1
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Palandri F, Auteri G, Abruzzese E, Caocci G, Bonifacio M, Mendicino F, Latagliata R, Iurlo A, Branzanti F, Garibaldi B, Trawinska MM, Cattaneo D, Krampera M, Mulas O, Martino EA, Cavo M, Vianelli N, Impera S, Efficace F, Heidel F, Breccia M, Elli EM, Palumbo GA. Ruxolitinib Adherence in Myelofibrosis and Polycythemia Vera: the "RAMP" Italian multicenter prospective study. Ann Hematol 2024; 103:1931-1940. [PMID: 38478023 PMCID: PMC11090921 DOI: 10.1007/s00277-024-05704-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 03/09/2024] [Indexed: 05/14/2024]
Abstract
Ruxolitinib is beneficial in patients with myelofibrosis (MF) and polycythemia vera (PV). Information on ruxolitinib adherence is scant. The Ruxolitinib Adherence in Myelofibrosis and Polycythemia Vera (RAMP) prospective multicenter study (NCT06078319) included 189 ruxolitinib-treated patients. Patients completed the Adherence to Refills and Medications Scale (ARMS) and Distress Thermometer and Problem List (DTPL) at the earliest convenience, after registration in the study, and at later timepoints. At week-0, low adherence (ARMS > 14) and high distress (DT ≥ 4) were declared by 49.7% and 40.2% of patients, respectively. The main reason for low adherence was difficult ruxolitinib supply (49%), intentional (4.3%) and unintentional (46.7%) non-take. In multivariable regression analysis, low adherence was associated to male sex (p = 0.001), high distress (p < 0.001), and treatment duration ≥ 1 year (p = 0.03). Over time, rates of low adherence and high distress remained stable, but unintentional non-take decreased from 47.9% to 26.0% at week-48. MF patients with stable high adherence/low distress were more likely to obtain/maintain the spleen response at week-24. Low adherence to ruxolitinib represents an unmet clinical need that require a multifaceted approach, based on reason behind it (patients characteristics and treatment duration). Its recognition may help distinguishing patients who are truly refractory and those in need of therapy optimization.
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Affiliation(s)
- F Palandri
- IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Istituto Di Ematologia "Seràgnoli", Bologna, Italy.
| | - G Auteri
- IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Istituto Di Ematologia "Seràgnoli", Bologna, Italy
- Dipartimento Di Medicina Specialistica, Diagnostica E Sperimentale, Università Di Bologna, Bologna, Italy
| | - E Abruzzese
- Hematology, S.Eugenio Hospital, Tor Vergata University, ASL Roma2, Rome, Italy
| | - G Caocci
- Hematology Unit, Department of Medical Sciences, University of Cagliari, Cagliari, Italy
| | - M Bonifacio
- Hematology and Bone Marrow Transplant Unit, Section of Biomedicine of Innovation, Department of Engineering for Innovative Medicine, University of Verona, Verona, Italy
| | - F Mendicino
- U.O.C. Di Ematologia, Department of Hemato-Oncology, Azienda Ospedaliera Annunziata, Cosenza, Italy
| | - R Latagliata
- Hematology Unit, Ospedale Belcolle, Viterbo, Italy
| | - A Iurlo
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - F Branzanti
- Dipartimento Di Medicina Specialistica, Diagnostica E Sperimentale, Università Di Bologna, Bologna, Italy
| | - B Garibaldi
- Postgraduate School of Hematology, University of Catania, Catania, Italy
| | - M M Trawinska
- Hematology, S.Eugenio Hospital, Tor Vergata University, ASL Roma2, Rome, Italy
| | - D Cattaneo
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M Krampera
- Hematology and Bone Marrow Transplant Unit, Section of Biomedicine of Innovation, Department of Engineering for Innovative Medicine, University of Verona, Verona, Italy
| | - O Mulas
- Hematology Unit, Department of Medical Sciences, University of Cagliari, Cagliari, Italy
| | - E A Martino
- U.O.C. Di Ematologia, Department of Hemato-Oncology, Azienda Ospedaliera Annunziata, Cosenza, Italy
| | - M Cavo
- IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Istituto Di Ematologia "Seràgnoli", Bologna, Italy
- Dipartimento Di Medicina Specialistica, Diagnostica E Sperimentale, Università Di Bologna, Bologna, Italy
| | - N Vianelli
- IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Istituto Di Ematologia "Seràgnoli", Bologna, Italy
| | - S Impera
- Department of Hematology, ARNAS Garibaldi, Catania, Italy
| | - F Efficace
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Rome, Italy
| | - F Heidel
- Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School (MHH), Hannover, Germany
| | - M Breccia
- Division of Cellular Biotechnologies and Hematology, University Sapienza, Rome, Italy
| | - E M Elli
- Divisione di Ematologia e Unità Trapianto di Midollo, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | - G A Palumbo
- Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", Università Di Catania, Catania, Italy
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2
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Elli EM, Mauri M, D'Aliberti D, Crespiatico I, Fontana D, Redaelli S, Pelucchi S, Spinelli S, Manghisi B, Cavalca F, Aroldi A, Ripamonti A, Ferrari S, Palamini S, Mottadelli F, Massimino L, Ramazzotti D, Cazzaniga G, Piperno A, Gambacorti-Passerini C, Piazza R. Idiopathic erythrocytosis: a germline disease? Clin Exp Med 2024; 24:11. [PMID: 38244120 PMCID: PMC10799805 DOI: 10.1007/s10238-023-01283-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/08/2023] [Indexed: 01/22/2024]
Abstract
Polycythemia Vera (PV) is typically caused by V617F or exon 12 JAK2 mutations. Little is known about Polycythemia cases where no JAK2 variants can be detected, and no other causes identified. This condition is defined as idiopathic erythrocytosis (IE). We evaluated clinical-laboratory parameters of a cohort of 56 IE patients and we determined their molecular profile at diagnosis with paired blood/buccal-DNA exome-sequencing coupled with a high-depth targeted OncoPanel to identify a possible underling germline or somatic cause. We demonstrated that most of our cohort (40/56: 71.4%) showed no evidence of clonal hematopoiesis, suggesting that IE is, in large part, a germline disorder. We identified 20 low mutation burden somatic variants (Variant allelic fraction, VAF, < 10%) in only 14 (25%) patients, principally involving DNMT3A and TET2. Only 2 patients presented high mutation burden somatic variants, involving DNMT3A, TET2, ASXL1 and WT1. We identified recurrent germline variants in 42 (75%) patients occurring mainly in JAK/STAT, Hypoxia and Iron metabolism pathways, among them: JAK3-V722I and HIF1A-P582S; a high fraction of patients (48.2%) resulted also mutated in homeostatic iron regulatory gene HFE-H63D or C282Y. By generating cellular models, we showed that JAK3-V722I causes activation of the JAK-STAT5 axis and upregulation of EPAS1/HIF2A, while HIF1A-P582S causes suppression of hepcidin mRNA synthesis, suggesting a major role for these variants in the onset of IE.
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Affiliation(s)
- E M Elli
- Division of Hematology and Bone Marrow Transplant Unit, Fondazione IRCCS, San Gerardo dei Tintori, Monza, Italy
| | - M Mauri
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - D D'Aliberti
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - I Crespiatico
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - D Fontana
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - S Redaelli
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - S Pelucchi
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - S Spinelli
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - B Manghisi
- Division of Hematology and Bone Marrow Transplant Unit, Fondazione IRCCS, San Gerardo dei Tintori, Monza, Italy
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - F Cavalca
- Division of Hematology and Bone Marrow Transplant Unit, Fondazione IRCCS, San Gerardo dei Tintori, Monza, Italy
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - A Aroldi
- Division of Hematology and Bone Marrow Transplant Unit, Fondazione IRCCS, San Gerardo dei Tintori, Monza, Italy
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - A Ripamonti
- Division of Hematology and Bone Marrow Transplant Unit, Fondazione IRCCS, San Gerardo dei Tintori, Monza, Italy
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - S Ferrari
- Division of Hematology and Bone Marrow Transplant Unit, Fondazione IRCCS, San Gerardo dei Tintori, Monza, Italy
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - S Palamini
- Tettamanti Research Center, IRCCS, San Gerardo dei Tintori, Monza, Italy
| | - F Mottadelli
- Monza and Brianza Foundation for the Child and his Mother (MBBM), IRCCS, San Gerardo dei Tintori, Monza, Italy
| | - L Massimino
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - D Ramazzotti
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - G Cazzaniga
- Tettamanti Research Center, IRCCS, San Gerardo dei Tintori, Monza, Italy
| | - A Piperno
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - C Gambacorti-Passerini
- Division of Hematology and Bone Marrow Transplant Unit, Fondazione IRCCS, San Gerardo dei Tintori, Monza, Italy
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - R Piazza
- Division of Hematology and Bone Marrow Transplant Unit, Fondazione IRCCS, San Gerardo dei Tintori, Monza, Italy.
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy.
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3
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Palandri F, Rossi E, Auteri G, Breccia M, Paglia S, Benevolo G, Elli EM, Cavazzini F, Binotto G, Tieghi A, Tiribelli M, Heidel FH, Bonifacio M, Pugliese N, Caocci G, Crugnola M, Mendicino F, D'Addio A, Tomassetti S, Martino B, Polverelli N, Ceglie S, Mazzoni C, Mullai R, Ripamonti A, Garibaldi B, Pane F, Cuneo A, Krampera M, Semenzato G, Lemoli RM, Vianelli N, Palumbo GA, Andriani A, Cavo M, Latagliata R, De Stefano V. Predictors of Response to Hydroxyurea and Switch to Ruxolitinib in HU-Resistant Polycythaemia VERA Patients: A Real-World PV-NET Study. Cancers (Basel) 2023; 15:3706. [PMID: 37509367 PMCID: PMC10377857 DOI: 10.3390/cancers15143706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/14/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
In polycythemia vera (PV), the prognostic relevance of an ELN-defined complete response (CR) to hydroxyurea (HU), the predictors of response, and patients' triggers for switching to ruxolitinib are uncertain. In a real-world analysis, we evaluated the predictors of response, their impact on the clinical outcomes of CR to HU, and the correlations between partial or no response (PR/NR) and a patient switching to ruxolitinib. Among 563 PV patients receiving HU for ≥12 months, 166 (29.5%) achieved CR, 264 achieved PR, and 133 achieved NR. In a multivariate analysis, the absence of splenomegaly (p = 0.03), pruritus (p = 0.002), and a median HU dose of ≥1 g/day (p < 0.001) remained associated with CR. Adverse events were more frequent with a median HU dose of ≥1 g/day. Overall, 283 PR/NR patients (71.3%) continued HU, and 114 switched to ruxolitinib. In the 449 patients receiving only HU, rates of thrombosis, hemorrhages, progression, and overall survival were comparable among the CR, PR, and NR groups. Many PV patients received underdosed HU, leading to lower CR and toxicity rates. In addition, many patients continued HU despite a PR/NR; however, splenomegaly and other symptoms were the main drivers of an early switch. Better HU management, standardization of the criteria for and timing of responses to HU, and adequate intervention in poor responders should be advised.
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Affiliation(s)
- Francesca Palandri
- Istituto di Ematologia "Seràgnoli", IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Elena Rossi
- Section of Hematology, Department of Radiological and Hematological Sciences, Catholic University School of Medicine, 00168 Rome, Italy
- Institute of Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Giuseppe Auteri
- Istituto di Ematologia "Seràgnoli", IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, 40126 Bologna, Italy
| | - Massimo Breccia
- Division of Cellular Biotechnologies and Hematology, University Sapienza, 00161 Rome, Italy
| | - Simona Paglia
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, 40126 Bologna, Italy
| | - Giulia Benevolo
- Division of Hematology, Città della Salute e della Scienza Hospital, 10126 Torino, Italy
| | - Elena M Elli
- Hematology Division, San Gerardo Hospital, ASST Monza, 20900 Monza, Italy
| | | | - Gianni Binotto
- Unit of Hematology and Clinical Immunology, University of Padova, 35020 Padova, Italy
| | - Alessia Tieghi
- Department of Hematology, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy
| | - Mario Tiribelli
- Division of Hematology and BMT, Azienda Sanitaria Universitaria Integrata di Udine, 33100 Udine, Italy
| | - Florian H Heidel
- Innere Medicine C, Universitätsmedizin Greifswald, 17475 Greifswald, Germany
| | - Massimiliano Bonifacio
- Hematology and Bone Marrow Transplant Unit, Section of Biomedicine of Innovation, Department of Engineering for Innovative Medicine, University of Verona, 37134 Verona, Italy
| | - Novella Pugliese
- Department of Clinical Medicine and Surgery, Hematology Section, University of Naples "Federico II", 80131 Naples, Italy
| | - Giovanni Caocci
- Hematology Unit, Department of Medical Sciences, University of Cagliari, 09124 Cagliari, Italy
| | - Monica Crugnola
- Division of Hematology, Azienda Ospedaliero-Universitaria di Parma, 43126 Parma, Italy
| | | | - Alessandra D'Addio
- Division of Hematology, Onco-Hematologic Department, AUSL della Romagna, 47923 Ravenna, Italy
| | | | - Bruno Martino
- Division of Hematology, Azienda Ospedaliera 'Bianchi Melacrino Morelli', 89133 Reggio Calabria, Italy
| | - Nicola Polverelli
- Unit of Blood Diseases and Stem Cell Transplantation, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Sara Ceglie
- Section of Hematology, Department of Radiological and Hematological Sciences, Catholic University School of Medicine, 00168 Rome, Italy
| | - Camilla Mazzoni
- Istituto di Ematologia "Seràgnoli", IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, 40126 Bologna, Italy
| | - Rikard Mullai
- Division of Hematology and BMT, Azienda Sanitaria Universitaria Integrata di Udine, 33100 Udine, Italy
| | - Alessia Ripamonti
- Hematology Division, San Gerardo Hospital, ASST Monza, 20900 Monza, Italy
| | - Bruno Garibaldi
- Postgraduate School of Hematology, University of Catania, 90121 Catania, Italy
| | - Fabrizio Pane
- Department of Clinical Medicine and Surgery, Hematology Section, University of Naples "Federico II", 80131 Naples, Italy
| | - Antonio Cuneo
- Division of Hematology, University of Ferrara, 44121 Ferrara, Italy
| | - Mauro Krampera
- Hematology and Bone Marrow Transplant Unit, Section of Biomedicine of Innovation, Department of Engineering for Innovative Medicine, University of Verona, 37134 Verona, Italy
| | - Gianpietro Semenzato
- Unit of Hematology and Clinical Immunology, University of Padova, 35020 Padova, Italy
| | - Roberto M Lemoli
- Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genova, 16126 Genova, Italy
- IRCCS Policlinico San Martino, 16132 Genova, Italy
| | - Nicola Vianelli
- Istituto di Ematologia "Seràgnoli", IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Giuseppe A Palumbo
- Department of Scienze Mediche, Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", University of Catania, 95123 Catania, Italy
| | | | - Michele Cavo
- Istituto di Ematologia "Seràgnoli", IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, 40126 Bologna, Italy
| | | | - Valerio De Stefano
- Section of Hematology, Department of Radiological and Hematological Sciences, Catholic University School of Medicine, 00168 Rome, Italy
- Institute of Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
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Khurana H, Muthusamy B, Yanamandra U, Garapati K, Premdeep H, Subramanian S, Pandey A. Whole Exome Sequencing Reveals Novel Variants in Unexplained Erythrocytosis. OMICS : A JOURNAL OF INTEGRATIVE BIOLOGY 2023; 27:299-304. [PMID: 37428608 PMCID: PMC10357103 DOI: 10.1089/omi.2023.0059] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
Erythrocytosis is characterized by an increase in red cells in peripheral blood. Polycythemia vera, the commonest primary erythrocytosis, results from pathogenic variants in JAK2 in ∼98% of cases. Although some variants have been reported in JAK2-negative polycythemia, the causal genetic variants remain unidentified in ∼80% of cases. To discover genetic variants in unexplained erythrocytosis, we performed whole exome sequencing in 27 patients with JAK2-negative polycythemia after excluding the presence of any mutations in genes previously associated with erythrocytosis (EPOR, VHL, PHD2, EPAS1, HBA, and HBB). We found that the majority of patients (25/27) had variants in genes involved in epigenetic processes, including TET2 and ASXL1 or in genes related to hematopoietic signaling such as MPL and GFIB. Based on computational analysis, we believe that variants identified in 11 patients in this study could be pathogenic although functional studies will be required for confirmation. To our knowledge, this is the largest study reporting novel variants in individuals with unexplained erythrocytosis. Our results suggest that genes involved in epigenetic processes and hematopoietic signaling pathways are likely associated with unexplained erythrocytosis in individuals lacking JAK2 mutations. With very few previous studies targeting JAK2-negative polycythemia patients to identify underlying variants, this study opens a new avenue in evaluating and managing JAK2-negative polycythemia.
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Affiliation(s)
- Harshit Khurana
- Command Hospital (Air Force), Bangalore, India
- Department of Internal Medicine, Armed Forces Medical College, Pune, India
| | | | - Uday Yanamandra
- Department of Internal Medicine, Armed Forces Medical College, Pune, India
| | - Kishore Garapati
- Institute of Bioinformatics, International Technology Park, Bangalore, India
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
- Manipal Academy of Higher Education, Manipal, India
| | | | | | - Akhilesh Pandey
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
- Center for Individualized Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Gaddam M, Prakash P, Devegowda D, Kumar R. Analysis of JAK2V617F Tyrosine Kinase Mutation in Blood Donors with Erythrocytosis - A Pilot Study in a Tertiary Care Teaching Hospital of South India. J Blood Med 2022; 13:439-446. [PMID: 35992633 PMCID: PMC9384845 DOI: 10.2147/jbm.s370687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 07/14/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Transfusion services and blood centers provide immediate medical evaluation to blood donors by physical examination and hemoglobin (Hb) screening. Screening for Hb value before every blood donation is mainly aimed to rule out anemia. However, it is not uncommon to defer the donors for high Hb value which can be due to primary or secondary polycythemia. This study aimed to analyze the frequency of JAK2V617F mutation among blood donors with a high Hb of >18 g/dl. Patients and Methods A prospective study was conducted over a period of 18 months involving blood donors with a persistently high Hb value of >18 g/dl. Complete blood count (CBC), JAK2V617F gene mutation and Serum Erythropoietin (EPO) levels in study donors were analyzed. Descriptive statistical analysis was performed using SPSS, version 24 (IBM, USA). Results Of 13,798 screened donors, 48 donors (0.34%) had persistent erythrocytosis with a high Hb value of >18 g/dl. Their age ranged between 20-50 years with a mean of 31.2 ± 6.66. The CBC parameters including red blood cell (RBC) count, Hb%, hematocrit (Hct), white blood cell (WBC) count and the platelet count ranged from 4.35-8.43 million/µL (6.2 ± 0.6), 18.6-24.4 g/dl (19 ± 0.94), 51.9-83.3% (58 ± 5.02), 3.99-10.8 × 103/µL (7.8 ± 1.5), and 120-450 × 103/µL (227 ± 57.2), respectively. Estimated mean EPO value was 8.29 mIU/± 0.04. JAK2V617F mutation was detected in 2 donors (4.1%). Conclusion The prevalence of persistent erythrocytosis among blood donors was 0.34% and among them, two donors (4.1%) harbored the JAK2V617F mutation. Thus, blood centers play an important role in the primary screening of donors with high hemoglobin leading to early detection and management of polycythemia vera (PV).
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Affiliation(s)
- Manasa Gaddam
- Department of Pathology, JSS Medical College, JSSAHER, Mysuru, Karnataka, India
| | - Pallavi Prakash
- Transfusion Medicine and Blood Center, Department of Pathology, JSS Medical College, JSSAHER, Mysuru, Karnataka, India
| | - Devananda Devegowda
- Department of Biochemistry, JSS Medical College, JSSAHER, Mysuru, Karnataka, India
| | - Ravindran Kumar
- Department of Microbiology, JSS Medical College, JSSAHER, Mysuru, Karnataka, India
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Torres DG, Paes J, da Costa AG, Malheiro A, Silva GV, Mourão LPDS, Tarragô AM. JAK2 Variant Signaling: Genetic, Hematologic and Immune Implication in Chronic Myeloproliferative Neoplasms. Biomolecules 2022; 12:291. [PMID: 35204792 PMCID: PMC8961666 DOI: 10.3390/biom12020291] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/04/2022] [Accepted: 02/05/2022] [Indexed: 02/04/2023] Open
Abstract
The JAK2V617F variant constitutes a genetic alteration of higher frequency in BCR/ABL1 negative chronic myeloproliferative neoplasms, which is caused by a substitution of a G ˃ T at position 1849 and results in the substitution of valine with phenylalanine at codon 617 of the polypeptide chain. Clinical, morphological and molecular genetic features define the diagnosis criteria of polycythemia vera, essential thrombocythemia and primary myelofibrosis. Currently, JAK2V617F is associated with clonal hematopoiesis, genomic instability, dysregulations in hemostasis and immune response. JAK2V617F clones induce an inflammatory immune response and lead to a process of immunothrombosis. Recent research has shown great interest in trying to understand the mechanisms associated with JAK2V617F signaling and activation of cellular and molecular responses that progressively contribute to the development of inflammatory and vascular conditions in association with chronic myeloproliferative neoplasms. Thus, the aim of this review is to describe the main genetic, hematological and immunological findings that are linked to JAK2 variant signaling in chronic myeloproliferative neoplasms.
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Affiliation(s)
- Dania G. Torres
- Programa de Pós-Graduação em Ciências Aplicadas à Hematologia, Universidade do Estado do Amazonas (UEA), Manaus 69850-000, AM, Brazil; (D.G.T.); (J.P.); (A.G.d.C.); (A.M.); (G.V.S.)
| | - Jhemerson Paes
- Programa de Pós-Graduação em Ciências Aplicadas à Hematologia, Universidade do Estado do Amazonas (UEA), Manaus 69850-000, AM, Brazil; (D.G.T.); (J.P.); (A.G.d.C.); (A.M.); (G.V.S.)
| | - Allyson G. da Costa
- Programa de Pós-Graduação em Ciências Aplicadas à Hematologia, Universidade do Estado do Amazonas (UEA), Manaus 69850-000, AM, Brazil; (D.G.T.); (J.P.); (A.G.d.C.); (A.M.); (G.V.S.)
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Universidade Federal do Amazonas (UFAM), Manaus 69067-005, AM, Brazil
| | - Adriana Malheiro
- Programa de Pós-Graduação em Ciências Aplicadas à Hematologia, Universidade do Estado do Amazonas (UEA), Manaus 69850-000, AM, Brazil; (D.G.T.); (J.P.); (A.G.d.C.); (A.M.); (G.V.S.)
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Universidade Federal do Amazonas (UFAM), Manaus 69067-005, AM, Brazil
| | - George V. Silva
- Programa de Pós-Graduação em Ciências Aplicadas à Hematologia, Universidade do Estado do Amazonas (UEA), Manaus 69850-000, AM, Brazil; (D.G.T.); (J.P.); (A.G.d.C.); (A.M.); (G.V.S.)
- Fundação Oswaldo Cruz–Instituto Leônidas e Maria Deane (Fiocruz), Manaus 69027-070, AM, Brazil
- Fundação Centro de Controle de Oncologia do Amazonas (FCECON), Manaus 69040-010, AM, Brazil
| | - Lucivana P. de Souza Mourão
- Programa de Pós-Graduação em Ciências Aplicadas à Hematologia, Universidade do Estado do Amazonas (UEA), Manaus 69850-000, AM, Brazil; (D.G.T.); (J.P.); (A.G.d.C.); (A.M.); (G.V.S.)
| | - Andréa M. Tarragô
- Programa de Pós-Graduação em Ciências Aplicadas à Hematologia, Universidade do Estado do Amazonas (UEA), Manaus 69850-000, AM, Brazil; (D.G.T.); (J.P.); (A.G.d.C.); (A.M.); (G.V.S.)
- Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (FHEMOAM), Manaus 69050-001, AM, Brazil
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7
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Osho P, Ojo M, Osho E. Profile of polycythaemia vera in South Western Nigeria. NIGERIAN JOURNAL OF MEDICINE 2022. [DOI: 10.4103/njm.njm_56_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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8
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Loscocco GG, Rotunno G, Mannelli L, Mannelli F, Vergoni F, Guglielmelli P, Vannucchi AM. BRAFV600E mutation in the wrong place: a case of concomitant polycythemia vera, hairy cell leukemia, and thyroid adenoma. TUMORI JOURNAL 2021; 107:NP28-NP32. [PMID: 33430710 DOI: 10.1177/0300891620986621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Polycythemia vera (PV) is one of the Philadelphia-negative myeloproliferative neoplasms (MPN), characterized by a pan-myelosis with an erythroid-predominant proliferation mainly driven by somatic JAK2V617F gain-of-function mutation. Hairy cell leukemia (HCL) is a rare B-cell lineage lymphoproliferative disease (LPD) with a typic immunophenotypic profile. BRAFV600E, leading to constitutive activation of the RAF/MEK/ERK signalling pathway and increased cell proliferation, is identified as the driver mutation in almost all cases. Although the risk of developing an LPD is significantly increased in patients with MPN compared with the general population, few cases of co-occurring PV and HCL are reported to date. BRAF is one of the most frequently mutated oncogenes in human cancer and some point mutations were identified in multiple neoplasms in addition to HCL, including follicular and papillary thyroid adenoma and carcinoma. CASE PRESENTATION Here we report a molecular diagnostic challenge in a woman with a concomitant diagnosis of JAK2V617F PV, BRAFV600E HCL, and HRASQ61K thyroid follicular adenoma. CONCLUSION In the age of molecular and precision medicine, this case underlines the importance of integrating molecular results with clinical, radiologic, cytologic, and histopathologic investigations.
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Affiliation(s)
- Giuseppe G Loscocco
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Denothe Excellence Center, Florence, Italy
| | - Giada Rotunno
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Denothe Excellence Center, Florence, Italy
| | - Lara Mannelli
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Denothe Excellence Center, Florence, Italy.,Doctorate School GEnoMEC, University of Siena, Siena, Italy
| | - Francesco Mannelli
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Denothe Excellence Center, Florence, Italy
| | - Federica Vergoni
- Department of Surgery and Translational Medicine, Division of Pathology, University of Florence, Florence, Italy
| | - Paola Guglielmelli
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Denothe Excellence Center, Florence, Italy
| | - Alessandro M Vannucchi
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Denothe Excellence Center, Florence, Italy
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9
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Foltz L, Pica GM, Zerazhi H, Van Droogenbroeck J, Visanica S, Báez de la Fuente E, Leber B, de Almeida AM, Ranta D, Kiladjian JJ, Chrit L, Kandra A, Morando J, Devos T. Safety and efficacy findings from the open-label, multicenter, phase 3b, expanded treatment protocol study of ruxolitinib for treatment of patients with polycythemia vera who are resistant/intolerant to hydroxyurea and for whom no alternative treatments are available. Leuk Lymphoma 2019; 60:3493-3502. [DOI: 10.1080/10428194.2019.1636985] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Lynda Foltz
- St. Paul’s Hospital, University of British Columbia, Vancouver, Canada
| | - Gian-Matteo Pica
- Service of Hematology, Centre Hospitalier Métropole Savoie, Chambery, France
| | | | | | - Sorin Visanica
- Service Hématologie, Hôpital Belle Isle, HP Metz, France
| | | | - Brian Leber
- Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, Canada
| | | | - Dana Ranta
- Centre Hospitalier Universitaire, Nancy, France
| | - Jean-Jacques Kiladjian
- Centre d’Investigations Cliniques, AP-HP, Hôpital Saint-Louis, Université Paris Diderot, INSERM CIC 1427, Paris, France
| | | | | | | | - Timothy Devos
- Department of Hematology, University Hospitals Leuven, Leuven, Belgium
- Laboratory of Experimental Transplantation, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
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10
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Hatalova A, Schwarz J, Gotic M, Penka M, Hrubisko M, Kusec R, Egyed M, Griesshammer M, Podolak-Dawidziak M, Hellmann A, Klymenko S, Niculescu-Mizil E, Petrides PE, Grosicki S, Sever M, Cantoni N, Thiele J, Wolf D, Gisslinger H. Recommendations for the diagnosis and treatment of patients with polycythaemia vera. Eur J Haematol 2018; 101:654-664. [PMID: 30058088 DOI: 10.1111/ejh.13156] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 06/28/2018] [Accepted: 06/28/2018] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To present the Central European Myeloproliferative Neoplasm Organisation (CEMPO) treatment recommendations for polycythaemia vera (PV). METHODS During meetings held from 2015 through 2017, CEMPO discussed PV and its treatment and recent data. RESULTS PV is associated with increased risks of thrombosis/thrombo-haemorrhagic complications, fibrotic progression and leukaemic transformation. Presence of Janus kinase (JAK)-2 gene mutations is a diagnostic marker and standard diagnostic criterion. World Health Organization 2016 diagnostic criteria for PV, focusing on haemoglobin levels and bone marrow morphology, are mandatory. PV therapy aims at managing long-term risks of vascular complications and progression towards transformation to acute myeloid leukaemia and myelodysplastic syndrome. Risk stratification for thrombotic complications guides therapeutic decisions. Low-risk patients are treated first line with low-dose aspirin and phlebotomy. Cytoreduction is considered for low-risk (phlebotomy intolerance, severe/progressive symptoms, cardiovascular risk factors) and high-risk patients. Hydroxyurea is suspected of leukaemogenic potential. IFN-α has demonstrated efficacy in many clinical trials; its pegylated form is best tolerated, enabling less frequent administration than standard interferon. Ropeginterferon alfa-2b has been shown to be more efficacious than hydroxyurea. JAK1/JAK2 inhibitor ruxolitinib is approved for hydroxyurea resistant/intolerant patients. CONCLUSIONS Greater understanding of PV is serving as a platform for new therapy development and treatment response predictors.
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Affiliation(s)
- Antónia Hatalova
- Clinic of Hematology and Blood Transfusion, University Hospital, Faculty of Medicine, Medical School Comenius University, Slovak Medical University, Bratislava, Slovakia
| | - Jiri Schwarz
- Clinical Section, Institute of Hematology and Blood Transfusion, Institute of Clinical and Experimental Hematology, Charles University, Prague, Czechia
| | - Mirjana Gotic
- Clinic for Hematology Clinical Center of Serbia, Medical Faculty University of Belgrade, Belgrade, Serbia
| | - Miroslav Penka
- Department of Clinical Hematology, Masaryk University Hospital, Brno, Czechia
| | - Mikulas Hrubisko
- Clinic of Hematology and Blood Transfusion, University Hospital, Faculty of Medicine, Medical School Comenius University, Slovak Medical University, Bratislava, Slovakia
| | - Rajko Kusec
- Department of Hematology, Dubrava University Hospital, University of Zagreb, Medical School, Zagreb, Croatia
| | - Miklós Egyed
- Department of Hematology, Somogy County Mór Kaposi General Hospital, Kaposvár, Hungary
| | - Martin Griesshammer
- Department of Hematology, Oncology and Palliative Medicine, Johannes Wesling Academic Medical Center, Minden, Germany
- University Clinic for Hematology, Oncology and Palliative Medicine, Johannes Wesling Medical Center Minden, University of Bochum, Bochum, Germany
| | - Maria Podolak-Dawidziak
- Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wróclaw Medical University, Wróclaw, Poland
| | - Andrzej Hellmann
- Department of Hematology and Transplantology, Medical University Hospital, Gdaňsk, Poland
| | - Sergiy Klymenko
- Department of Medical Genetics, State Institution National Research Center for Radiation Medicine of National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
| | | | - Petro E Petrides
- Hematology Oncology Center Munich, Ludwig-Maximilian's University, Munich, Germany
| | - Sebastian Grosicki
- Department of Cancer Prevention, Public School of Health, Silesian Medical University, Katowice, Poland
| | - Matjaz Sever
- Department of Hematology, University Clinical Center, Ljubljana, Slovenia
| | - Nathan Cantoni
- Division of Hematology, University Clinic of Medicine, Kantonsspital Aarau, Switzerland
| | - Jürgen Thiele
- Institute of Pathology, University of Cologne, Cologne, Germany
| | - Dominik Wolf
- Department of Internal Medicine V, Hematology & Oncology, Innsbruck Medical University, Innsbruck, Austria
- Medical Clinic 3, Oncology, Hematology and Rheumatology, University Hospital of Bonn, Bonn, Germany
| | - Heinz Gisslinger
- Division of Hematology and Blood Coagulation, Department of Internal Medicine I, Medical University of Vienna Hospital, Vienna, Austria
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11
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Ruxolitinib for the treatment of inadequately controlled polycythemia vera without splenomegaly: 80-week follow-up from the RESPONSE-2 trial. Ann Hematol 2018; 97:1591-1600. [PMID: 29804268 PMCID: PMC6097748 DOI: 10.1007/s00277-018-3365-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 05/07/2018] [Indexed: 01/11/2023]
Abstract
RESPONSE-2 is a phase 3 study comparing the efficacy and safety of ruxolitinib with the best available therapy (BAT) in hydroxyurea-resistant/hydroxyurea-intolerant polycythemia vera (PV) patients without palpable splenomegaly. This analysis evaluated the durability of the efficacy and safety of ruxolitinib after patients completed the visit at week 80 or discontinued the study. Endpoints included proportion of patients achieving hematocrit control (< 45%), proportion of patients achieving complete hematologic remission (CHR) at week 28, and the durability of hematocrit control and CHR. At the time of analysis, 93% (69/74) of patients randomized to ruxolitinib were receiving ruxolitinib; while in the BAT arm, 77% (58/75) of patients crossed over to ruxolitinib after week 28. No patient remained on BAT by week 80. Among patients who achieved a hematocrit response at week 28, the probability of maintaining response up to week 80 was 78% in the ruxolitinib arm. At week 80, durable CHR was achieved in 18 patients (24%) in the ruxolitinib arm versus 2 patients (3%) in the BAT arm. The safety profile of ruxolitinib was consistent with previous reports. These data support that ruxolitinib treatment should be considered also as a standard of care for hydroxyurea-resistant/hydroxyurea-intolerant PV patients without palpable splenomegaly.
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12
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Cardoso EM, Esgalhado AJ, Patrão L, Santos M, Neves VP, Martinez J, Patto MAV, Silva H, Arosa FA. Distinctive CD8 + T cell and MHC class I signatures in polycythemia vera patients. Ann Hematol 2018; 97:1563-1575. [PMID: 29789880 DOI: 10.1007/s00277-018-3332-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 04/05/2018] [Indexed: 12/18/2022]
Abstract
Polycythemia vera (PV) is a myeloproliferative neoplasm characterized by overproduction of red blood cells. We have performed a comprehensive characterization of blood immune cells for expression of naïve and memory receptors as well as β2m-associated and β2m-free MHC class I heavy chains, also known as closed and open conformers, respectively, in PV patients and age-matched controls (CTR). We show that the peripheral CD3+CD8+ T cell pool in PV patients is clearly divided into two discrete populations, a more granular CD3+CD8high T cell population enriched in effector-memory CD45RA+ T cells (CD8+ TEMRA) when compared to CTR (P < 0.001), and a less granular CD3+CD8int T cell population that is completely absent in the CTR group (78 vs. 0%, P < 0.001) and is a mixture of naïve (CD8+ TN) and CD8+ TEMRA cells expressing intermediate levels of CD28, i.e., CD3+CD8intCD28int. While the percentage of CD3+CD8int TN cells correlated positively with the number of erythrocytes, the percentage of CD3+CD8int TEMRA correlated negatively with the number of platelets. Finally, we report that PV patients' lymphocytes and monocytes display lower levels of closed (W6/32+) MHC-I conformers at the cell surface while exhibiting increased amounts of open (HC-10+) MHC-I conformers. The implications of this distinctive immune signature are discussed.
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Affiliation(s)
- Elsa M Cardoso
- CICS-UBI-Health Sciences Research Center, University of Beira Interior, Av. Infante D. Henrique, 6200-506, Covilhã, Portugal.,FCS-Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal.,IPG-Instituto Politécnico da Guarda, Guarda, Portugal
| | - André J Esgalhado
- CICS-UBI-Health Sciences Research Center, University of Beira Interior, Av. Infante D. Henrique, 6200-506, Covilhã, Portugal
| | - Luís Patrão
- FCS-Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal.,CHTV-Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Mónica Santos
- CHTV-Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | | | - Jorge Martinez
- FCS-Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal.,CHCB-Centro Hospitalar Cova da Beira, Covilhã, Portugal
| | - Maria Assunção Vaz Patto
- CICS-UBI-Health Sciences Research Center, University of Beira Interior, Av. Infante D. Henrique, 6200-506, Covilhã, Portugal.,FCS-Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal.,ULSG-Unidade Local de Saúde, Guarda, Portugal
| | - Helena Silva
- CHTV-Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Fernando A Arosa
- CICS-UBI-Health Sciences Research Center, University of Beira Interior, Av. Infante D. Henrique, 6200-506, Covilhã, Portugal. .,FCS-Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal.
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13
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Rocca S, Carrà G, Poggio P, Morotti A, Brancaccio M. Targeting few to help hundreds: JAK, MAPK and ROCK pathways as druggable targets in atypical chronic myeloid leukemia. Mol Cancer 2018; 17:40. [PMID: 29455651 PMCID: PMC5817721 DOI: 10.1186/s12943-018-0774-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 02/01/2018] [Indexed: 12/19/2022] Open
Abstract
Atypical Chronic Myeloid Leukemia (aCML) is a myeloproliferative neoplasm characterized by neutrophilic leukocytosis and dysgranulopoiesis. From a genetic point of view, aCML shows a heterogeneous mutational landscape with mutations affecting signal transduction proteins but also broad genetic modifiers and chromatin remodelers, making difficult to understand the molecular mechanisms causing the onset of the disease. The JAK-STAT, MAPK and ROCK pathways are known to be responsible for myeloproliferation in physiological conditions and to be aberrantly activated in myeloproliferative diseases. Furthermore, experimental evidences suggest the efficacy of inhibitors targeting these pathways in repressing myeloproliferation, opening the way to deep clinical investigations. However, the activation status of these pathways is rarely analyzed when genetic mutations do not occur in a component of the signaling cascade. Given that mutations in functionally unrelated genes give rise to the same pathology, it is tempting to speculate that alteration in the few signaling pathways mentioned above might be a common feature of pathological myeloproliferation. If so, targeted therapy would be an option to be considered for aCML patients.
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Affiliation(s)
- Stefania Rocca
- Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126, Torino, Italy
| | - Giovanna Carrà
- Department of Clinical and Biological Sciences, University of Torino, 10043, Orbassano, Italy
| | - Pietro Poggio
- Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126, Torino, Italy
| | - Alessandro Morotti
- Department of Clinical and Biological Sciences, University of Torino, 10043, Orbassano, Italy
| | - Mara Brancaccio
- Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126, Torino, Italy.
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14
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Kiladjian JJ, Guglielmelli P, Griesshammer M, Saydam G, Masszi T, Durrant S, Passamonti F, Jones M, Zhen H, Li J, Gadbaw B, Perez Ronco J, Khan M, Verstovsek S. Efficacy and safety of ruxolitinib after and versus interferon use in the RESPONSE studies. Ann Hematol 2018; 97:617-627. [DOI: 10.1007/s00277-017-3225-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 12/20/2017] [Indexed: 12/21/2022]
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15
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Anti-Platelet Factor 4/Heparin Antibody Formation Occurs Endogenously and at Unexpected High Frequency in Polycythemia Vera. BIOMED RESEARCH INTERNATIONAL 2017; 2017:9876819. [PMID: 28698883 PMCID: PMC5494054 DOI: 10.1155/2017/9876819] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 04/05/2017] [Accepted: 04/24/2017] [Indexed: 12/23/2022]
Abstract
Background Myeloproliferative neoplasms (MPN) encounter thromboses due to multiple known risk factors. Heparin-induced thrombocytopenia (HIT) is a thrombotic syndrome mediated by anti-platelet factor 4 (PF4)/heparin antibodies with undetermined significance for thrombosis in MPN. We hypothesized that anti-PF4/heparin Ab might occur in MPN and promote thrombosis. Methods Anti-PF4/heparin antibodies were analyzed in 127 MPN patients including 76 PV and 51 ET. Screening, validation testing, and isotype testing of anti-PF4/heparin Ab were correlated with disease characteristics. Results Anti-PF4/heparin antibodies were detected in 21% of PV and 12% of ET versus 0.3–3% in heparin-exposed patients. Validation testing confirmed anti-PF4/heparin immunoglobulins in 15% of PV and 10% of ET. Isotype testing detected 9.2% IgG and 5.3% IgM in PV and exclusively IgM in ET. IgG-positive PV patients encountered thromboses in 57.1% suggesting anti-PF4/heparin IgG may contribute to higher risk for thrombosis in MPN. Overall, 45% of PV patients experienced thromboses with 11.8% positive for anti-PF4/heparin IgG versus 7.1% in PV without thrombosis. Conclusion Anti-PF4/heparin antibodies occur endogenously and more frequently in MPN than upon heparin exposure. Thrombotic risk increases in anti-PF4/heparin IgG-positive PV reflecting potential implications and calling for larger, confirmatory cohorts. Anti-PF4/heparin IgG should be assessed upon thrombosis in PV to facilitate avoidance of heparin in anti-PF4/heparin IgG-positive PV.
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16
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Langabeer SE. Hemochromatosis, Erythrocytosis and the JAK2 p.V617F Mutation. EJIFCC 2017; 28:92-93. [PMID: 28439222 PMCID: PMC5387703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Stephen E. Langabeer
- FRCPath Cancer Molecular Diagnostics Central Pathology Laboratory St. James’s Hospital Dublin 8, Ireland +35 314103576+35 314103513
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