washington University-Siteman Cancer Center, St Louis, Missouri; St. Jude Children's Research Hospital, Memphis, Tennessee; University of Alabama at Birmingham, Birmingham, Alabama; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Yale University School of Medicine; New Haven, Connecticut; University of Utah, Salt Lake City, Utah; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; City of Hope Cancer Center, Los Angeles, California; The University of Texas MD Anderson Cancer Center, Houston, Texas; and Mayo Clinic Cancer Center, Scottsdale, Arizona
| | - Jason Gotlib
- From Northwestern University Feinberg School of Medicine, Chicago, Illinois; Stanford Cancer Institute, Stanford University, Stanford, California; Duke Cancer Institute, Duke University, Durham, North Carolina; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; University of California, San Francisco, San Francisco, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; Moores Cancer Center, UC San Diego, San Diego, California; University of Colorado Cancer Center, Aurora, Colorado; Fred Hutchinson Cancer Research Center, Seattle, Washington; Dana Farber Cancer Institute, Boston, Massachusetts; Memorial Sloan Kettering Cancer Center, New York; New York; Moffitt Cancer Center and Research Institute, Tampa, Florida; The Ohio State University, Columbus, Ohio; Fred & Pamela Buffett Cancer Center, Omaha, Nebraska; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Roswell Park Cancer Institute, Buffalo, New York; Washington University-Siteman Cancer Center, St Louis, Missouri; St. Jude Children's Research Hospital, Memphis, Tennessee; University of Alabama at Birmingham, Birmingham, Alabama; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Yale University School of Medicine; New Haven, Connecticut; University of Utah, Salt Lake City, Utah; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; City of Hope Cancer Center, Los Angeles, California; The University of Texas MD Anderson Cancer Center, Houston, Texas; and Mayo Clinic Cancer Center, Scottsdale, Arizona
| | - Murat Arcasoy
- From Northwestern University Feinberg School of Medicine, Chicago, Illinois; Stanford Cancer Institute, Stanford University, Stanford, California; Duke Cancer Institute, Duke University, Durham, North Carolina; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; University of California, San Francisco, San Francisco, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; Moores Cancer Center, UC San Diego, San Diego, California; University of Colorado Cancer Center, Aurora, Colorado; Fred Hutchinson Cancer Research Center, Seattle, Washington; Dana Farber Cancer Institute, Boston, Massachusetts; Memorial Sloan Kettering Cancer Center, New York; New York; Moffitt Cancer Center and Research Institute, Tampa, Florida; The Ohio State University, Columbus, Ohio; Fred & Pamela Buffett Cancer Center, Omaha, Nebraska; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Roswell Park Cancer Institute, Buffalo, New York; Washington University-Siteman Cancer Center, St Louis, Missouri; St. Jude Children's Research Hospital, Memphis, Tennessee; University of Alabama at Birmingham, Birmingham, Alabama; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Yale University School of Medicine; New Haven, Connecticut; University of Utah, Salt Lake City, Utah; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; City of Hope Cancer Center, Los Angeles, California; The University of Texas MD Anderson Cancer Center, Houston, Texas; and Mayo Clinic Cancer Center, Scottsdale, Arizona
| | - Marie Huong Nguyen
- From Northwestern University Feinberg School of Medicine, Chicago, Illinois; Stanford Cancer Institute, Stanford University, Stanford, California; Duke Cancer Institute, Duke University, Durham, North Carolina; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; University of California, San Francisco, San Francisco, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; Moores Cancer Center, UC San Diego, San Diego, California; University of Colorado Cancer Center, Aurora, Colorado; Fred Hutchinson Cancer Research Center, Seattle, Washington; Dana Farber Cancer Institute, Boston, Massachusetts; Memorial Sloan Kettering Cancer Center, New York; New York; Moffitt Cancer Center and Research Institute, Tampa, Florida; The Ohio State University, Columbus, Ohio; Fred & Pamela Buffett Cancer Center, Omaha, Nebraska; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Roswell Park Cancer Institute, Buffalo, New York; Washington University-Siteman Cancer Center, St Louis, Missouri; St. Jude Children's Research Hospital, Memphis, Tennessee; University of Alabama at Birmingham, Birmingham, Alabama; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Yale University School of Medicine; New Haven, Connecticut; University of Utah, Salt Lake City, Utah; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; City of Hope Cancer Center, Los Angeles, California; The University of Texas MD Anderson Cancer Center, Houston, Texas; and Mayo Clinic Cancer Center, Scottsdale, Arizona
| | - Neil Shah
- From Northwestern University Feinberg School of Medicine, Chicago, Illinois; Stanford Cancer Institute, Stanford University, Stanford, California; Duke Cancer Institute, Duke University, Durham, North Carolina; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; University of California, San Francisco, San Francisco, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; Moores Cancer Center, UC San Diego, San Diego, California; University of Colorado Cancer Center, Aurora, Colorado; Fred Hutchinson Cancer Research Center, Seattle, Washington; Dana Farber Cancer Institute, Boston, Massachusetts; Memorial Sloan Kettering Cancer Center, New York; New York; Moffitt Cancer Center and Research Institute, Tampa, Florida; The Ohio State University, Columbus, Ohio; Fred & Pamela Buffett Cancer Center, Omaha, Nebraska; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Roswell Park Cancer Institute, Buffalo, New York; Washington University-Siteman Cancer Center, St Louis, Missouri; St. Jude Children's Research Hospital, Memphis, Tennessee; University of Alabama at Birmingham, Birmingham, Alabama; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Yale University School of Medicine; New Haven, Connecticut; University of Utah, Salt Lake City, Utah; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; City of Hope Cancer Center, Los Angeles, California; The University of Texas MD Anderson Cancer Center, Houston, Texas; and Mayo Clinic Cancer Center, Scottsdale, Arizona
| | - Alison Moliterno
- From Northwestern University Feinberg School of Medicine, Chicago, Illinois; Stanford Cancer Institute, Stanford University, Stanford, California; Duke Cancer Institute, Duke University, Durham, North Carolina; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; University of California, San Francisco, San Francisco, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; Moores Cancer Center, UC San Diego, San Diego, California; University of Colorado Cancer Center, Aurora, Colorado; Fred Hutchinson Cancer Research Center, Seattle, Washington; Dana Farber Cancer Institute, Boston, Massachusetts; Memorial Sloan Kettering Cancer Center, New York; New York; Moffitt Cancer Center and Research Institute, Tampa, Florida; The Ohio State University, Columbus, Ohio; Fred & Pamela Buffett Cancer Center, Omaha, Nebraska; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Roswell Park Cancer Institute, Buffalo, New York; Washington University-Siteman Cancer Center, St Louis, Missouri; St. Jude Children's Research Hospital, Memphis, Tennessee; University of Alabama at Birmingham, Birmingham, Alabama; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Yale University School of Medicine; New Haven, Connecticut; University of Utah, Salt Lake City, Utah; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; City of Hope Cancer Center, Los Angeles, California; The University of Texas MD Anderson Cancer Center, Houston, Texas; and Mayo Clinic Cancer Center, Scottsdale, Arizona
| | - Catriona Jamieson
- From Northwestern University Feinberg School of Medicine, Chicago, Illinois; Stanford Cancer Institute, Stanford University, Stanford, California; Duke Cancer Institute, Duke University, Durham, North Carolina; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; University of California, San Francisco, San Francisco, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; Moores Cancer Center, UC San Diego, San Diego, California; University of Colorado Cancer Center, Aurora, Colorado; Fred Hutchinson Cancer Research Center, Seattle, Washington; Dana Farber Cancer Institute, Boston, Massachusetts; Memorial Sloan Kettering Cancer Center, New York; New York; Moffitt Cancer Center and Research Institute, Tampa, Florida; The Ohio State University, Columbus, Ohio; Fred & Pamela Buffett Cancer Center, Omaha, Nebraska; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Roswell Park Cancer Institute, Buffalo, New York; Washington University-Siteman Cancer Center, St Louis, Missouri; St. Jude Children's Research Hospital, Memphis, Tennessee; University of Alabama at Birmingham, Birmingham, Alabama; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Yale University School of Medicine; New Haven, Connecticut; University of Utah, Salt Lake City, Utah; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; City of Hope Cancer Center, Los Angeles, California; The University of Texas MD Anderson Cancer Center, Houston, Texas; and Mayo Clinic Cancer Center, Scottsdale, Arizona
| | - Daniel A Pollyea
- From Northwestern University Feinberg School of Medicine, Chicago, Illinois; Stanford Cancer Institute, Stanford University, Stanford, California; Duke Cancer Institute, Duke University, Durham, North Carolina; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; University of California, San Francisco, San Francisco, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; Moores Cancer Center, UC San Diego, San Diego, California; University of Colorado Cancer Center, Aurora, Colorado; Fred Hutchinson Cancer Research Center, Seattle, Washington; Dana Farber Cancer Institute, Boston, Massachusetts; Memorial Sloan Kettering Cancer Center, New York; New York; Moffitt Cancer Center and Research Institute, Tampa, Florida; The Ohio State University, Columbus, Ohio; Fred & Pamela Buffett Cancer Center, Omaha, Nebraska; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Roswell Park Cancer Institute, Buffalo, New York; Washington University-Siteman Cancer Center, St Louis, Missouri; St. Jude Children's Research Hospital, Memphis, Tennessee; University of Alabama at Birmingham, Birmingham, Alabama; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Yale University School of Medicine; New Haven, Connecticut; University of Utah, Salt Lake City, Utah; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; City of Hope Cancer Center, Los Angeles, California; The University of Texas MD Anderson Cancer Center, Houston, Texas; and Mayo Clinic Cancer Center, Scottsdale, Arizona
| | - Bart Scott
- From Northwestern University Feinberg School of Medicine, Chicago, Illinois; Stanford Cancer Institute, Stanford University, Stanford, California; Duke Cancer Institute, Duke University, Durham, North Carolina; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; University of California, San Francisco, San Francisco, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; Moores Cancer Center, UC San Diego, San Diego, California; University of Colorado Cancer Center, Aurora, Colorado; Fred Hutchinson Cancer Research Center, Seattle, Washington; Dana Farber Cancer Institute, Boston, Massachusetts; Memorial Sloan Kettering Cancer Center, New York; New York; Moffitt Cancer Center and Research Institute, Tampa, Florida; The Ohio State University, Columbus, Ohio; Fred & Pamela Buffett Cancer Center, Omaha, Nebraska; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Roswell Park Cancer Institute, Buffalo, New York; Washington University-Siteman Cancer Center, St Louis, Missouri; St. Jude Children's Research Hospital, Memphis, Tennessee; University of Alabama at Birmingham, Birmingham, Alabama; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Yale University School of Medicine; New Haven, Connecticut; University of Utah, Salt Lake City, Utah; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; City of Hope Cancer Center, Los Angeles, California; The University of Texas MD Anderson Cancer Center, Houston, Texas; and Mayo Clinic Cancer Center, Scottsdale, Arizona
| | - Martha Wadleigh
- From Northwestern University Feinberg School of Medicine, Chicago, Illinois; Stanford Cancer Institute, Stanford University, Stanford, California; Duke Cancer Institute, Duke University, Durham, North Carolina; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; University of California, San Francisco, San Francisco, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; Moores Cancer Center, UC San Diego, San Diego, California; University of Colorado Cancer Center, Aurora, Colorado; Fred Hutchinson Cancer Research Center, Seattle, Washington; Dana Farber Cancer Institute, Boston, Massachusetts; Memorial Sloan Kettering Cancer Center, New York; New York; Moffitt Cancer Center and Research Institute, Tampa, Florida; The Ohio State University, Columbus, Ohio; Fred & Pamela Buffett Cancer Center, Omaha, Nebraska; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Roswell Park Cancer Institute, Buffalo, New York; Washington University-Siteman Cancer Center, St Louis, Missouri; St. Jude Children's Research Hospital, Memphis, Tennessee; University of Alabama at Birmingham, Birmingham, Alabama; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Yale University School of Medicine; New Haven, Connecticut; University of Utah, Salt Lake City, Utah; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; City of Hope Cancer Center, Los Angeles, California; The University of Texas MD Anderson Cancer Center, Houston, Texas; and Mayo Clinic Cancer Center, Scottsdale, Arizona
| | - Ross Levine
- From Northwestern University Feinberg School of Medicine, Chicago, Illinois; Stanford Cancer Institute, Stanford University, Stanford, California; Duke Cancer Institute, Duke University, Durham, North Carolina; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; University of California, San Francisco, San Francisco, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; Moores Cancer Center, UC San Diego, San Diego, California; University of Colorado Cancer Center, Aurora, Colorado; Fred Hutchinson Cancer Research Center, Seattle, Washington; Dana Farber Cancer Institute, Boston, Massachusetts; Memorial Sloan Kettering Cancer Center, New York; New York; Moffitt Cancer Center and Research Institute, Tampa, Florida; The Ohio State University, Columbus, Ohio; Fred & Pamela Buffett Cancer Center, Omaha, Nebraska; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Roswell Park Cancer Institute, Buffalo, New York; Washington University-Siteman Cancer Center, St Louis, Missouri; St. Jude Children's Research Hospital, Memphis, Tennessee; University of Alabama at Birmingham, Birmingham, Alabama; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Yale University School of Medicine; New Haven, Connecticut; University of Utah, Salt Lake City, Utah; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; City of Hope Cancer Center, Los Angeles, California; The University of Texas MD Anderson Cancer Center, Houston, Texas; and Mayo Clinic Cancer Center, Scottsdale, Arizona
| | - Rami Komrokji
- From Northwestern University Feinberg School of Medicine, Chicago, Illinois; Stanford Cancer Institute, Stanford University, Stanford, California; Duke Cancer Institute, Duke University, Durham, North Carolina; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; University of California, San Francisco, San Francisco, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; Moores Cancer Center, UC San Diego, San Diego, California; University of Colorado Cancer Center, Aurora, Colorado; Fred Hutchinson Cancer Research Center, Seattle, Washington; Dana Farber Cancer Institute, Boston, Massachusetts; Memorial Sloan Kettering Cancer Center, New York; New York; Moffitt Cancer Center and Research Institute, Tampa, Florida; The Ohio State University, Columbus, Ohio; Fred & Pamela Buffett Cancer Center, Omaha, Nebraska; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Roswell Park Cancer Institute, Buffalo, New York; Washington University-Siteman Cancer Center, St Louis, Missouri; St. Jude Children's Research Hospital, Memphis, Tennessee; University of Alabama at Birmingham, Birmingham, Alabama; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Yale University School of Medicine; New Haven, Connecticut; University of Utah, Salt Lake City, Utah; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; City of Hope Cancer Center, Los Angeles, California; The University of Texas MD Anderson Cancer Center, Houston, Texas; and Mayo Clinic Cancer Center, Scottsdale, Arizona
| | - Rebecca Klisovic
- From Northwestern University Feinberg School of Medicine, Chicago, Illinois; Stanford Cancer Institute, Stanford University, Stanford, California; Duke Cancer Institute, Duke University, Durham, North Carolina; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; University of California, San Francisco, San Francisco, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; Moores Cancer Center, UC San Diego, San Diego, California; University of Colorado Cancer Center, Aurora, Colorado; Fred Hutchinson Cancer Research Center, Seattle, Washington; Dana Farber Cancer Institute, Boston, Massachusetts; Memorial Sloan Kettering Cancer Center, New York; New York; Moffitt Cancer Center and Research Institute, Tampa, Florida; The Ohio State University, Columbus, Ohio; Fred & Pamela Buffett Cancer Center, Omaha, Nebraska; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Roswell Park Cancer Institute, Buffalo, New York; Washington University-Siteman Cancer Center, St Louis, Missouri; St. Jude Children's Research Hospital, Memphis, Tennessee; University of Alabama at Birmingham, Birmingham, Alabama; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Yale University School of Medicine; New Haven, Connecticut; University of Utah, Salt Lake City, Utah; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; City of Hope Cancer Center, Los Angeles, California; The University of Texas MD Anderson Cancer Center, Houston, Texas; and Mayo Clinic Cancer Center, Scottsdale, Arizona
| | - Krishna Gundabolu
- From Northwestern University Feinberg School of Medicine, Chicago, Illinois; Stanford Cancer Institute, Stanford University, Stanford, California; Duke Cancer Institute, Duke University, Durham, North Carolina; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; University of California, San Francisco, San Francisco, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; Moores Cancer Center, UC San Diego, San Diego, California; University of Colorado Cancer Center, Aurora, Colorado; Fred Hutchinson Cancer Research Center, Seattle, Washington; Dana Farber Cancer Institute, Boston, Massachusetts; Memorial Sloan Kettering Cancer Center, New York; New York; Moffitt Cancer Center and Research Institute, Tampa, Florida; The Ohio State University, Columbus, Ohio; Fred & Pamela Buffett Cancer Center, Omaha, Nebraska; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Roswell Park Cancer Institute, Buffalo, New York; Washington University-Siteman Cancer Center, St Louis, Missouri; St. Jude Children's Research Hospital, Memphis, Tennessee; University of Alabama at Birmingham, Birmingham, Alabama; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Yale University School of Medicine; New Haven, Connecticut; University of Utah, Salt Lake City, Utah; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; City of Hope Cancer Center, Los Angeles, California; The University of Texas MD Anderson Cancer Center, Houston, Texas; and Mayo Clinic Cancer Center, Scottsdale, Arizona
| | - Patricia Kropf
- From Northwestern University Feinberg School of Medicine, Chicago, Illinois; Stanford Cancer Institute, Stanford University, Stanford, California; Duke Cancer Institute, Duke University, Durham, North Carolina; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; University of California, San Francisco, San Francisco, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; Moores Cancer Center, UC San Diego, San Diego, California; University of Colorado Cancer Center, Aurora, Colorado; Fred Hutchinson Cancer Research Center, Seattle, Washington; Dana Farber Cancer Institute, Boston, Massachusetts; Memorial Sloan Kettering Cancer Center, New York; New York; Moffitt Cancer Center and Research Institute, Tampa, Florida; The Ohio State University, Columbus, Ohio; Fred & Pamela Buffett Cancer Center, Omaha, Nebraska; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Roswell Park Cancer Institute, Buffalo, New York; Washington University-Siteman Cancer Center, St Louis, Missouri; St. Jude Children's Research Hospital, Memphis, Tennessee; University of Alabama at Birmingham, Birmingham, Alabama; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Yale University School of Medicine; New Haven, Connecticut; University of Utah, Salt Lake City, Utah; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; City of Hope Cancer Center, Los Angeles, California; The University of Texas MD Anderson Cancer Center, Houston, Texas; and Mayo Clinic Cancer Center, Scottsdale, Arizona
| | - Meir Wetzler
- From Northwestern University Feinberg School of Medicine, Chicago, Illinois; Stanford Cancer Institute, Stanford University, Stanford, California; Duke Cancer Institute, Duke University, Durham, North Carolina; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; University of California, San Francisco, San Francisco, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; Moores Cancer Center, UC San Diego, San Diego, California; University of Colorado Cancer Center, Aurora, Colorado; Fred Hutchinson Cancer Research Center, Seattle, Washington; Dana Farber Cancer Institute, Boston, Massachusetts; Memorial Sloan Kettering Cancer Center, New York; New York; Moffitt Cancer Center and Research Institute, Tampa, Florida; The Ohio State University, Columbus, Ohio; Fred & Pamela Buffett Cancer Center, Omaha, Nebraska; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Roswell Park Cancer Institute, Buffalo, New York; Washington University-Siteman Cancer Center, St Louis, Missouri; St. Jude Children's Research Hospital, Memphis, Tennessee; University of Alabama at Birmingham, Birmingham, Alabama; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Yale University School of Medicine; New Haven, Connecticut; University of Utah, Salt Lake City, Utah; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; City of Hope Cancer Center, Los Angeles, California; The University of Texas MD Anderson Cancer Center, Houston, Texas; and Mayo Clinic Cancer Center, Scottsdale, Arizona
| | - Stephen T Oh
- From Northwestern University Feinberg School of Medicine, Chicago, Illinois; Stanford Cancer Institute, Stanford University, Stanford, California; Duke Cancer Institute, Duke University, Durham, North Carolina; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; University of California, San Francisco, San Francisco, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; Moores Cancer Center, UC San Diego, San Diego, California; University of Colorado Cancer Center, Aurora, Colorado; Fred Hutchinson Cancer Research Center, Seattle, Washington; Dana Farber Cancer Institute, Boston, Massachusetts; Memorial Sloan Kettering Cancer Center, New York; New York; Moffitt Cancer Center and Research Institute, Tampa, Florida; The Ohio State University, Columbus, Ohio; Fred & Pamela Buffett Cancer Center, Omaha, Nebraska; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Roswell Park Cancer Institute, Buffalo, New York; Washington University-Siteman Cancer Center, St Louis, Missouri; St. Jude Children's Research Hospital, Memphis, Tennessee; University of Alabama at Birmingham, Birmingham, Alabama; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Yale University School of Medicine; New Haven, Connecticut; University of Utah, Salt Lake City, Utah; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; City of Hope Cancer Center, Los Angeles, California; The University of Texas MD Anderson Cancer Center, Houston, Texas; and Mayo Clinic Cancer Center, Scottsdale, Arizona
| | - Raul Ribeiro
- From Northwestern University Feinberg School of Medicine, Chicago, Illinois; Stanford Cancer Institute, Stanford University, Stanford, California; Duke Cancer Institute, Duke University, Durham, North Carolina; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; University of California, San Francisco, San Francisco, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; Moores Cancer Center, UC San Diego, San Diego, California; University of Colorado Cancer Center, Aurora, Colorado; Fred Hutchinson Cancer Research Center, Seattle, Washington; Dana Farber Cancer Institute, Boston, Massachusetts; Memorial Sloan Kettering Cancer Center, New York; New York; Moffitt Cancer Center and Research Institute, Tampa, Florida; The Ohio State University, Columbus, Ohio; Fred & Pamela Buffett Cancer Center, Omaha, Nebraska; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Roswell Park Cancer Institute, Buffalo, New York; Washington University-Siteman Cancer Center, St Louis, Missouri; St. Jude Children's Research Hospital, Memphis, Tennessee; University of Alabama at Birmingham, Birmingham, Alabama; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Yale University School of Medicine; New Haven, Connecticut; University of Utah, Salt Lake City, Utah; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; City of Hope Cancer Center, Los Angeles, California; The University of Texas MD Anderson Cancer Center, Houston, Texas; and Mayo Clinic Cancer Center, Scottsdale, Arizona
| | - Rita Paschal
- From Northwestern University Feinberg School of Medicine, Chicago, Illinois; Stanford Cancer Institute, Stanford University, Stanford, California; Duke Cancer Institute, Duke University, Durham, North Carolina; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; University of California, San Francisco, San Francisco, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; Moores Cancer Center, UC San Diego, San Diego, California; University of Colorado Cancer Center, Aurora, Colorado; Fred Hutchinson Cancer Research Center, Seattle, Washington; Dana Farber Cancer Institute, Boston, Massachusetts; Memorial Sloan Kettering Cancer Center, New York; New York; Moffitt Cancer Center and Research Institute, Tampa, Florida; The Ohio State University, Columbus, Ohio; Fred & Pamela Buffett Cancer Center, Omaha, Nebraska; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Roswell Park Cancer Institute, Buffalo, New York; Washington University-Siteman Cancer Center, St Louis, Missouri; St. Jude Children's Research Hospital, Memphis, Tennessee; University of Alabama at Birmingham, Birmingham, Alabama; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Yale University School of Medicine; New Haven, Connecticut; University of Utah, Salt Lake City, Utah; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; City of Hope Cancer Center, Los Angeles, California; The University of Texas MD Anderson Cancer Center, Houston, Texas; and Mayo Clinic Cancer Center, Scottsdale, Arizona
| | - Sanjay Mohan
- From Northwestern University Feinberg School of Medicine, Chicago, Illinois; Stanford Cancer Institute, Stanford University, Stanford, California; Duke Cancer Institute, Duke University, Durham, North Carolina; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; University of California, San Francisco, San Francisco, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; Moores Cancer Center, UC San Diego, San Diego, California; University of Colorado Cancer Center, Aurora, Colorado; Fred Hutchinson Cancer Research Center, Seattle, Washington; Dana Farber Cancer Institute, Boston, Massachusetts; Memorial Sloan Kettering Cancer Center, New York; New York; Moffitt Cancer Center and Research Institute, Tampa, Florida; The Ohio State University, Columbus, Ohio; Fred & Pamela Buffett Cancer Center, Omaha, Nebraska; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Roswell Park Cancer Institute, Buffalo, New York; Washington University-Siteman Cancer Center, St Louis, Missouri; St. Jude Children's Research Hospital, Memphis, Tennessee; University of Alabama at Birmingham, Birmingham, Alabama; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Yale University School of Medicine; New Haven, Connecticut; University of Utah, Salt Lake City, Utah; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; City of Hope Cancer Center, Los Angeles, California; The University of Texas MD Anderson Cancer Center, Houston, Texas; and Mayo Clinic Cancer Center, Scottsdale, Arizona
| | - Nikolai Podoltsev
- From Northwestern University Feinberg School of Medicine, Chicago, Illinois; Stanford Cancer Institute, Stanford University, Stanford, California; Duke Cancer Institute, Duke University, Durham, North Carolina; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; University of California, San Francisco, San Francisco, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; Moores Cancer Center, UC San Diego, San Diego, California; University of Colorado Cancer Center, Aurora, Colorado; Fred Hutchinson Cancer Research Center, Seattle, Washington; Dana Farber Cancer Institute, Boston, Massachusetts; Memorial Sloan Kettering Cancer Center, New York; New York; Moffitt Cancer Center and Research Institute, Tampa, Florida; The Ohio State University, Columbus, Ohio; Fred & Pamela Buffett Cancer Center, Omaha, Nebraska; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Roswell Park Cancer Institute, Buffalo, New York; Washington University-Siteman Cancer Center, St Louis, Missouri; St. Jude Children's Research Hospital, Memphis, Tennessee; University of Alabama at Birmingham, Birmingham, Alabama; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Yale University School of Medicine; New Haven, Connecticut; University of Utah, Salt Lake City, Utah; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; City of Hope Cancer Center, Los Angeles, California; The University of Texas MD Anderson Cancer Center, Houston, Texas; and Mayo Clinic Cancer Center, Scottsdale, Arizona
| | - Josef Prchal
- From Northwestern University Feinberg School of Medicine, Chicago, Illinois; Stanford Cancer Institute, Stanford University, Stanford, California; Duke Cancer Institute, Duke University, Durham, North Carolina; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; University of California, San Francisco, San Francisco, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; Moores Cancer Center, UC San Diego, San Diego, California; University of Colorado Cancer Center, Aurora, Colorado; Fred Hutchinson Cancer Research Center, Seattle, Washington; Dana Farber Cancer Institute, Boston, Massachusetts; Memorial Sloan Kettering Cancer Center, New York; New York; Moffitt Cancer Center and Research Institute, Tampa, Florida; The Ohio State University, Columbus, Ohio; Fred & Pamela Buffett Cancer Center, Omaha, Nebraska; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Roswell Park Cancer Institute, Buffalo, New York; Washington University-Siteman Cancer Center, St Louis, Missouri; St. Jude Children's Research Hospital, Memphis, Tennessee; University of Alabama at Birmingham, Birmingham, Alabama; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Yale University School of Medicine; New Haven, Connecticut; University of Utah, Salt Lake City, Utah; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; City of Hope Cancer Center, Los Angeles, California; The University of Texas MD Anderson Cancer Center, Houston, Texas; and Mayo Clinic Cancer Center, Scottsdale, Arizona
| | - Moshe Talpaz
- From Northwestern University Feinberg School of Medicine, Chicago, Illinois; Stanford Cancer Institute, Stanford University, Stanford, California; Duke Cancer Institute, Duke University, Durham, North Carolina; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; University of California, San Francisco, San Francisco, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; Moores Cancer Center, UC San Diego, San Diego, California; University of Colorado Cancer Center, Aurora, Colorado; Fred Hutchinson Cancer Research Center, Seattle, Washington; Dana Farber Cancer Institute, Boston, Massachusetts; Memorial Sloan Kettering Cancer Center, New York; New York; Moffitt Cancer Center and Research Institute, Tampa, Florida; The Ohio State University, Columbus, Ohio; Fred & Pamela Buffett Cancer Center, Omaha, Nebraska; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Roswell Park Cancer Institute, Buffalo, New York; Washington University-Siteman Cancer Center, St Louis, Missouri; St. Jude Children's Research Hospital, Memphis, Tennessee; University of Alabama at Birmingham, Birmingham, Alabama; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Yale University School of Medicine; New Haven, Connecticut; University of Utah, Salt Lake City, Utah; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; City of Hope Cancer Center, Los Angeles, California; The University of Texas MD Anderson Cancer Center, Houston, Texas; and Mayo Clinic Cancer Center, Scottsdale, Arizona
| | - David Snyder
- From Northwestern University Feinberg School of Medicine, Chicago, Illinois; Stanford Cancer Institute, Stanford University, Stanford, California; Duke Cancer Institute, Duke University, Durham, North Carolina; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; University of California, San Francisco, San Francisco, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; Moores Cancer Center, UC San Diego, San Diego, California; University of Colorado Cancer Center, Aurora, Colorado; Fred Hutchinson Cancer Research Center, Seattle, Washington; Dana Farber Cancer Institute, Boston, Massachusetts; Memorial Sloan Kettering Cancer Center, New York; New York; Moffitt Cancer Center and Research Institute, Tampa, Florida; The Ohio State University, Columbus, Ohio; Fred & Pamela Buffett Cancer Center, Omaha, Nebraska; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Roswell Park Cancer Institute, Buffalo, New York; Washington University-Siteman Cancer Center, St Louis, Missouri; St. Jude Children's Research Hospital, Memphis, Tennessee; University of Alabama at Birmingham, Birmingham, Alabama; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Yale University School of Medicine; New Haven, Connecticut; University of Utah, Salt Lake City, Utah; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; City of Hope Cancer Center, Los Angeles, California; The University of Texas MD Anderson Cancer Center, Houston, Texas; and Mayo Clinic Cancer Center, Scottsdale, Arizona
| | - Srdan Verstovsek
- From Northwestern University Feinberg School of Medicine, Chicago, Illinois; Stanford Cancer Institute, Stanford University, Stanford, California; Duke Cancer Institute, Duke University, Durham, North Carolina; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; University of California, San Francisco, San Francisco, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; Moores Cancer Center, UC San Diego, San Diego, California; University of Colorado Cancer Center, Aurora, Colorado; Fred Hutchinson Cancer Research Center, Seattle, Washington; Dana Farber Cancer Institute, Boston, Massachusetts; Memorial Sloan Kettering Cancer Center, New York; New York; Moffitt Cancer Center and Research Institute, Tampa, Florida; The Ohio State University, Columbus, Ohio; Fred & Pamela Buffett Cancer Center, Omaha, Nebraska; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Roswell Park Cancer Institute, Buffalo, New York; Washington University-Siteman Cancer Center, St Louis, Missouri; St. Jude Children's Research Hospital, Memphis, Tennessee; University of Alabama at Birmingham, Birmingham, Alabama; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Yale University School of Medicine; New Haven, Connecticut; University of Utah, Salt Lake City, Utah; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; City of Hope Cancer Center, Los Angeles, California; The University of Texas MD Anderson Cancer Center, Houston, Texas; and Mayo Clinic Cancer Center, Scottsdale, Arizona
| | - Ruben A Mesa
- From Northwestern University Feinberg School of Medicine, Chicago, Illinois; Stanford Cancer Institute, Stanford University, Stanford, California; Duke Cancer Institute, Duke University, Durham, North Carolina; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; University of California, San Francisco, San Francisco, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; Moores Cancer Center, UC San Diego, San Diego, California; University of Colorado Cancer Center, Aurora, Colorado; Fred Hutchinson Cancer Research Center, Seattle, Washington; Dana Farber Cancer Institute, Boston, Massachusetts; Memorial Sloan Kettering Cancer Center, New York; New York; Moffitt Cancer Center and Research Institute, Tampa, Florida; The Ohio State University, Columbus, Ohio; Fred & Pamela Buffett Cancer Center, Omaha, Nebraska; Fox Chase Cancer Center, Philadelphia, Pennsylvania; Roswell Park Cancer Institute, Buffalo, New York; Washington University-Siteman Cancer Center, St Louis, Missouri; St. Jude Children's Research Hospital, Memphis, Tennessee; University of Alabama at Birmingham, Birmingham, Alabama; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Yale University School of Medicine; New Haven, Connecticut; University of Utah, Salt Lake City, Utah; University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; City of Hope Cancer Center, Los Angeles, California; The University of Texas MD Anderson Cancer Center, Houston, Texas; and Mayo Clinic Cancer Center, Scottsdale, Arizona
| |
Collapse
|
41
|
JAK2+ Essential Thrombocythemia in a Young Girl With Budd-Chiari Syndrome: Diagnostic and Therapeutic Considerations When Adult Disease Strikes the Young. J Pediatr Hematol Oncol 2016; 38:70-3. [PMID: 26523382 DOI: 10.1097/mph.0000000000000453] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 12-year-old female with Budd-Chiari syndrome underwent liver transplant and subsequent splenectomy. Her platelet count began to rise postoperatively after previous normal values. JAK2V617F-positive essential thrombocythemia (ET) was diagnosed. This case demonstrates that the diagnosis of ET should be considered in the face of normal platelet counts and included on the differential diagnosis for pediatric patients. With this population in mind, we review the current literature on long-term use of platelet-lowering agents. We conclude that it is reasonable to use anagrelide as a first-line treatment for ET diagnosed according to the World Health Organization (WHO) system. In cases where WHO criteria do not result in a definitive diagnosis or when a patient experiences thrombotic events despite anagrelide therapy, hydroxyurea may be utilized as a first-line agent or as an adjunct. Further study in this area is warranted.
Collapse
|
42
|
Degnan AJ, Capek E, Bowman A. Chorea in the older adult: a full blooded answer. J R Coll Physicians Edinb 2016; 46:244-246. [DOI: 10.4997/jrcpe.2016.407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
43
|
Wang Z. [Advances in research of essential thrombocythemia]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2015; 36:802-4. [PMID: 26462788 PMCID: PMC7342712 DOI: 10.3760/cma.j.issn.0253-2727.2015.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Zhaoyue Wang
- Key Lab of Thrombosis and Hemostasis of Ministry of Health, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| |
Collapse
|
44
|
Stein BL, Oh ST, Berenzon D, Hobbs GS, Kremyanskaya M, Rampal RK, Abboud CN, Adler K, Heaney ML, Jabbour EJ, Komrokji RS, Moliterno AR, Ritchie EK, Rice L, Mascarenhas J, Hoffman R. Polycythemia Vera: An Appraisal of the Biology and Management 10 Years After the Discovery of JAK2 V617F. J Clin Oncol 2015; 33:3953-60. [PMID: 26324368 DOI: 10.1200/jco.2015.61.6474] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Polycythemia vera (PV) is a chronic myeloproliferative neoplasm that is associated with a substantial symptom burden, thrombohemorrhagic complications, and impaired survival. A decade after the seminal discovery of an activating mutation in the tyrosine kinase JAK2 in nearly all patients with PV, new treatment options are finally beginning to emerge, necessitating a critical reappraisal of the underlying pathogenesis and therapeutic modalities available for PV. Herein, we comprehensively review clinical aspects of PV including diagnostic considerations, natural history, and risk factors for thrombosis. We summarize recent studies delineating the genetic basis of PV, including their implications for evolution to myelofibrosis and secondary acute myeloid leukemia. We assess the quality of evidence to support the use of currently available therapies, including aspirin, phlebotomy, hydroxyurea, and interferon. We analyze recent studies evaluating the safety and efficacy of JAK inhibitors, such as ruxolitinib, and evaluate their role in the context of other available therapies for PV. This review provides a framework for practicing hematologists and oncologists to make rational treatment decisions for patients with PV.
Collapse
Affiliation(s)
- Brady L Stein
- Brady L. Stein, Northwestern Feinberg University School of Medicine, Chicago, IL; Stephen T. Oh and Camille Abboud, Washington University School of Medicine, St Louis, MO; Dmitriy Berenzon, Wake Forest University School of Medicine, Winston Salem, NC; Gabriela S. Hobbs, Massachusetts General Hospital, Boston, MA; Marina Kremyanskaya, John Mascarenhas, and Ronald Hoffman, Mount Sinai School of Medicine; Raajit K. Rampal, Memorial Sloan Kettering Cancer Center; Mark L. Heaney, Columbia University Medical Center; Ellen K. Ritchie, Cornell University School of Medicine, New York, NY; Kenneth Adler, Regional Cancer Care Associates, Morristown, NJ; Elias J. Jabbour, MD Anderson Cancer Center; Lawrence Rice, Cornell Houston Methodist Hospital, Houston, TX; Rami S. Komrokji, Moffitt Cancer Center, Tampa, FL; and Alison R. Moliterno, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Stephen T Oh
- Brady L. Stein, Northwestern Feinberg University School of Medicine, Chicago, IL; Stephen T. Oh and Camille Abboud, Washington University School of Medicine, St Louis, MO; Dmitriy Berenzon, Wake Forest University School of Medicine, Winston Salem, NC; Gabriela S. Hobbs, Massachusetts General Hospital, Boston, MA; Marina Kremyanskaya, John Mascarenhas, and Ronald Hoffman, Mount Sinai School of Medicine; Raajit K. Rampal, Memorial Sloan Kettering Cancer Center; Mark L. Heaney, Columbia University Medical Center; Ellen K. Ritchie, Cornell University School of Medicine, New York, NY; Kenneth Adler, Regional Cancer Care Associates, Morristown, NJ; Elias J. Jabbour, MD Anderson Cancer Center; Lawrence Rice, Cornell Houston Methodist Hospital, Houston, TX; Rami S. Komrokji, Moffitt Cancer Center, Tampa, FL; and Alison R. Moliterno, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dmitriy Berenzon
- Brady L. Stein, Northwestern Feinberg University School of Medicine, Chicago, IL; Stephen T. Oh and Camille Abboud, Washington University School of Medicine, St Louis, MO; Dmitriy Berenzon, Wake Forest University School of Medicine, Winston Salem, NC; Gabriela S. Hobbs, Massachusetts General Hospital, Boston, MA; Marina Kremyanskaya, John Mascarenhas, and Ronald Hoffman, Mount Sinai School of Medicine; Raajit K. Rampal, Memorial Sloan Kettering Cancer Center; Mark L. Heaney, Columbia University Medical Center; Ellen K. Ritchie, Cornell University School of Medicine, New York, NY; Kenneth Adler, Regional Cancer Care Associates, Morristown, NJ; Elias J. Jabbour, MD Anderson Cancer Center; Lawrence Rice, Cornell Houston Methodist Hospital, Houston, TX; Rami S. Komrokji, Moffitt Cancer Center, Tampa, FL; and Alison R. Moliterno, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Gabriela S Hobbs
- Brady L. Stein, Northwestern Feinberg University School of Medicine, Chicago, IL; Stephen T. Oh and Camille Abboud, Washington University School of Medicine, St Louis, MO; Dmitriy Berenzon, Wake Forest University School of Medicine, Winston Salem, NC; Gabriela S. Hobbs, Massachusetts General Hospital, Boston, MA; Marina Kremyanskaya, John Mascarenhas, and Ronald Hoffman, Mount Sinai School of Medicine; Raajit K. Rampal, Memorial Sloan Kettering Cancer Center; Mark L. Heaney, Columbia University Medical Center; Ellen K. Ritchie, Cornell University School of Medicine, New York, NY; Kenneth Adler, Regional Cancer Care Associates, Morristown, NJ; Elias J. Jabbour, MD Anderson Cancer Center; Lawrence Rice, Cornell Houston Methodist Hospital, Houston, TX; Rami S. Komrokji, Moffitt Cancer Center, Tampa, FL; and Alison R. Moliterno, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Marina Kremyanskaya
- Brady L. Stein, Northwestern Feinberg University School of Medicine, Chicago, IL; Stephen T. Oh and Camille Abboud, Washington University School of Medicine, St Louis, MO; Dmitriy Berenzon, Wake Forest University School of Medicine, Winston Salem, NC; Gabriela S. Hobbs, Massachusetts General Hospital, Boston, MA; Marina Kremyanskaya, John Mascarenhas, and Ronald Hoffman, Mount Sinai School of Medicine; Raajit K. Rampal, Memorial Sloan Kettering Cancer Center; Mark L. Heaney, Columbia University Medical Center; Ellen K. Ritchie, Cornell University School of Medicine, New York, NY; Kenneth Adler, Regional Cancer Care Associates, Morristown, NJ; Elias J. Jabbour, MD Anderson Cancer Center; Lawrence Rice, Cornell Houston Methodist Hospital, Houston, TX; Rami S. Komrokji, Moffitt Cancer Center, Tampa, FL; and Alison R. Moliterno, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Raajit K Rampal
- Brady L. Stein, Northwestern Feinberg University School of Medicine, Chicago, IL; Stephen T. Oh and Camille Abboud, Washington University School of Medicine, St Louis, MO; Dmitriy Berenzon, Wake Forest University School of Medicine, Winston Salem, NC; Gabriela S. Hobbs, Massachusetts General Hospital, Boston, MA; Marina Kremyanskaya, John Mascarenhas, and Ronald Hoffman, Mount Sinai School of Medicine; Raajit K. Rampal, Memorial Sloan Kettering Cancer Center; Mark L. Heaney, Columbia University Medical Center; Ellen K. Ritchie, Cornell University School of Medicine, New York, NY; Kenneth Adler, Regional Cancer Care Associates, Morristown, NJ; Elias J. Jabbour, MD Anderson Cancer Center; Lawrence Rice, Cornell Houston Methodist Hospital, Houston, TX; Rami S. Komrokji, Moffitt Cancer Center, Tampa, FL; and Alison R. Moliterno, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Camille N Abboud
- Brady L. Stein, Northwestern Feinberg University School of Medicine, Chicago, IL; Stephen T. Oh and Camille Abboud, Washington University School of Medicine, St Louis, MO; Dmitriy Berenzon, Wake Forest University School of Medicine, Winston Salem, NC; Gabriela S. Hobbs, Massachusetts General Hospital, Boston, MA; Marina Kremyanskaya, John Mascarenhas, and Ronald Hoffman, Mount Sinai School of Medicine; Raajit K. Rampal, Memorial Sloan Kettering Cancer Center; Mark L. Heaney, Columbia University Medical Center; Ellen K. Ritchie, Cornell University School of Medicine, New York, NY; Kenneth Adler, Regional Cancer Care Associates, Morristown, NJ; Elias J. Jabbour, MD Anderson Cancer Center; Lawrence Rice, Cornell Houston Methodist Hospital, Houston, TX; Rami S. Komrokji, Moffitt Cancer Center, Tampa, FL; and Alison R. Moliterno, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kenneth Adler
- Brady L. Stein, Northwestern Feinberg University School of Medicine, Chicago, IL; Stephen T. Oh and Camille Abboud, Washington University School of Medicine, St Louis, MO; Dmitriy Berenzon, Wake Forest University School of Medicine, Winston Salem, NC; Gabriela S. Hobbs, Massachusetts General Hospital, Boston, MA; Marina Kremyanskaya, John Mascarenhas, and Ronald Hoffman, Mount Sinai School of Medicine; Raajit K. Rampal, Memorial Sloan Kettering Cancer Center; Mark L. Heaney, Columbia University Medical Center; Ellen K. Ritchie, Cornell University School of Medicine, New York, NY; Kenneth Adler, Regional Cancer Care Associates, Morristown, NJ; Elias J. Jabbour, MD Anderson Cancer Center; Lawrence Rice, Cornell Houston Methodist Hospital, Houston, TX; Rami S. Komrokji, Moffitt Cancer Center, Tampa, FL; and Alison R. Moliterno, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mark L Heaney
- Brady L. Stein, Northwestern Feinberg University School of Medicine, Chicago, IL; Stephen T. Oh and Camille Abboud, Washington University School of Medicine, St Louis, MO; Dmitriy Berenzon, Wake Forest University School of Medicine, Winston Salem, NC; Gabriela S. Hobbs, Massachusetts General Hospital, Boston, MA; Marina Kremyanskaya, John Mascarenhas, and Ronald Hoffman, Mount Sinai School of Medicine; Raajit K. Rampal, Memorial Sloan Kettering Cancer Center; Mark L. Heaney, Columbia University Medical Center; Ellen K. Ritchie, Cornell University School of Medicine, New York, NY; Kenneth Adler, Regional Cancer Care Associates, Morristown, NJ; Elias J. Jabbour, MD Anderson Cancer Center; Lawrence Rice, Cornell Houston Methodist Hospital, Houston, TX; Rami S. Komrokji, Moffitt Cancer Center, Tampa, FL; and Alison R. Moliterno, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Elias J Jabbour
- Brady L. Stein, Northwestern Feinberg University School of Medicine, Chicago, IL; Stephen T. Oh and Camille Abboud, Washington University School of Medicine, St Louis, MO; Dmitriy Berenzon, Wake Forest University School of Medicine, Winston Salem, NC; Gabriela S. Hobbs, Massachusetts General Hospital, Boston, MA; Marina Kremyanskaya, John Mascarenhas, and Ronald Hoffman, Mount Sinai School of Medicine; Raajit K. Rampal, Memorial Sloan Kettering Cancer Center; Mark L. Heaney, Columbia University Medical Center; Ellen K. Ritchie, Cornell University School of Medicine, New York, NY; Kenneth Adler, Regional Cancer Care Associates, Morristown, NJ; Elias J. Jabbour, MD Anderson Cancer Center; Lawrence Rice, Cornell Houston Methodist Hospital, Houston, TX; Rami S. Komrokji, Moffitt Cancer Center, Tampa, FL; and Alison R. Moliterno, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Rami S Komrokji
- Brady L. Stein, Northwestern Feinberg University School of Medicine, Chicago, IL; Stephen T. Oh and Camille Abboud, Washington University School of Medicine, St Louis, MO; Dmitriy Berenzon, Wake Forest University School of Medicine, Winston Salem, NC; Gabriela S. Hobbs, Massachusetts General Hospital, Boston, MA; Marina Kremyanskaya, John Mascarenhas, and Ronald Hoffman, Mount Sinai School of Medicine; Raajit K. Rampal, Memorial Sloan Kettering Cancer Center; Mark L. Heaney, Columbia University Medical Center; Ellen K. Ritchie, Cornell University School of Medicine, New York, NY; Kenneth Adler, Regional Cancer Care Associates, Morristown, NJ; Elias J. Jabbour, MD Anderson Cancer Center; Lawrence Rice, Cornell Houston Methodist Hospital, Houston, TX; Rami S. Komrokji, Moffitt Cancer Center, Tampa, FL; and Alison R. Moliterno, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Alison R Moliterno
- Brady L. Stein, Northwestern Feinberg University School of Medicine, Chicago, IL; Stephen T. Oh and Camille Abboud, Washington University School of Medicine, St Louis, MO; Dmitriy Berenzon, Wake Forest University School of Medicine, Winston Salem, NC; Gabriela S. Hobbs, Massachusetts General Hospital, Boston, MA; Marina Kremyanskaya, John Mascarenhas, and Ronald Hoffman, Mount Sinai School of Medicine; Raajit K. Rampal, Memorial Sloan Kettering Cancer Center; Mark L. Heaney, Columbia University Medical Center; Ellen K. Ritchie, Cornell University School of Medicine, New York, NY; Kenneth Adler, Regional Cancer Care Associates, Morristown, NJ; Elias J. Jabbour, MD Anderson Cancer Center; Lawrence Rice, Cornell Houston Methodist Hospital, Houston, TX; Rami S. Komrokji, Moffitt Cancer Center, Tampa, FL; and Alison R. Moliterno, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ellen K Ritchie
- Brady L. Stein, Northwestern Feinberg University School of Medicine, Chicago, IL; Stephen T. Oh and Camille Abboud, Washington University School of Medicine, St Louis, MO; Dmitriy Berenzon, Wake Forest University School of Medicine, Winston Salem, NC; Gabriela S. Hobbs, Massachusetts General Hospital, Boston, MA; Marina Kremyanskaya, John Mascarenhas, and Ronald Hoffman, Mount Sinai School of Medicine; Raajit K. Rampal, Memorial Sloan Kettering Cancer Center; Mark L. Heaney, Columbia University Medical Center; Ellen K. Ritchie, Cornell University School of Medicine, New York, NY; Kenneth Adler, Regional Cancer Care Associates, Morristown, NJ; Elias J. Jabbour, MD Anderson Cancer Center; Lawrence Rice, Cornell Houston Methodist Hospital, Houston, TX; Rami S. Komrokji, Moffitt Cancer Center, Tampa, FL; and Alison R. Moliterno, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lawrence Rice
- Brady L. Stein, Northwestern Feinberg University School of Medicine, Chicago, IL; Stephen T. Oh and Camille Abboud, Washington University School of Medicine, St Louis, MO; Dmitriy Berenzon, Wake Forest University School of Medicine, Winston Salem, NC; Gabriela S. Hobbs, Massachusetts General Hospital, Boston, MA; Marina Kremyanskaya, John Mascarenhas, and Ronald Hoffman, Mount Sinai School of Medicine; Raajit K. Rampal, Memorial Sloan Kettering Cancer Center; Mark L. Heaney, Columbia University Medical Center; Ellen K. Ritchie, Cornell University School of Medicine, New York, NY; Kenneth Adler, Regional Cancer Care Associates, Morristown, NJ; Elias J. Jabbour, MD Anderson Cancer Center; Lawrence Rice, Cornell Houston Methodist Hospital, Houston, TX; Rami S. Komrokji, Moffitt Cancer Center, Tampa, FL; and Alison R. Moliterno, Johns Hopkins University School of Medicine, Baltimore, MD
| | - John Mascarenhas
- Brady L. Stein, Northwestern Feinberg University School of Medicine, Chicago, IL; Stephen T. Oh and Camille Abboud, Washington University School of Medicine, St Louis, MO; Dmitriy Berenzon, Wake Forest University School of Medicine, Winston Salem, NC; Gabriela S. Hobbs, Massachusetts General Hospital, Boston, MA; Marina Kremyanskaya, John Mascarenhas, and Ronald Hoffman, Mount Sinai School of Medicine; Raajit K. Rampal, Memorial Sloan Kettering Cancer Center; Mark L. Heaney, Columbia University Medical Center; Ellen K. Ritchie, Cornell University School of Medicine, New York, NY; Kenneth Adler, Regional Cancer Care Associates, Morristown, NJ; Elias J. Jabbour, MD Anderson Cancer Center; Lawrence Rice, Cornell Houston Methodist Hospital, Houston, TX; Rami S. Komrokji, Moffitt Cancer Center, Tampa, FL; and Alison R. Moliterno, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ronald Hoffman
- Brady L. Stein, Northwestern Feinberg University School of Medicine, Chicago, IL; Stephen T. Oh and Camille Abboud, Washington University School of Medicine, St Louis, MO; Dmitriy Berenzon, Wake Forest University School of Medicine, Winston Salem, NC; Gabriela S. Hobbs, Massachusetts General Hospital, Boston, MA; Marina Kremyanskaya, John Mascarenhas, and Ronald Hoffman, Mount Sinai School of Medicine; Raajit K. Rampal, Memorial Sloan Kettering Cancer Center; Mark L. Heaney, Columbia University Medical Center; Ellen K. Ritchie, Cornell University School of Medicine, New York, NY; Kenneth Adler, Regional Cancer Care Associates, Morristown, NJ; Elias J. Jabbour, MD Anderson Cancer Center; Lawrence Rice, Cornell Houston Methodist Hospital, Houston, TX; Rami S. Komrokji, Moffitt Cancer Center, Tampa, FL; and Alison R. Moliterno, Johns Hopkins University School of Medicine, Baltimore, MD.
| |
Collapse
|
45
|
Rationale for revision and proposed changes of the WHO diagnostic criteria for polycythemia vera, essential thrombocythemia and primary myelofibrosis. Blood Cancer J 2015; 5:e337. [PMID: 26832847 PMCID: PMC4558589 DOI: 10.1038/bcj.2015.64] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 06/30/2015] [Indexed: 12/19/2022] Open
Abstract
The 2001/2008 World Health Organization (WHO)-based diagnostic criteria for polycythemia vera (PV), essential thrombocythemia (ET) and primary myelofibrosis (PMF) were recently revised to accomodate new information on disease-specific mutations and underscore distinguishing morphologic features. In this context, it seems to be reasonable to compare first major diagnostic criteria of the former WHO classifications for myeloproliferative neoplasm (MPN) and then to focus on details that have been discussed and will be proposed for the upcoming revision of diagnostic guidelines. In PV, a characteristic bone marrow (BM) morphology was added as one of three major diagnostic criteria, which allowed lowering of the hemoglobin/hematocrit threshold for diagnosis, which is another major criterion, to 16.5 g/dl/49% in men and 16 g/dl/48% in women. The presence of a JAK2 mutation remains the third major diagnostic criterion in PV. Subnormal serum erythropoietin level is now the only minor criterion in PV and is used to capture JAK2-unmutated cases. In ET and PMF, mutations that are considered to confirm clonality and specific diagnosis now include CALR, in addition to JAK2 and MPL. Also in the 2015 discussed revision, overtly fibrotic PMF is clearly distinguished from early/prefibrotic PMF and each PMF variant now includes a separate list of diagnostic criteria. The main rationale for these changes was to enhance the distinction between so-called masked PV and JAK2-mutated ET and between ET and prefibrotic early PMF. The proposed changes also underscore the complementary role, as well as limitations of mutation analysis in morphologic diagnosis. On the other hand, discovery of new biological markers may probably be expected in the future to enhance discrimination of the different MPN subtypes in accordance with the histological BM patterns and corresponding clinical features.
Collapse
|
46
|
Madelung AB, Bondo H, Stamp I, Løvgreen P, Nielsen SL, Falensteen A, Knudsen H, Svendsen KD, Lange T, Ralfkiaer E, Nielsen K, Hasselbalch H, Thiele J. WHO classification 2008 of myeloproliferative neoplasms: a workshop learning effect--the Danish experience. APMIS 2015. [PMID: 26200697 DOI: 10.1111/apm.12417] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We examined the learning effect of a workshop for Danish hematopathologists led by an international expert regarding histological subtyping of myeloproliferative neoplasms (MPN). Six hematopathologists evaluated 43 bone marrow (BM) biopsies according to the WHO description (2008), blinded to clinical data. All panelists then participated in the workshop. The case biopsies - mixed with 251 other MPN BM biopsies - were reviewed again. Consensus regarding the histological subtype was significantly improved; from 49% to 72% (Fleiss kappa value 0.302 pre-workshop, 0.474 post-workshop; p = 0.004). There was no significant effect on the isolated morphological characteristics. Agreement between cases with histological consensus and clinical diagnosis was 86% without significant change during workshop sessions. Our study demonstrates that experienced hematopathologists can significantly improve their diagnostic ability by a workshop led by an international expert; not by improving the evaluation of individual histological parameters but by weighting these in their conclusive diagnosis.
Collapse
Affiliation(s)
- Ann B Madelung
- Department of Pathology, Naestved and Slagelse Hospitals, Naestved, Denmark
| | - Henrik Bondo
- Department of Pathology, Naestved and Slagelse Hospitals, Naestved, Denmark
| | - Inger Stamp
- Department of Pathology, Naestved and Slagelse Hospitals, Naestved, Denmark
| | - Preben Løvgreen
- Department of Pathology, Roskilde and Køge Hospitals, Roskilde, Denmark
| | | | | | - Helle Knudsen
- Department of Pathology, Herlev Hospital, Herlev, Denmark
| | - Kira D Svendsen
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Theis Lange
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Elisabeth Ralfkiaer
- Department of Pathology, Copenhagen University Hospital, Denmark, Copenhagen, Denmark
| | - Karsten Nielsen
- Department of Pathology, Naestved and Slagelse Hospitals, Naestved, Denmark
| | - Hans Hasselbalch
- Department of Haematology, Roskilde and Køge Hospitals, Roskilde, Denmark
| | - Jürgen Thiele
- Institute of Pathology, University of Cologne, Cologne, Germany
| |
Collapse
|
47
|
Lee G, Arcasoy MO. The clinical and laboratory evaluation of the patient with erythrocytosis. Eur J Intern Med 2015; 26:297-302. [PMID: 25837692 DOI: 10.1016/j.ejim.2015.03.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 03/14/2015] [Accepted: 03/16/2015] [Indexed: 12/19/2022]
Abstract
Erythrocytosis is frequently encountered as an incidental abnormality on laboratory testing that reveals persistent elevation of the hematocrit level (>52% in men and >48% in women). In many cases, erythrocytosis is the manifestation of an underlying cardiopulmonary process, drug-induced due to androgens, or secondary to smoking, rather than a primary bone marrow disorder such as polycythemia vera. A systematic approach to the clinical and laboratory evaluation of each patient is indicated to consider diverse differential diagnosis possibilities and to identify the underlying etiology of erythrocytosis in order to formulate appropriate subspecialist referral and management plans. A thorough medical history and meticulous physical examination supplemented by a focused initial laboratory evaluation will enable the general practitioner to ascertain the etiology of erythrocytosis in the majority of cases. Patients with clinical and laboratory features suggestive of polycythemia vera and those patients without an apparent underlying condition known to cause erythrocytosis benefit from early referral to a hematologist for further specialized diagnostic evaluation and therapy considerations.
Collapse
Affiliation(s)
- Grace Lee
- Division of Hematology, Department of Medicine, Duke Cancer Institute, Duke University School of Medicine, Durham, NC, USA
| | - Murat O Arcasoy
- Division of Hematology, Department of Medicine, Duke Cancer Institute, Duke University School of Medicine, Durham, NC, USA.
| |
Collapse
|
48
|
Changing incidence of myeloproliferative neoplasms: trends and subgroup risk profiles in the USA, 1973-2011. J Cancer Res Clin Oncol 2015; 141:2131-8. [PMID: 25968903 DOI: 10.1007/s00432-015-1983-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Accepted: 04/27/2015] [Indexed: 12/27/2022]
Abstract
PURPOSE Recent diagnostic and cancer reporting changes influencing myeloproliferative neoplasms (MPNs) encourage the assessment of trends and examination of the recently identified MPN subtypes: polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF), across the age continuum by race and ethnicity. METHODS Surveillance, Epidemiology, and End Results data provided MPN incidence data since 1973 and MPN subtype data since 2001. Joinpoint regression estimated annual percent changes. Poisson regression estimated risk ratios. RESULTS The 2005 JAK2 V617F discovery and the 2008 WHO diagnostic guideline for the JAK2 V617F mutation coincide with a 31 % increase in ET and a 21 % decrease in PV incidence rates. We found that younger women had a 13-33 % higher ET risk and that women under the age of 34 had a 58 % higher PMF risk, relative to men. Blacks, aged 35-49 with a higher ET risk, also had a 69 % higher PMF risk relative to whites. CONCLUSION Demographic characteristic of ET and PMF patients may be useful for improving risk prediction and informing clinical screening and treatment strategies. Changing guidelines, new discoveries, and in-depth analysis of a large population-based study have implications for accurately identifying incident cases of MPNs, MPN subgroups, and health resource planning.
Collapse
|
49
|
Rupoli S, Goteri G, Picardi P, Micucci G, Canafoglia L, Scortechini AR, Federici I, Giantomassi F, Da Lio L, Zizzi A, Honorati E, Leoni P. Thrombosis in essential thrombocytemia and early/prefibrotic primary myelofibrosis: the role of the WHO histological diagnosis. Diagn Pathol 2015; 10:29. [PMID: 25885405 PMCID: PMC4407780 DOI: 10.1186/s13000-015-0269-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 04/07/2015] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Vascular events represent the most frequent complications of thrombocytemias. We aimed to evaluate their risk in the WHO histologic categories of Essential Thrombocytemia (ET) and early Primary Myelofibrosis (PMF). METHODS From our clinical database of 283 thrombocytemic patients, we selected those with available bone marrow histology performed before any treatment, at or within 1 year from diagnosis, and reclassified the 131 cases as true ET or early PMF, with or without fibrosis, according to the WHO histological criteria. Vaso-occlusive events at diagnosis and in the follow-up were compared in the WHO-groups. RESULTS Histologic review reclassified 61 cases as ET and 72 cases as early PMF (26 prefibrotic and 42 with grade 1 or 2 fibrosis). Compared to ET, early PMF showed a significant higher rate of thrombosis both in the past history (22% vs 8%) and at diagnosis (15.2% vs 1.6%), and an increased leukocyte count (8389 vs 7500/mmc). Venous thromboses (mainly atypical) were relatively more common in PMF than in ET. Patients with prefibrotic PMF, although younger, showed a significant higher 15-year risk of developing thrombosis (48% vs 16% in fibrotic PMF and 17% in ET). At multivariate analysis, age and WHO histology were both independent risk-factors for thrombosis during follow-up; patients >60 yr-old or with prefibrotic PMF showed a significantly higher risk at 20 years than patients <60 yr-old with ET or fibrotic PMF (47% vs 4%, p = 0.005). CONCLUSIONS Our study support the importance of WHO histologic categories in the thrombotic risk stratification of patients with thrombocytemias. VIRTUAL SLIDES The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/2020211863144412 .
Collapse
Affiliation(s)
- Serena Rupoli
- Department of Clinical and Molecular Sciences, Clinic of Hematology, Polytechnic University of Marche Region, Ancona, Italy.
| | - Gaia Goteri
- Department of Biomedical Sciences and Public Health, Section of Pathologic Anatomy and Histopathology, Polytechnic University of Marche Region, Torrette, Ancona, Italy.
| | - Paola Picardi
- Department of Clinical and Molecular Sciences, Clinic of Hematology, Polytechnic University of Marche Region, Ancona, Italy.
| | - Giorgia Micucci
- Department of Clinical and Molecular Sciences, Clinic of Hematology, Polytechnic University of Marche Region, Ancona, Italy.
| | - Lucia Canafoglia
- Department of Clinical and Molecular Sciences, Clinic of Hematology, Polytechnic University of Marche Region, Ancona, Italy.
| | - Anna Rita Scortechini
- Department of Clinical and Molecular Sciences, Clinic of Hematology, Polytechnic University of Marche Region, Ancona, Italy.
| | - Irene Federici
- Department of Clinical and Molecular Sciences, Clinic of Hematology, Polytechnic University of Marche Region, Ancona, Italy.
| | - Federica Giantomassi
- Department of Biomedical Sciences and Public Health, Section of Pathologic Anatomy and Histopathology, Polytechnic University of Marche Region, Torrette, Ancona, Italy.
| | - Lidia Da Lio
- Clinical Pathology, United Ancona Hospital, Ancona, Italy.
| | - Antonio Zizzi
- Department of Biomedical Sciences and Public Health, Section of Pathologic Anatomy and Histopathology, Polytechnic University of Marche Region, Torrette, Ancona, Italy.
| | - Elisa Honorati
- Department of Clinical and Molecular Sciences, Clinic of Hematology, Polytechnic University of Marche Region, Ancona, Italy.
| | - Pietro Leoni
- Department of Clinical and Molecular Sciences, Clinic of Hematology, Polytechnic University of Marche Region, Ancona, Italy.
| |
Collapse
|
50
|
Cornea MIP, Levrat E, Pugin P, Betticher DC. BCR-ABL1- positive chronic myeloid leukemia with erythrocytosis presenting as polycythemia vera: a case report. J Med Case Rep 2015; 9:30. [PMID: 26187587 PMCID: PMC4506443 DOI: 10.1186/1752-1947-9-30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 12/16/2014] [Indexed: 01/27/2023] Open
Abstract
Introduction The World Health Organization classification of chronic myeloproliferative disease encompasses eight entities of bone marrow neoplasms, among them Breakpoint cluster region-Abelson murine leukemia viral oncogene homolog 1-positive chronic myeloid leukemia and polycythemia vera. Polycythemia vera requires, in the majority of cases (95%), the negativity of Breakpoint cluster region-Abelson murine leukemia viral oncogene homolog 1 rearrangement and the presence of the Janus kinase 2 mutation. We report a case of erythrocytosis as the primary manifestation of a chronic myeloid leukemia, with the presence of the Philadelphia chromosome and the Breakpoint cluster region-Abelson murine leukemia viral oncogene homolog 1 fusion gene, and in the absence of any Janus kinase 2 mutation. Case presentation A 68-year-old Caucasian woman, with a history of cigarette consumption and obstructive sleep apnoea syndrome (undergoing continuous positive airway pressure treatment) had presented to our institution with fatigue and a hemoglobin level of 18.6g/L, with slight leukocytosis at 16G/L, and no other anomalies on her complete blood cell count. Examination of her arterial blood gases found only a slight hypoxemia; erythropoietin and ferritin levels were very low and could not explain a secondary erythrocytosis. Further analyses revealed the absence of any Janus kinase 2 mutation, thus excluding polycythemia vera. Taken together with a high vitamin B12 level, we conducted a Breakpoint cluster region-Abelson murine leukemia viral oncogene homolog 1 gene analysis and bone marrow cytogenetic analysis, both of which returned positive, leading to the diagnosis of chronic myeloid leukemia. Conclusions To date, this case is the first description of a Breakpoint cluster region-Abelson murine leukemia viral oncogene homolog 1-positive chronic myeloid leukemia, presenting with erythrocytosis as the initial manifestation, and mimicking a Janus kinase 2 V617F-negative polycythemia vera. Her impressive response to imatinib therapy underscores the importance of not missing this diagnosis.
Collapse
Affiliation(s)
| | - Emmanuel Levrat
- Hôpital Cantonal Fribourg, Chemin des Pensionnats 2, 1708, Fribourg, Switzerland.
| | - Paul Pugin
- Hôpital Cantonal Fribourg, Chemin des Pensionnats 2, 1708, Fribourg, Switzerland.
| | - Daniel C Betticher
- Hôpital Cantonal Fribourg, Chemin des Pensionnats 2, 1708, Fribourg, Switzerland.
| |
Collapse
|