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Puli'uvea C, Immanuel T, Green TN, Tsai P, Shepherd PR, Kalev-Zylinska ML. Insights into the role of JAK2-I724T variant in myeloproliferative neoplasms from a unique cohort of New Zealand patients. Hematology 2024; 29:2297597. [PMID: 38197452 DOI: 10.1080/16078454.2023.2297597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 12/12/2023] [Indexed: 01/11/2024] Open
Abstract
OBJECTIVES This study aimed to compile bioinformatic and experimental information for JAK2 missense variants previously reported in myeloproliferative neoplasms (MPN) and determine if germline JAK2-I724T, recently found to be common in New Zealand Polynesians, associates with MPN. METHODS For all JAK2 variants found in the literature, gnomAD_exome allele frequencies were extracted and REVEL scores were calculated using the dbNSFP database. We investigated the prevalence of JAK2-I724T in a cohort of 111 New Zealand MPN patients using a TaqMan assay, examined its allelic co-occurrence with JAK2-V617F using Oxford Nanopore sequencing, and modelled the impact of I724T on JAK2 using I-Mutant and ChimeraX software. RESULTS Several non-V617F JAK2 variants previously reported in MPN had REVEL scores greater than 0.5, suggesting pathogenicity. JAK2-I724T (REVEL score 0.753) was more common in New Zealand Polynesian MPN patients (n = 2/27; 7.4%) than in other New Zealand patients (n = 0/84; 0%) but less common than expected for healthy Polynesians (n = 56/377; 14.9%). Patients carrying I724T (n = 2), one with polycythaemia vera and one with essential thrombocythaemia, had high-risk MPN. Both patients with JAK2-I724T were also positive for JAK2-V617F, found on the same allele as I724T, as well as separately. In silico modelling did not identify noticeable structural changes that would give JAK2-I724T a gain-of-function. CONCLUSION Several non-canonical JAK2 variants with high REVEL scores have been reported in MPN, highlighting the need to further understand their relationship with disease. The JAK2-I724T variant does not drive MPN, but additional investigations are required to exclude any potential modulatory effect on the MPN phenotype.
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Affiliation(s)
- Christopher Puli'uvea
- Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Maurice Wilkins Centre for Molecular Biodiscovery, Hosted by the University of Auckland, Auckland, New Zealand
| | - Tracey Immanuel
- Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Taryn N Green
- Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Peter Tsai
- Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Maurice Wilkins Centre for Molecular Biodiscovery, Hosted by the University of Auckland, Auckland, New Zealand
| | - Peter R Shepherd
- Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Maurice Wilkins Centre for Molecular Biodiscovery, Hosted by the University of Auckland, Auckland, New Zealand
| | - Maggie L Kalev-Zylinska
- Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Pathology and Laboratory Medicine, Auckland City Hospital, Auckland, New Zealand
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Lekovic D, Bogdanovic A, Sobas M, Arsenovic I, Smiljanic M, Ivanovic J, Bodrozic J, Cokic V, Milic N. Easily Applicable Predictive Score for Differential Diagnosis of Prefibrotic Primary Myelofibrosis from Essential Thrombocythemia. Cancers (Basel) 2023; 15:4180. [PMID: 37627208 PMCID: PMC10452817 DOI: 10.3390/cancers15164180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/12/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
Essential thrombocythemia (ET) and prefibrotic primary myelofibrosis (prePMF) initially have a similar phenotypic presentation with thrombocytosis. The aim of our study was to determine significant clinical-laboratory parameters at presentation to differentiate prePMF from ET as well as to develop and validate a predictive diagnostic prePMF model. This retrospective study included 464 patients divided into ET (289 pts) and prePMF (175 pts) groups. The model was built using data from a development cohort (229 pts; 143 ET, 86 prePMF), which was then tested in an internal validation cohort (235 pts; 146 ET, 89 prePMF). The most important prePMF predictors in the multivariate logistic model were age ≥ 60 years (RR = 2.2), splenomegaly (RR = 13.2), and increased lactat-dehidrogenase (RR = 2.8). Risk scores were assigned according to derived relative risk (RR) for age ≥ 60 years (1 point), splenomegaly (2 points), and increased lactat-dehidrogenase (1 point). Positive predictive value (PPV) for pre-PMF diagnosis with a score of ≥points was 69.8%, while for a score of ≥3 it was 88.2%. Diagnostic performance had similar values in the validation cohort. In MPN patients with thrombocytosis at presentation, the application of the new model enables differentiation of pre-PMF from ET, which is clinically relevant considering that these diseases have different prognoses and treatments.
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Affiliation(s)
- Danijela Lekovic
- Clinic of Hematology, University Clinical Center Serbia, 11000 Belgrade, Serbia or (A.B.); (I.A.); (M.S.); (J.I.); (J.B.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Andrija Bogdanovic
- Clinic of Hematology, University Clinical Center Serbia, 11000 Belgrade, Serbia or (A.B.); (I.A.); (M.S.); (J.I.); (J.B.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Marta Sobas
- Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, 50-367 Wroclaw, Poland;
| | - Isidora Arsenovic
- Clinic of Hematology, University Clinical Center Serbia, 11000 Belgrade, Serbia or (A.B.); (I.A.); (M.S.); (J.I.); (J.B.)
| | - Mihailo Smiljanic
- Clinic of Hematology, University Clinical Center Serbia, 11000 Belgrade, Serbia or (A.B.); (I.A.); (M.S.); (J.I.); (J.B.)
| | - Jelena Ivanovic
- Clinic of Hematology, University Clinical Center Serbia, 11000 Belgrade, Serbia or (A.B.); (I.A.); (M.S.); (J.I.); (J.B.)
| | - Jelena Bodrozic
- Clinic of Hematology, University Clinical Center Serbia, 11000 Belgrade, Serbia or (A.B.); (I.A.); (M.S.); (J.I.); (J.B.)
| | - Vladan Cokic
- Institute for Medical Research, University of Belgrade, 11000 Belgrade, Serbia;
| | - Natasa Milic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Institute of Medical Statistics & Informatics, University of Belgrade, 11000 Belgrade, Serbia
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Nurgat Z, Lawrence M. Management of Myeloproliferative Neoplasms (MPNs). J Oncol Pharm Pract 2022; 28:1400-1410. [PMID: 35296179 DOI: 10.1177/10781552221082293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To provide up to date guidance, practice recommendations and highlight barriers to medication adherence in the long-term management of chronic myeloproliferative neoplasms (MPNs). AIM Current drug therapy for MPN is not curative and has not been shown to prolong survival. The main indication for treatment is the prevention of thrombosis and medication adherence remains a challenge in this group of patients. Identifying potentially modifiable barriers to medication adherence including primary nonadherence and non-persistent adherence enables timely interventions to be put in place and improve overall medication adherence. METHODS A systematic review of peer-reviewed literature and expert opinions was performed using electronic databases (PubMed, EMBASE, MEDLINE, and Web of Science) that were searched for articles reporting MPN and medication adherence. Discussions A case vignette is discussed throughout the article and expert opinion with international peer reviewed guidelines that are authored to support clinical decision making at the point of care were utilised. The evidence base was combined with more practical/clinical (data based) insight from real world clinical practice. Adoption of a broad range of digital health care activities and services in the health care system (telehealth applications) by the advanced practice providers (Non-Medical Prescribers-NMPs) in MPN clinics included medication prescribing and management, oral drug compliance and adherence evaluations, interventions, chronic care management, counselling and patient education on treatments. CONCLUSION Current drug therapy for MPN is neither curative nor has it been shown to prolong survival, and medication adherence remains a challenge in this group of patients. The longevity of the patients' disease course may contribute to the high risk of non-adherence in this patient cohort. Poor adherence to long-term therapies severely compromises the effectiveness of treatment. Adherence interventions should be tailored to the needs of the patient in order to achieve maximum impact. Interventions aimed at improving adherence provide the best experience and outcome for the patient and their families and can have a profound impact on the quality of life and mitigation of disease consequences.
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Affiliation(s)
- Zubeir Nurgat
- Lead Pharmacist, Haematology / Oncology & Clinical Trials, Medway NHS Foundation Trust, Windmill Road, Gillingham, Kent, UK
| | - Myer Lawrence
- Lead Nurse Acute Oncology Service, East Suffolk and North Essex NHS Foundation Trust, Colchester General & Ipswich Hospital, England, UK
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Gecht J, Tsoukakis I, Kricheldorf K, Stegelmann F, Klausmann M, Griesshammer M, Schulz H, Hollburg W, Göthert JR, Sockel K, Heidel FH, Gattermann N, Maintz C, Al-Ali HK, Platzbecker U, Hansen R, Hänel M, Parmentier S, Bommer M, Pahl HL, Lang F, Kirschner M, Isfort S, Brümmendorf TH, Döhner K, Koschmieder S. Kidney Dysfunction Is Associated with Thrombosis and Disease Severity in Myeloproliferative Neoplasms: Implications from the German Study Group for MPN Bioregistry. Cancers (Basel) 2021; 13:cancers13164086. [PMID: 34439237 PMCID: PMC8393882 DOI: 10.3390/cancers13164086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/29/2021] [Accepted: 08/10/2021] [Indexed: 01/04/2023] Open
Abstract
Simple Summary In patients with myeloproliferative neoplasms (MPN) and in patients with kidney dysfunction, a higher rate of thrombosis has been reported compared with the general population. Furthermore, MPN patients are more prone to develop kidney dysfunction. In our study, we assessed the importance of specific risk factors for kidney dysfunction and thrombosis in MPN patients. We found that the rate of thrombosis is correlated with the degree of kidney dysfunction, especially in myelofibrosis. Significant associations for kidney dysfunction included arterial hypertension, MPN treatment, and increased inflammation, and those for thrombosis comprised arterial hypertension, non-excessive platelet counts, and antithrombotic therapy. The identified risk factor associations varied between MPN subtypes. Our data suggest that kidney dysfunction in MPN patients is associated with an increased risk of thrombosis, mandating closer monitoring, and, possibly, early thromboprophylaxis. Abstract Inflammation-induced thrombosis represents a severe complication in patients with myeloproliferative neoplasms (MPN) and in those with kidney dysfunction. Overlapping disease-specific attributes suggest common mechanisms involved in MPN pathogenesis, kidney dysfunction, and thrombosis. Data from 1420 patients with essential thrombocythemia (ET, 33.7%), polycythemia vera (PV, 38.5%), and myelofibrosis (MF, 27.9%) were extracted from the bioregistry of the German Study Group for MPN. The total cohort was subdivided according to the calculated estimated glomerular filtration rate (eGFR, (mL/min/1.73 m2)) into eGFR1 (≥90, 21%), eGFR2 (60–89, 56%), and eGFR3 (<60, 22%). A total of 29% of the patients had a history of thrombosis. A higher rate of thrombosis and longer MPN duration was observed in eGFR3 than in eGFR2 and eGFR1. Kidney dysfunction occurred earlier in ET than in PV or MF. Multiple logistic regression analysis identified arterial hypertension, MPN treatment, increased uric acid, and lactate dehydrogenase levels as risk factors for kidney dysfunction in MPN patients. Risk factors for thrombosis included arterial hypertension, non-excessive platelet counts, and antithrombotic therapy. The risk factors for kidney dysfunction and thrombosis varied between MPN subtypes. Physicians should be aware of the increased risk for kidney disease in MPN patients, which warrants closer monitoring and, possibly, early thromboprophylaxis.
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Affiliation(s)
- Judith Gecht
- Department of Hematology, Oncology, Hemostaseology and SCT, Faculty of Medicine, RWTH Aachen University, 52074 Aachen, Germany; (J.G.); (I.T.); (K.K.); (M.K.); (S.I.); (T.H.B.)
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), 52074 Aachen, Germany;
| | - Ioannis Tsoukakis
- Department of Hematology, Oncology, Hemostaseology and SCT, Faculty of Medicine, RWTH Aachen University, 52074 Aachen, Germany; (J.G.); (I.T.); (K.K.); (M.K.); (S.I.); (T.H.B.)
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), 52074 Aachen, Germany;
- Department of Medicine, Hematology/Oncology, Goethe-University, 60590 Frankfurt am Main, Germany;
| | - Kim Kricheldorf
- Department of Hematology, Oncology, Hemostaseology and SCT, Faculty of Medicine, RWTH Aachen University, 52074 Aachen, Germany; (J.G.); (I.T.); (K.K.); (M.K.); (S.I.); (T.H.B.)
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), 52074 Aachen, Germany;
| | - Frank Stegelmann
- Department of Internal Medicine III, University Hospital of Ulm, 89081 Ulm, Germany; (F.S.); (K.D.)
| | | | - Martin Griesshammer
- Johannes Wesling Medical Center, University Clinic for Hematology, Oncology, Hemostaseology, and Palliative Care (UKRUB), University of Bochum, 32429 Minden, Germany;
| | | | - Wiebke Hollburg
- HOPA-Hämatologisch-Onkologische Praxis Altona, 22767 Hamburg, Germany;
| | - Joachim R. Göthert
- Department of Hematology and Stem Cell Transplantation, University Hospital Essen, 45147 Essen, Germany;
| | - Katja Sockel
- Medical Clinic and Policlinic I, University Hospital Carl Gustav Carus, TU Dresden, 01307 Dresden, Germany;
| | - Florian H. Heidel
- Innere Medizin C, Universitätsmedizin Greifswald, 17475 Greifswald, Germany;
- Department of Hematology/Oncology, Clinic of Internal Medicine II, Jena University Hospital, 07747 Jena, Germany
| | - Norbert Gattermann
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), 52074 Aachen, Germany;
- Department of Hematology, Oncology and Clinical Immunology, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
| | | | - Haifa K. Al-Ali
- Department of Hematology/Oncology, University Hospital Halle, 06120 Halle, Germany;
| | - Uwe Platzbecker
- Department of Hematology and Cellular Therapy, Medical Clinic and Policlinic I, Leipzig University Hospital, 04103 Leipzig, Germany;
| | - Richard Hansen
- Oncological Practice Dres. Hansen & Reeb, 67655 Kaiserslautern, Germany;
| | - Mathias Hänel
- Department of Internal Medicine III, Klinikum Chemnitz, 09116 Chemnitz, Germany;
| | - Stefani Parmentier
- Department of Hematology and Oncology, Rems-Murr-Klinikum Winnenden, 71364 Winnenden, Germany;
- Onkologie/Hämatologie, Claraspital Tumorzentrum Basel, 4058 Basel, Switzerland
| | - Martin Bommer
- Department of Hematology, Oncology, Infectious Diseases and Palliative Care, Alb-Fils-Kliniken, 73035 Göppingen, Germany;
| | - Heike L. Pahl
- Department of Medicine I, Hematology and Oncology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany;
| | - Fabian Lang
- Department of Medicine, Hematology/Oncology, Goethe-University, 60590 Frankfurt am Main, Germany;
| | - Martin Kirschner
- Department of Hematology, Oncology, Hemostaseology and SCT, Faculty of Medicine, RWTH Aachen University, 52074 Aachen, Germany; (J.G.); (I.T.); (K.K.); (M.K.); (S.I.); (T.H.B.)
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), 52074 Aachen, Germany;
| | - Susanne Isfort
- Department of Hematology, Oncology, Hemostaseology and SCT, Faculty of Medicine, RWTH Aachen University, 52074 Aachen, Germany; (J.G.); (I.T.); (K.K.); (M.K.); (S.I.); (T.H.B.)
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), 52074 Aachen, Germany;
| | - Tim H. Brümmendorf
- Department of Hematology, Oncology, Hemostaseology and SCT, Faculty of Medicine, RWTH Aachen University, 52074 Aachen, Germany; (J.G.); (I.T.); (K.K.); (M.K.); (S.I.); (T.H.B.)
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), 52074 Aachen, Germany;
| | - Konstanze Döhner
- Department of Internal Medicine III, University Hospital of Ulm, 89081 Ulm, Germany; (F.S.); (K.D.)
| | - Steffen Koschmieder
- Department of Hematology, Oncology, Hemostaseology and SCT, Faculty of Medicine, RWTH Aachen University, 52074 Aachen, Germany; (J.G.); (I.T.); (K.K.); (M.K.); (S.I.); (T.H.B.)
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), 52074 Aachen, Germany;
- Correspondence: ; Tel.: +49-241-8036102
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Longhitano L, Li Volti G, Giallongo C, Spampinato M, Barbagallo I, Di Rosa M, Romano A, Avola R, Tibullo D, Palumbo GA. The Role of Inflammation and Inflammasome in Myeloproliferative Disease. J Clin Med 2020; 9:E2334. [PMID: 32707883 PMCID: PMC7464195 DOI: 10.3390/jcm9082334] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/01/2020] [Accepted: 07/17/2020] [Indexed: 12/22/2022] Open
Abstract
Polycythemia vera (PV), essential thrombocythemia (ET) and primary myelofibrosis (PMF) are rare hematological conditions known as myeloproliferative neoplasms (MPNs). They are characterized for being BCR-ABL negative malignancies and affected patients often present with symptoms which can significantly impact their quality of life. MPNs are characterized by a clonal proliferation of an abnormal hematopoietic stem/progenitor cell. In MPNs; cells of all myeloid lineages; including those involved in the immune and inflammatory response; may belong to the malignant clone thus leading to an altered immune response and an overexpression of cytokines and inflammatory receptors; further worsening chronic inflammation. Many of these cytokines; in particular, IL-1β and IL-18; are released in active form by activating the inflammasome complexes which in turn mediate the inflammatory process. Despite this; little is known about the functional effects of stem cell-driven inflammasome signaling in MPN pathogenesis. In this review we focused on the role of inflammatory pathway and inflammasome in MPN diseases. A better understanding of the inflammatory-state-driving MPNs and of the role of the inflammasome may provide new insights on possible therapeutic strategies.
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Affiliation(s)
- Lucia Longhitano
- Section of Biochemistry, Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy; (L.L.); (G.L.V.); (M.S.); (R.A.)
| | - Giovanni Li Volti
- Section of Biochemistry, Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy; (L.L.); (G.L.V.); (M.S.); (R.A.)
| | - Cesarina Giallongo
- Department of Scienze Mediche Chirurgiche e Tecnologie Avanzate “G.F. Ingrassia”, University of Catania, 95123 Catania, Italy;
| | - Mariarita Spampinato
- Section of Biochemistry, Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy; (L.L.); (G.L.V.); (M.S.); (R.A.)
| | - Ignazio Barbagallo
- Section of Biochemistry, Department of Drug Sciences, University of Catania, 95123 Catania, Italy;
| | - Michelino Di Rosa
- Section of Human Anatomy, Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy;
| | - Alessandra Romano
- Division of Hematology, Department of General Surgery and Medical-Surgical Specialties, A.O.U. “Policlinico-Vittorio Emanuele”, University of Catania, 95123 Catania, Italy;
| | - Roberto Avola
- Section of Biochemistry, Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy; (L.L.); (G.L.V.); (M.S.); (R.A.)
| | - Daniele Tibullo
- Section of Biochemistry, Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy; (L.L.); (G.L.V.); (M.S.); (R.A.)
| | - Giuseppe Alberto Palumbo
- Department of Scienze Mediche Chirurgiche e Tecnologie Avanzate “G.F. Ingrassia”, University of Catania, 95123 Catania, Italy;
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Dogliotti I, Fava C, Serra A, Gottardi E, Daraio F, Carnuccio F, Giugliano E, Bocchia M, Saglio G, Rege-Cambrin G. CALR-positive myeloproliferative disorder in a patient with Ph-positive chronic myeloid leukemia in durable treatment-free remission: a case report. Stem Cell Investig 2017; 4:57. [PMID: 28725653 DOI: 10.21037/sci.2017.06.02] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 05/24/2017] [Indexed: 01/15/2023]
Abstract
Current diagnostic criteria for Philadelphia-negative myeloproliferative neoplasia (MPN) have been redefined by the discovery of Janus kinase 2 (JAK2), myeloproliferative leukemia (MPL) and calreticulin (CALR) genetic alterations. Only few cases of coexistence of CALR-mutated MPN and Philadelphia-positive chronic myeloid leukemia (CML) have been described so far. Here we report the case of a patient with CML diagnosed in 2001, treated with imatinib and pegylated interferon (IFN) frontline. She reached complete molecular remission (CMR) and discontinued imatinib, maintaining treatment free remission. Due to persistent thrombocytosis, we repeated bone marrow (BM) analysis and diagnosed CARL-mutated essential thrombocythemia (ET). A CALR-positive clone was found to be present since 2001, and was unaffected by imatinib treatment, possibly representing a molecular abnormality arising at stem cell level.
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Affiliation(s)
- Irene Dogliotti
- Department of Clinical and Biological Science, University of Turin, Turin, Italy
| | - Carmen Fava
- Department of Clinical and Biological Science, University of Turin, Turin, Italy
| | - Anna Serra
- Department of Clinical and Biological Science, University of Turin, Turin, Italy
| | - Enrico Gottardi
- Department of Clinical and Biological Science, University of Turin, Turin, Italy
| | - Filomena Daraio
- Department of Clinical and Biological Science, University of Turin, Turin, Italy
| | - Francesca Carnuccio
- Department of Clinical and Biological Science, University of Turin, Turin, Italy
| | - Emilia Giugliano
- Department of Clinical and Biological Science, University of Turin, Turin, Italy
| | - Monica Bocchia
- Department of Hematology, University of Siena, Siena, Italy
| | - Giuseppe Saglio
- Department of Clinical and Biological Science, University of Turin, Turin, Italy
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