1
|
Puglianini OC, Peker D, Zhang L, Papadantonakis N. Essential Thrombocythemia and Post-Essential Thrombocythemia Myelofibrosis: Updates on Diagnosis, Clinical Aspects, and Management. Lab Med 2023; 54:13-22. [PMID: 35960786 DOI: 10.1093/labmed/lmac074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Although several decades have passed since the description of myeloproliferative neoplasms (MPN), many aspects of their pathophysiology have not been elucidated. In this review, we discuss the mutational landscape of patients with essential thrombocythemia (ET), prognostic scores and salient pathology, and clinical points. We discuss also the diagnostic challenges of differentiating ET from prefibrotic MF. We then focus on post-essential thrombocythemia myelofibrosis (post-ET MF), a rare subset of MPN that is usually studied in conjunction with post-polycythemia vera MF. The transition of ET to post-ET MF is not well studied on a molecular level, and we present available data. Patients with secondary MF could benefit from allogenic hematopoietic stem cell transplantation, and we present available data focusing on post-ET MF.
Collapse
Affiliation(s)
- Omar Castaneda Puglianini
- H. Lee Moffitt Cancer Center & Research Institute, Department of Blood & Marrow Transplant & Cellular Immunotherapy, Tampa, FL, USA
- Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Deniz Peker
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Linsheng Zhang
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Nikolaos Papadantonakis
- Winship Cancer Institute of Emory University, Department of Hematology and Medical Oncology, Atlanta, GA, USA
| |
Collapse
|
2
|
How We Manage Myelofibrosis Candidates for Allogeneic Stem Cell Transplantation. Cells 2022; 11:cells11030553. [PMID: 35159362 PMCID: PMC8834299 DOI: 10.3390/cells11030553] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 01/31/2022] [Accepted: 02/03/2022] [Indexed: 02/01/2023] Open
Abstract
Moving from indication to transplantation is a critical process in myelofibrosis. Most of guidelines specifically focus on either myelofibrosis disease or transplant procedure, and, currently, no distinct indication for the management of MF candidates to transplant is available. Nevertheless, this period of time is crucial for the transplant outcome because engraftment, non-relapse mortality, and relapse incidence are greatly dependent upon the pre-transplant management. Based on these premises, in this review, we will go through the path of identification of the MF patients suitable for a transplant, by using disease-specific prognostic scores, and the evaluation of eligibility for a transplant, based on performance, comorbidity, and other combined tools. Then, we will focus on the process of donor and conditioning regimens’ choice. The pre-transplant management of splenomegaly and constitutional symptoms, cytopenias, iron overload and transplant timing will be comprehensively discussed. The principal aim of this review is, therefore, to give a practical guidance for managing MF patients who are potential candidates for allo-HCT.
Collapse
|
3
|
Shponka V, Bone K, Nomani L, Hunt B. Fine-needle aspiration diagnosis of clonal extramedullary hematopoiesis in a case of myeloproliferative neoplasm. Diagn Cytopathol 2021; 50:E43-E46. [PMID: 34617678 DOI: 10.1002/dc.24884] [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: 08/13/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 11/06/2022]
Abstract
Extramedullary hematopoiesis (EMH)-the proliferation of hematopoietic progenitors outside of the bone marrow (BM) is a well-known phenomenon in myeloproliferative neoplasms (MPN). Abundant literature describes EMH at various body sites in cases of MPN, and some studies showed the presence of cytogenetic changes associated with MPN in the EMH tissues. We present a case of an 80-year-old female, with a history of MPN, presenting with mediastinal adenopathy. The transbronchial fine-needle aspiration (FNA) of the mediastinal lymph node showed EMH with atypical megakaryocytes and del(13q) demonstrated by fluorescence in situ hybridization. The subsequent BM biopsy demonstrated myelofibrosis with atypical megakaryocytes harboring the same cytogenetic abnormality. Our case highlights the capability of FNA cytology for providing accurate morphologic, immunohistochemical, and cytogenetic diagnosis of clonal EMH.
Collapse
Affiliation(s)
- Volodymyr Shponka
- Department of Pathology, Froedtert/Medical College Lab Building FMCLB 226, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Kathleen Bone
- Department of Pathology, Froedtert/Medical College Lab Building FMCLB 226, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Laila Nomani
- Department of Pathology, Froedtert/Medical College Lab Building FMCLB 226, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Bryan Hunt
- Department of Pathology, Froedtert/Medical College Lab Building FMCLB 226, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| |
Collapse
|
4
|
Yoon J, Pettit K. Improving symptom burden and quality of life in patients with myelofibrosis: current strategies and future directions. Expert Rev Hematol 2021; 14:607-619. [PMID: 34148506 DOI: 10.1080/17474086.2021.1944096] [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: 10/21/2022]
Abstract
INTRODUCTION Myelofibrosis (MF) is a complex and aggressive hematologic malignancy resulting from JAK/STAT-driven myeloproliferation and abnormal fibrogenesis. The clinical manifestations are heterogeneous and negatively impact quality of life and survival. JAK inhibitors improve symptoms and splenomegaly to a variable degree in a proportion of patients, but the effects for many patients are insufficient or short-lived. AREAS COVERED This review examines the constellation of symptoms that befall patients with MF, describes methods to quantify and serially monitor these symptoms, and evaluates pharmacologic and non-pharmacologic interventions for disease-related symptoms. The review also includes a discussion of areas of unmet medical need, and proposes future methods for meeting this need. EXPERT OPINION The treatment landscape for MF is evolving rapidly. The most effective therapies or combinations of therapies will likely simultaneously impact both the malignant hematopoietic stem cell and mechanisms of aberrant fibrogenesis that drive this disease. The goals of treatment for patients with myelofibrosis should be to improve length and quality of life. Clinical trials must be designed with these goals in mind, with endpoints focused on overall survival and symptom reduction, as opposed to surrogate endpoints such as spleen volume reduction.
Collapse
Affiliation(s)
- James Yoon
- Department of Medicine, Division of Hematology/Oncology, Michigan Medicine and University of Michigan Medical School, Ann Arbor, Michigan, United States
| | - Kristen Pettit
- Department of Medicine, Division of Hematology/Oncology, Michigan Medicine and University of Michigan Medical School, Ann Arbor, Michigan, United States
| |
Collapse
|
5
|
Nann D, Fend F. Synoptic Diagnostics of Myeloproliferative Neoplasms: Morphology and Molecular Genetics. Cancers (Basel) 2021; 13:cancers13143528. [PMID: 34298741 PMCID: PMC8303289 DOI: 10.3390/cancers13143528] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/06/2021] [Accepted: 07/09/2021] [Indexed: 02/02/2023] Open
Abstract
Simple Summary The diagnosis of myeloproliferative neoplasms requires assessment of a combination of clinical, morphological, immunophenotypic and genetic features, and this integrated, multimodal approach forms the basis for precise classification. Evaluation includes cell counts and morphology in the peripheral blood, bone marrow aspiration and trephine biopsy, and may encompass flow cytometry for specific questions. Diagnosis nowadays is completed by targeted molecular analysis for the detection of recurrent driver and, optionally, disease-modifying mutations. According to the current World Health Organization classification, all myeloproliferative disorders require assessment of molecular features to support the diagnosis or confirm a molecularly defined entity. This requires a structured molecular analysis workflow tailored for a rapid and cost-effective diagnosis. The review focuses on the morphological and molecular features of Ph-negative myeloproliferative neoplasms and their differential diagnoses, addresses open questions of classification, and emphasizes the enduring role of histopathological assessment in the molecular era. Abstract The diagnosis of a myeloid neoplasm relies on a combination of clinical, morphological, immunophenotypic and genetic features, and an integrated, multimodality approach is needed for precise classification. The basic diagnostics of myeloid neoplasms still rely on cell counts and morphology of peripheral blood and bone marrow aspirate, flow cytometry, cytogenetics and bone marrow trephine biopsy, but particularly in the setting of Ph− myeloproliferative neoplasms (MPN), the trephine biopsy has a crucial role. Nowadays, molecular studies are of great importance in confirming or refining a diagnosis and providing prognostic information. All myeloid neoplasms of chronic evolution included in this review, nowadays feature the presence or absence of specific genetic markers in their diagnostic criteria according to the current WHO classification, underlining the importance of molecular studies. Crucial differential diagnoses of Ph− MPN are the category of myeloid/lymphoid neoplasms with eosinophilia and gene rearrangement of PDGFRA, PDGFRB or FGFR1, or with PCM1-JAK2, and myelodysplastic/myeloproliferative neoplasms (MDS/MPN). This review focuses on morphological, immunophenotypical and molecular features of BCR-ABL1-negative MPN and their differential diagnoses. Furthermore, areas of difficulties and open questions in their classification are addressed, and the persistent role of morphology in the area of molecular medicine is discussed.
Collapse
Affiliation(s)
- Dominik Nann
- Institute of Pathology and Neuropathology, University Hospital Tübingen, 72076 Tübingen, Germany;
- Comprehensive Cancer Center, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Falko Fend
- Institute of Pathology and Neuropathology, University Hospital Tübingen, 72076 Tübingen, Germany;
- Comprehensive Cancer Center, University Hospital Tübingen, 72076 Tübingen, Germany
- Correspondence: ; Tel.: +49-7071-2980207
| |
Collapse
|
6
|
Guy A, Bidet A, Ling C, Caumont C, Boureau L, Viallard JF, Parrens M. Novel findings of splenic extramedullary hematopoiesis during primary myelofibrosis, post-essential thrombocythemia, and post-polycythemia vera myelofibrosis. Virchows Arch 2021; 479:755-764. [PMID: 33934231 DOI: 10.1007/s00428-021-03110-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/17/2021] [Accepted: 04/22/2021] [Indexed: 01/14/2023]
Abstract
BCR-ABL-fusion-negative myeloproliferative neoplasms (MPNs) with myelofibrosis (MF) include primary MF, post-polycythemia vera MF and post-essential thrombocythemia MF. Clonal extramedullary hematopoiesis (EMH) can occur during MPN pathogenesis. Although histopathological bone-marrow (BM) features during clonal EMH have been investigated, those of the spleen have been poorly described. We analyzed splenectomy samples from 28 patients with MF and BM samples from 20 of them. Slides were stained with hematoxylin and eosin, reticulin, and trichrome, with immunohistochemical labeling of glycophorin A, myeloperoxidase, CD61, CD34, and CD117. We also subjected splenectomy and BM samples from six patients and spleen samples from seven patients to next-generation sequencing (NGS). Megakaryocyte-rich spleen nodules (MRSNs), seen in seven of the 28 patients, were significantly associated with megakaryocyte proliferation in the spleen (p = 0.04). We devised a grading system for spleen fibrosis (SF) and found that SF was increased in 20 of 28 patients. Notably, patients with SF were more likely to have MRSNs, suggesting that megakaryocytes might participate in SF, as previously described in BM. Comparisons of spleen and BM NGS findings of six patients' specimens revealed identical mutational status in the two organs for half of the patients. We observed additional mutations in the spleen of two patients. However, the meaning of this finding remains unknown since there was a long interval between BM and spleen samplings (68 and 82 months, respectively).
Collapse
Affiliation(s)
- Alexandre Guy
- UMR 1034, Inserm, Biology of Cardiovascular Diseases, University of Bordeaux, 33600, Pessac, France. .,Laboratory of Hematology, University Hospital Center of Bordeaux, Haut-Lévêque Hospital, 33600, Pessac, France.
| | - Audrey Bidet
- Laboratory of Hematology, University Hospital Center of Bordeaux, Haut-Lévêque Hospital, 33600, Pessac, France
| | - Catherine Ling
- Pathology Department, University Hospital Center of Bordeaux, Haut-Lévêque Hospital, 33600, Pessac, France
| | - Charline Caumont
- Tumor Biology Department, University Hospital Center of Bordeaux, Haut-Lévêque Hospital, 33600, Pessac, France
| | - Lisa Boureau
- Laboratory of Hematology, University Hospital Center of Bordeaux, Haut-Lévêque Hospital, 33600, Pessac, France
| | - Jean-François Viallard
- UMR 1034, Inserm, Biology of Cardiovascular Diseases, University of Bordeaux, 33600, Pessac, France.,Internal Medicine Department, University Hospital Center of Bordeaux, Haut-Lévêque Hospital, 33600, Pessac, France
| | - Marie Parrens
- Pathology Department, University Hospital Center of Bordeaux, Haut-Lévêque Hospital, 33600, Pessac, France.,INSERM U1053, University of Bordeaux, 33076, Bordeaux, France
| |
Collapse
|
7
|
Polverelli N, Mauff K, Kröger N, Robin M, Beelen D, Beauvais D, Chevallier P, Mohty M, Passweg J, Rubio MT, Maertens J, Finke J, Bornhäuser M, Vrhovac R, Helbig G, Mear J, Castagna L, Reményi P, Angelucci E, Karakasis D, Rifòn J, Sirait T, Russo D, Wreede L, Czerw T, Hernández‐Boluda JC, Hayden P, McLornan D, Yakoub‐Agha I. Impact of spleen size and splenectomy on outcomes of allogeneic hematopoietic cell transplantation for myelofibrosis: A retrospective analysis by the chronic malignancies working party on behalf of European society for blood and marrow transplantation (EBMT). Am J Hematol 2021; 96:69-79. [PMID: 33064301 DOI: 10.1002/ajh.26020] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/07/2020] [Accepted: 10/12/2020] [Indexed: 12/12/2022]
Abstract
The role of spleen size and splenectomy for the prediction of post-allogeneic hematopoietic stem cell transplant (allo-HCT) outcome in myelofibrosis remains under debate. In EBMT registry, we identified a cohort of 1195 myelofibrosis patients transplanted between 2000-2017 after either fludarabine-busulfan or fludarabine-melphalan regimens. Overall, splenectomy was performed in 202 (16.9%) patients and its use decreased over time (28.3% in 2000-2009 vs 14.1% in 2010-2017 period). By multivariate analysis, splenectomy was associated with less NRM (HR 0.64, 95% CI 0.44-0.93, P = .018) but increased risk of relapse (HR 1.43, 95% CI 1.01-2.02, P = .042), with no significant impact on OS (HR 0.86, 95% CI 0.67-1.12, P = .274). However, in subset analysis comparing the impact of splenectomy vs specific spleen sizes, for patients with progressive disease, an improved survival was seen in splenectomised subjects compared to those patients with a palpable spleen length ≥ 15 cm (HR 0.44, 95% CI 0.28-0.69, P < .001), caused by a significant reduction in NRM (HR 0.26, 95% CI 0.14-0.49, P < .001), without significantly increased relapse risk (HR 1.47, 95% CI 0.87-2.49, P = .147). Overall, despite the possible biases typical of retrospective cohorts, this study highlights the potential detrimental effect of massive splenomegaly in transplant outcome and supports the role of splenectomy for myelofibrosis patients with progressive disease and large splenomegaly.
Collapse
Affiliation(s)
- Nicola Polverelli
- Unit of Blood Diseases and Stem Cells Transplantation, Department of Clinical and Experimental Sciences University of Brescia ASST Spedali Civili of Brescia
| | | | - Nicolaus Kröger
- Department of Hematology University Hospital Eppendorf Hamburg Germany
| | - Marie Robin
- Department of Hematology Hôpital Saint‐Louis, APHP Paris France
| | - Dietrich Beelen
- Department of Hematology University Hospital of Essen Essen Germany
| | | | | | - Mohamad Mohty
- Sorbonne University Paris France
- Service d'Hématologie Clinique et Thérapie cellulaire Hopital Saint‐Antoine Paris France
- INSERM Paris France
| | - Jakob Passweg
- Department of Hematology University Hospital Basel Basel Switzerland
| | | | - Johan Maertens
- Department of Hematology University Hospital Gasthuisberg Leuven Belgium
| | - Jürgen Finke
- Department of Hematology University of Freiburg Freiburg Germany
| | - Martin Bornhäuser
- Department of Hematology University Hospital Dresded Dresden Germany
| | - Radovan Vrhovac
- Department of Hematology University Hospital Center Rebro Zagreb Croatia
| | - Grzegorz Helbig
- Department of Hematology Silesian Medical Academy Katowice Poland
| | - Jean‐Baptiste Mear
- Department of Hematology Centre Hospitalier Universitaire de Rennes Rennes France
| | - Luca Castagna
- Department of Hematology Centre de Recherche en Cancérologie de Marseille Marseille France
| | - Péter Reményi
- Department of Hematology Dél‐pesti Centrumkórház Budapest Hungary
| | - Emanuele Angelucci
- Hematology and Transplant Center IRCCS Ospedale Policlinico San Martino Genoa Italy
| | | | - Jose Rifòn
- Department of Hematology Clínica Universitaria de Navarra Pamplona Spain
| | | | - Domenico Russo
- Unit of Blood Diseases and Stem Cells Transplantation, Department of Clinical and Experimental Sciences University of Brescia ASST Spedali Civili of Brescia
| | - Liesbeth Wreede
- Department of Biomedical Data Sciences LUMC Leiden Netherlands
| | - Tomasz Czerw
- Department of Bone Marrow Transplantation and Onco‐Hematology Maria Sklodowska‐Curie National Research Institute of Oncology Gliwice Poland
| | | | - Patrick Hayden
- Department of Hematology St. James's Hospital Dublin Ireland
| | - Donal McLornan
- Department of Hematology Guy's and St Thomas' NHS Foundation Trust and University College London Hospitals London UK
| | | |
Collapse
|
8
|
Coltro G, Vannucchi AM. The safety of JAK kinase inhibitors for the treatment of myelofibrosis. Expert Opin Drug Saf 2020; 20:139-154. [PMID: 33327810 DOI: 10.1080/14740338.2021.1865912] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION During the last decade, the development of small molecule inhibitors of Janus kinases (JAKi) contributed to revolutionize the therapeutic landscape of myelofibrosis (MF). JAKi proved to be effective in controlling disease-related symptoms and splenomegaly with remarkable inter-drug variability. However, in some cases the border between clinical efficacy of JAKi and dose-dependent toxicities is narrow leading to sub-optimal dose modifications and/or treatment discontinuation. AREAS COVERED In the current review, the authors aimed at providing a comprehensive review of the safety profile of JAKi that are currently approved or in advanced clinical development. Also, a short discussion of promising JAKi in early clinical evaluation and molecules 'lost' early in clinical development is provided. Finally, we discuss the possible strategies aimed at strengthening the safety of JAKi while improving the therapeutic efficacy. EXPERT OPINION Overall, JAKi display a satisfactory risk-benefit ratio, with main toxicities being gastrointestinal or related to the myelo/immunosuppressive effects, generally mild and easily manageable. However, JAKi may be associated with potentially life-threatening toxicities, such as neurological and infectious events. Thus, many efforts are needed in order to optimize JAKi-based therapeutic strategies without burdening patient safety. This could be attempted through drug combinations or the development of more selective molecules.
Collapse
Affiliation(s)
- Giacomo Coltro
- Department of Clinical and Experimental Medicine, University of Florence , Florence, Italy.,CRIMM, Center of Research and Innovation for Myeloproliferative Neoplasms, AOU Careggi , Florence, Italy
| | - Alessandro M Vannucchi
- Department of Clinical and Experimental Medicine, University of Florence , Florence, Italy.,CRIMM, Center of Research and Innovation for Myeloproliferative Neoplasms, AOU Careggi , Florence, Italy
| |
Collapse
|
9
|
Sankar K, Pettit K. Non-Pharmacologic Management of Splenomegaly for Patients with Myelofibrosis: Is There Any Role for Splenectomy or Splenic Radiation in 2020? Curr Hematol Malig Rep 2020; 15:391-400. [DOI: 10.1007/s11899-020-00598-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
|
10
|
Prakash S, Padilla O, Tam W. Myeloid, mast cell, histiocytic and dendritic cell neoplasms and proliferations involving the spleen. Semin Diagn Pathol 2020; 38:144-153. [PMID: 33012564 DOI: 10.1053/j.semdp.2020.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 07/29/2020] [Indexed: 11/11/2022]
Abstract
Splenic involvement and consequent splenomegaly are usually seen as part of systemic involvement by myeloid neoplasms as well as mast cell and histiocytic neoplasms. Primary splenic involvement by these neoplasms is rare. Splenectomy is usually not performed for establishing a diagnosis of these entities. However, in rare instances, the pathologist may need to evaluate the spleen secondary to splenic rupture or palliative splenectomy to alleviate symptoms related to splenomegaly. This review article describes the clinicopathologic features of a broad group of myeloid, mastocytic, and histiocytic proliferative and neoplastic disorders.
Collapse
Affiliation(s)
- Sonam Prakash
- University of California San Francisco, Department of Laboratory Medicine, Box 0100, Parnassus Avenue, Room 569C, San Francisco, CA 94143, United States.
| | - Osvaldo Padilla
- Texas Tech University Health Sciences Center, PL Foster School of Medicine, Department of Pathology, MSC 41022, 5001 El Paso Drive, El Paso, TX 79905, United States
| | - Wayne Tam
- Weill Cornell Medicine, Department of Pathology and Laboratory Medicine, 525 E 68th Street, Starr Pavilion 715, New York, NY 10065, United States
| |
Collapse
|
11
|
Khoury JD, Chen W. Myeloid diseases in the lung and pleura. Semin Diagn Pathol 2020; 37:296-302. [PMID: 32591154 DOI: 10.1053/j.semdp.2020.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/07/2020] [Accepted: 06/09/2020] [Indexed: 11/11/2022]
Abstract
Myeloid diseases detected as primary or secondary lesions in the lung and pleura are rare. Clinical presentations and radiographic results may vary significantly depending on the nature of the diseases. The most common diseases associated with lung and pleura involvement are myeloid sarcoma/acute myeloid leukemia (AML) and extramedullary hematopoiesis (EMH). AML typically represents localized involvement by systemic acute leukemia, while EMH is frequently secondary to underlying benign hematolymphoid disorders or myeloproliferative neoplasms. This review provides an overview of the pathogenesis, clinical presentations, radiologic/imaging studies, pathologic and genetic findings, and treatment/outcomes associated with myeloid diseases in the lung and pleura.
Collapse
Affiliation(s)
- Joseph D Khoury
- Department of Hematopathology, MS-072, The University Texas MD Anderson Cancer Center, Houston, TX 77401, USA.
| | - Weina Chen
- Department of Pathology, UT Southwestern Medical Center, BioCenter EB3.234, 2330 Inwood Road, EB3.234, Dallas, TX 75390-9317, USA.
| |
Collapse
|
12
|
Coltro G, Mannelli F, Vergoni F, Santi R, Massi D, Siliani LM, Marzullo A, Bonifacio S, Pelo E, Pacilli A, Paoli C, Franci A, Calabresi L, Bosi A, Vannucchi AM, Guglielmelli P. Extramedullary blastic transformation of primary myelofibrosis in the form of disseminated myeloid sarcoma: a case report and review of the literature. Clin Exp Med 2020; 20:313-320. [PMID: 32065308 DOI: 10.1007/s10238-020-00616-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 02/10/2020] [Indexed: 12/11/2022]
Abstract
Splenomegaly is a key clinical manifestation of myelofibrosis, and splenectomy is currently indicated in patients with drug refractory, symptomatic splenomegaly or with the aim of improving refractory cytopenias. Transformation to acute myeloid leukemia occurs in up to 20% of patients with myelofibrosis, while cases of myeloid sarcoma have been reported very unfrequently. In this manuscript, we report the case of a 60-year-old man with a history of primary myelofibrosis who underwent splenectomy because of drug-refractory massive splenomegaly, systemic symptoms and anemia. At the opening of the peritoneal cavity, the spleen resulted massively enlarged and tenaciously entrapped by a pervasive neoplastic-like tissue. The extensive involvement of the abdomen fatally complicated the surgical procedure. At postmortem examination, the spleen showed a diffuse infiltration of immature cells that were also found in the peritoneum, bowel, liver, lungs and myocardium. After immunohistochemical, cytogenetic, flow cytometric and molecular characterization of neoplastic population, a diagnosis of disseminated myeloid sarcoma of the spleen was made. This case report highlights a very unusual case of myeloid sarcoma originating from the spleen in a patient with myelofibrosis who had no evidence of bone marrow or peripheral blood involvement by leukemic cells. Molecular characterization showed that leukemic cells originated from the founding clone of the chronic phase. The sarcoma could not be suspected based on clinical findings and was diagnosed only at the time of surgical procedure and autopsy. This case suggests that leukemic transformation of myelofibrosis can originate outside the bone marrow and, presumably rarely, present as a granulocytic sarcoma.
Collapse
Affiliation(s)
- Giacomo Coltro
- CRIMM, Center of Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliero-Universitaria Careggi, 50134, Florence, Italy.,Department of Experimental and Clinical Medicine, DenoThe Excellence Center, University of Florence, Florence, Italy.,Hematology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Francesco Mannelli
- CRIMM, Center of Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliero-Universitaria Careggi, 50134, Florence, Italy
| | - Federica Vergoni
- Istologia Patologica e Diagnostica Molecolare, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Raffaella Santi
- Istologia Patologica e Diagnostica Molecolare, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Daniela Massi
- Istologia Patologica e Diagnostica Molecolare, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.,Department of Surgery and Translational Medicine, Division of Pathology, University of Florence, Florence, Italy
| | - Luisa Margherita Siliani
- Division of Oncological and Robotic Surgery, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Antonella Marzullo
- Division of Genetic Diagnosis, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Stefania Bonifacio
- Division of Genetic Diagnosis, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Elisabetta Pelo
- Division of Genetic Diagnosis, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Annalisa Pacilli
- CRIMM, Center of Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliero-Universitaria Careggi, 50134, Florence, Italy.,Department of Experimental and Clinical Medicine, DenoThe Excellence Center, University of Florence, Florence, Italy
| | - Chiara Paoli
- CRIMM, Center of Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliero-Universitaria Careggi, 50134, Florence, Italy.,Department of Experimental and Clinical Medicine, DenoThe Excellence Center, University of Florence, Florence, Italy
| | - Annalisa Franci
- CRIMM, Center of Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliero-Universitaria Careggi, 50134, Florence, Italy.,Department of Experimental and Clinical Medicine, DenoThe Excellence Center, University of Florence, Florence, Italy
| | - Laura Calabresi
- CRIMM, Center of Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliero-Universitaria Careggi, 50134, Florence, Italy.,Department of Experimental and Clinical Medicine, DenoThe Excellence Center, University of Florence, Florence, Italy
| | - Alberto Bosi
- Hematology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Alessandro Maria Vannucchi
- CRIMM, Center of Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliero-Universitaria Careggi, 50134, Florence, Italy.,Department of Experimental and Clinical Medicine, DenoThe Excellence Center, University of Florence, Florence, Italy
| | - Paola Guglielmelli
- CRIMM, Center of Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliero-Universitaria Careggi, 50134, Florence, Italy. .,Department of Experimental and Clinical Medicine, DenoThe Excellence Center, University of Florence, Florence, Italy.
| |
Collapse
|
13
|
Edelmann B, Gupta N, Schnoeder TM, Oelschlegel AM, Shahzad K, Goldschmidt J, Philipsen L, Weinert S, Ghosh A, Saalfeld FC, Nimmagadda SC, Müller P, Braun-Dullaeus R, Mohr J, Wolleschak D, Kliche S, Amthauer H, Heidel FH, Schraven B, Isermann B, Müller AJ, Fischer T. JAK2-V617F promotes venous thrombosis through β1/β2 integrin activation. J Clin Invest 2018; 128:4359-4371. [PMID: 30024857 DOI: 10.1172/jci90312] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 07/03/2018] [Indexed: 12/18/2022] Open
Abstract
JAK2-V617F-positive chronic myeloproliferative neoplasia (CMN) commonly displays dysfunction of integrins and adhesion molecules expressed on platelets, erythrocytes, and leukocytes. However, the mechanism by which the 2 major leukocyte integrin chains, β1 and β2, may contribute to CMN pathophysiology remained unclear. β1 (α4β1; VLA-4) and β2 (αLβ2; LFA-1) integrins are essential regulators for attachment of leukocytes to endothelial cells. We here showed enhanced adhesion of granulocytes from mice with JAK2-V617F knockin (JAK2+/VF mice) to vascular cell adhesion molecule 1- (VCAM1-) and intercellular adhesion molecule 1-coated (ICAM1-coated) surfaces. Soluble VCAM1 and ICAM1 ligand binding assays revealed increased affinity of β1 and β2 integrins for their respective ligands. For β1 integrins, this correlated with a structural change from the low- to the high-affinity conformation induced by JAK2-V617F. JAK2-V617F triggered constitutive activation of the integrin inside-out signaling molecule Rap1, resulting in translocation toward the cell membrane. Employing a venous thrombosis model, we demonstrated that neutralizing anti-VLA-4 and anti-β2 integrin antibodies suppress pathologic thrombosis as observed in JAK2+/VF mice. In addition, aberrant homing of JAK2+/VF leukocytes to the spleen was inhibited by neutralizing anti-β2 antibodies and by pharmacologic inhibition of Rap1. Thus, our findings identified cross-talk between JAK2-V617F and integrin activation promoting pathologic thrombosis and abnormal trafficking of leukocytes to the spleen.
Collapse
Affiliation(s)
- Bärbel Edelmann
- Department of Hematology and Oncology, Medical Center, Otto-von-Guericke University, Magdeburg, Germany.,Gesundheitscampus Immunologie, Infektiologie und Inflammation (GCI3), Medical Center, Otto-von-Guericke University, Magdeburg, Germany
| | - Nibedita Gupta
- Department of Hematology and Oncology, Medical Center, Otto-von-Guericke University, Magdeburg, Germany.,Gesundheitscampus Immunologie, Infektiologie und Inflammation (GCI3), Medical Center, Otto-von-Guericke University, Magdeburg, Germany
| | - Tina M Schnoeder
- Department of Hematology and Oncology, Medical Center, Otto-von-Guericke University, Magdeburg, Germany.,Internal Medicine II, Hematology and Oncology, University Hospital Jena, Jena, Germany.,Leibniz Institute on Aging, Fritz-Lipmann-Institute, Jena, Germany
| | - Anja M Oelschlegel
- Leibniz Institute for Neurobiology, Magdeburg, Germany.,Institute of Anatomy
| | | | | | - Lars Philipsen
- Gesundheitscampus Immunologie, Infektiologie und Inflammation (GCI3), Medical Center, Otto-von-Guericke University, Magdeburg, Germany.,Institute of Molecular and Clinical Immunology, and
| | - Soenke Weinert
- Gesundheitscampus Immunologie, Infektiologie und Inflammation (GCI3), Medical Center, Otto-von-Guericke University, Magdeburg, Germany.,Department of Cardiology and Angiology, Medical Center, Otto-von-Guericke University, Magdeburg, Germany
| | - Aniket Ghosh
- Leibniz Institute for Neurobiology, Magdeburg, Germany
| | - Felix C Saalfeld
- Department of Hematology and Oncology, Medical Center, Otto-von-Guericke University, Magdeburg, Germany.,Gesundheitscampus Immunologie, Infektiologie und Inflammation (GCI3), Medical Center, Otto-von-Guericke University, Magdeburg, Germany
| | - Subbaiah Chary Nimmagadda
- Department of Hematology and Oncology, Medical Center, Otto-von-Guericke University, Magdeburg, Germany.,Gesundheitscampus Immunologie, Infektiologie und Inflammation (GCI3), Medical Center, Otto-von-Guericke University, Magdeburg, Germany
| | - Peter Müller
- Department of Hematology and Oncology, Medical Center, Otto-von-Guericke University, Magdeburg, Germany.,Gesundheitscampus Immunologie, Infektiologie und Inflammation (GCI3), Medical Center, Otto-von-Guericke University, Magdeburg, Germany
| | - Rüdiger Braun-Dullaeus
- Gesundheitscampus Immunologie, Infektiologie und Inflammation (GCI3), Medical Center, Otto-von-Guericke University, Magdeburg, Germany.,Department of Cardiology and Angiology, Medical Center, Otto-von-Guericke University, Magdeburg, Germany
| | - Juliane Mohr
- Gesundheitscampus Immunologie, Infektiologie und Inflammation (GCI3), Medical Center, Otto-von-Guericke University, Magdeburg, Germany.,Institute of Molecular and Clinical Immunology, and
| | - Denise Wolleschak
- Department of Hematology and Oncology, Medical Center, Otto-von-Guericke University, Magdeburg, Germany.,Gesundheitscampus Immunologie, Infektiologie und Inflammation (GCI3), Medical Center, Otto-von-Guericke University, Magdeburg, Germany
| | - Stefanie Kliche
- Gesundheitscampus Immunologie, Infektiologie und Inflammation (GCI3), Medical Center, Otto-von-Guericke University, Magdeburg, Germany.,Institute of Molecular and Clinical Immunology, and
| | - Holger Amthauer
- Department of Radiology and Nuclear Medicine, University Hospital, Magdeburg, Germany
| | - Florian H Heidel
- Department of Hematology and Oncology, Medical Center, Otto-von-Guericke University, Magdeburg, Germany.,Internal Medicine II, Hematology and Oncology, University Hospital Jena, Jena, Germany.,Leibniz Institute on Aging, Fritz-Lipmann-Institute, Jena, Germany
| | - Burkhart Schraven
- Gesundheitscampus Immunologie, Infektiologie und Inflammation (GCI3), Medical Center, Otto-von-Guericke University, Magdeburg, Germany.,Institute of Molecular and Clinical Immunology, and.,Helmholtz Centre for Infection Research, Department of Immune Control, Braunschweig, Germany
| | - Berend Isermann
- Gesundheitscampus Immunologie, Infektiologie und Inflammation (GCI3), Medical Center, Otto-von-Guericke University, Magdeburg, Germany.,Institute of Clinical Chemistry and Pathobiochemistry
| | - Andreas J Müller
- Gesundheitscampus Immunologie, Infektiologie und Inflammation (GCI3), Medical Center, Otto-von-Guericke University, Magdeburg, Germany.,Institute of Molecular and Clinical Immunology, and.,Helmholtz Centre for Infection Research, Department of Immune Control, Braunschweig, Germany
| | - Thomas Fischer
- Department of Hematology and Oncology, Medical Center, Otto-von-Guericke University, Magdeburg, Germany.,Gesundheitscampus Immunologie, Infektiologie und Inflammation (GCI3), Medical Center, Otto-von-Guericke University, Magdeburg, Germany
| |
Collapse
|
14
|
Zimran E, Tripodi J, Rampal R, Rappoport F, Zirkiev S, Hoffman R, Najfeld V. Genomic characterization of spleens in patients with myelofibrosis. Haematologica 2018; 103:e446-e449. [PMID: 29748436 DOI: 10.3324/haematol.2018.193763] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Eran Zimran
- Myeloproliferative Neoplasms Research Program, Department of Hematology and Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, Rockefeller University, New York, NY, USA
| | - Joseph Tripodi
- Myeloproliferative Neoplasms Research Program, Department of Hematology and Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, Rockefeller University, New York, NY, USA.,Tumor Cytogenomics Laboratory, Department of Pathology, Icahn School of Medicine at Mount Sinai, Rockefeller University, New York, NY, USA
| | - Raajit Rampal
- Human Oncology and Pathogenesis Program, Leukemia Service, Memorial Sloan-Kettering Cancer Center, Rockefeller University, New York, NY, USA
| | - Franck Rappoport
- Human Oncology and Pathogenesis Program, Leukemia Service, Memorial Sloan-Kettering Cancer Center, Rockefeller University, New York, NY, USA.,Center for Clinical and Translational Science, Rockefeller University, New York, NY, USA
| | - Sharon Zirkiev
- Tumor Cytogenomics Laboratory, Department of Pathology, Icahn School of Medicine at Mount Sinai, Rockefeller University, New York, NY, USA
| | - Ronald Hoffman
- Myeloproliferative Neoplasms Research Program, Department of Hematology and Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, Rockefeller University, New York, NY, USA
| | - Vesna Najfeld
- Myeloproliferative Neoplasms Research Program, Department of Hematology and Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, Rockefeller University, New York, NY, USA .,Tumor Cytogenomics Laboratory, Department of Pathology, Icahn School of Medicine at Mount Sinai, Rockefeller University, New York, NY, USA
| |
Collapse
|
15
|
The effects of hematopoietic stem cell transplant on splenic extramedullary hematopoiesis in patients with myeloproliferative neoplasm-associated myelofibrosis. Hematol Oncol Stem Cell Ther 2016; 9:96-104. [DOI: 10.1016/j.hemonc.2016.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 06/15/2016] [Accepted: 07/03/2016] [Indexed: 11/23/2022] Open
|
16
|
Barbieri SS, Petrucci G, Tarantino E, Amadio P, Rocca B, Pesce M, Machlus KR, Ranelletti FO, Gianellini S, Weksler B, Italiano JE, Tremoli E. Abnormal megakaryopoiesis and platelet function in cyclooxygenase-2-deficient mice. Thromb Haemost 2015; 114:1218-29. [PMID: 26272103 DOI: 10.1160/th14-10-0872] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 06/29/2015] [Indexed: 11/05/2022]
Abstract
Previous studies suggest that cyclooxygenase-2 (COX-2) might influence megakaryocyte (MK) maturation and platelet production in vitro. Using a gene deletion model, we analysed the effect of COX-2 deficiency on megakaryopoiesis and platelet function. COX-2-/- mice (10-12 weeks old) have hyper-responsive platelets as suggested by their enhanced aggregation, TXA2 biosynthesis, CD62P and CD41/CD61 expression, platelet-fibrinogen binding, and increased thromboembolic death after collagen/epinephrine injection compared to wild-type (WT). Moreover, increased platelet COX-1 expression and reticulated platelet fraction were observed in COX-2-/- mice while platelet count was similar to WT. MKs were significantly reduced in COX-2-/- bone marrows (BMs), with high nuclear/cytoplasmic ratios, low ploidy and poor expression of lineage markers of maturation (CD42d, CD49b). However, MKs were significantly increased in COX-2-/- spleens, with features of MK maturation markers which were not observed in MKs of WT spleens. Interestingly, the expression of COX-1, prostacyclin and PGE2 synthases and prostanoid pattern were modified in BMs and spleens of COX-2-/- mice. Moreover, COX-2 ablation reduced the percentage of CD49b+ cells, the platelet formation and the haematopoietic stem cells in bone marrow and increased their accumulation in the spleen. Splenectomy decreased peripheral platelet number, reverted their hyper-responsive phenotype and protected COX-2-/- mice from thromboembolism. Interestingly, fibrosis was observed in spleens of old COX-2-/- mice (28 weeks old). In conclusion, COX-2 deletion delays BM megakaryopoiesis promoting a compensatory splenic MK hyperplasia, with a release of hyper-responsive platelets and increased thrombogenicity in vivo. COX-2 seems to contribute to physiological MK maturation and pro-platelet formation.
Collapse
Affiliation(s)
- Silvia S Barbieri
- Silvia S. Barbieri, PhD, Centro Cardiologico Monzino, IRCCS, Via Parea 4, 20138 Milano, Italy, Tel.: +39 02 50318357, Fax: +39 02 50318250, E-mail:
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Jacobsen RN, Forristal CE, Raggatt LJ, Nowlan B, Barbier V, Kaur S, van Rooijen N, Winkler IG, Pettit AR, Levesque JP. Mobilization with granulocyte colony-stimulating factor blocks medullar erythropoiesis by depleting F4/80+VCAM1+CD169+ER-HR3+Ly6G+ erythroid island macrophages in the mouse. Exp Hematol 2014; 42:547-61.e4. [DOI: 10.1016/j.exphem.2014.03.009] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 03/25/2014] [Accepted: 03/31/2014] [Indexed: 01/05/2023]
|
18
|
Vignjević S, Budeč M, Marković D, Dikić D, Mitrović O, Mojsilović S, Durić SV, Koko V, Cokić BB, Cokić V, Jovčić G. Chronic psychological stress activates BMP4-dependent extramedullary erythropoiesis. J Cell Mol Med 2013; 18:91-103. [PMID: 24283209 PMCID: PMC3916121 DOI: 10.1111/jcmm.12167] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 09/16/2013] [Indexed: 01/14/2023] Open
Abstract
Psychological stress affects different physiological processes including haematopoiesis. However, erythropoietic effects of chronic psychological stress remain largely unknown. The adult spleen contains a distinct microenvironment favourable for rapid expansion of erythroid progenitors in response to stressful stimuli, and emerging evidence suggests that inappropriate activation of stress erythropoiesis may predispose to leukaemic transformation. We used a mouse model to study the influence of chronic psychological stress on erythropoiesis in the spleen and to investigate potential mediators of observed effects. Adult mice were subjected to 2 hrs daily restraint stress for 7 or 14 consecutive days. Our results showed that chronic exposure to restraint stress decreased the concentration of haemoglobin in the blood, elevated circulating levels of erythropoietin and corticosterone, and resulted in markedly increased number of erythroid progenitors and precursors in the spleen. Western blot analysis revealed significantly decreased expression of both erythropoietin receptor and glucocorticoid receptor in the spleen of restrained mice. Furthermore, chronic stress enhanced the expression of stem cell factor receptor in the red pulp. Moreover, chronically stressed animals exhibited significantly increased expression of bone morphogenetic protein 4 (BMP4) in the red pulp as well as substantially enhanced mRNA expression levels of its receptors in the spleen. These findings demonstrate for the first time that chronic psychological stress activates BMP4-dependent extramedullary erythropoiesis and leads to the prolonged activation of stress erythropoiesis pathways. Prolonged activation of these pathways along with an excessive production of immature erythroid cells may predispose chronically stressed subjects to a higher risk of leukaemic transformation.
Collapse
Affiliation(s)
- Sanja Vignjević
- Institute for Medical Research, University of Belgrade, Belgrade, Serbia
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Sekhar M, McVinnie K, Burroughs AK. Splanchnic vein thrombosis in myeloproliferative neoplasms. Br J Haematol 2013; 162:730-47. [PMID: 23855810 DOI: 10.1111/bjh.12461] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Splanchnic vein thrombosis (SVT) is one of the most important complications of myeloproliferative neoplasms (MPN). Although MPN are common causes of SVT, the pathophysiological mechanisms underlying this predisposition, their epidemiology and natural history are not fully understood. Studies have concentrated on the generalized prothrombotic environment generated by MPN and their relationship with abnormal blood counts, thereby furthering our knowledge of arterial and venous thrombosis in this population. In contrast, there are few studies that have specifically addressed SVT in the context of MPN. Recent research has demonstrated in patients with MPN the existence of factors increasing the risk of SVT such as the presence of the JAK2 V617F mutation and its 46/1 haplotype. Features unique to the circulating blood cells, splanchnic vasculature and surrounding micro-environment in patients with MPN have been described. There are also abnormalities in local haemodynamics, haemostatic molecules, the spleen, and splanchnic endothelial and endothelial progenitor cells. This review considers these important advances and discusses the contribution of individual anomalies that lead to the development of SVT in both the pre-neoplastic and overt stage of MPN. Clinical issues relating to epidemiology, recurrence and survival in these patients have also been reviewed and their results discussed.
Collapse
Affiliation(s)
- Mallika Sekhar
- Department of Haematology, Royal Free Hospital, London, UK
| | | | | |
Collapse
|
20
|
Wang X, Prakash S, Lu M, Tripodi J, Ye F, Najfeld V, Li Y, Schwartz M, Weinberg R, Roda P, Orazi A, Hoffman R. Spleens of myelofibrosis patients contain malignant hematopoietic stem cells. J Clin Invest 2013; 122:3888-99. [PMID: 23023702 DOI: 10.1172/jci64397] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 08/02/2012] [Indexed: 01/30/2023] Open
Abstract
Cancer stem cell behavior is thought to be largely determined by intrinsic properties and by regulatory signals provided by the microenvironment. Myelofibrosis (MF) is characterized by hematopoiesis occurring not only in the marrow but also in extramedullary sites such as the spleen. In order to study the effects of these different microenvironments on primitive malignant hematopoietic cells, we phenotypically and functionally characterized splenic and peripheral blood (PB) MF CD34+ cells from patients with MF. MF spleens contained greater numbers of malignant primitive HPCs than PB. Transplantation of PB MF CD34+ cells into immunodeficient (NOD/SCID/IL2Rγ(null)) mice resulted in a limited degree of donor cell chimerism and a differentiation program skewed toward myeloid lineages. By contrast, transplanted splenic MF CD34+ cells achieved a higher level of chimerism and generated both myeloid and lymphoid cells that contained molecular or cytogenetic abnormalities indicating their malignant nature. Only splenic MF CD34+ cells were able to sustain hematopoiesis for prolonged periods (9 months) and were able to engraft secondary recipients. These data document the existence of MF stem cells (MF-SCs) that reside in the spleens of MF patients and demonstrate that these MF-SCs retain a differentiation program identical to that of normal hematopoietic stem cells.
Collapse
Affiliation(s)
- Xiaoli Wang
- Division of Hematology/Oncology, Pathology and Surgery, Tisch Cancer Institute, Myeloproliferative Disorders Research Consortium, Mount Sinai School of Medicine, New York, New York 10029, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|