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Zanelli M, Fragliasso V, Loscocco GG, Sanguedolce F, Broggi G, Zizzo M, Palicelli A, Ricci S, Ambrogi E, Martino G, Aversa S, Coppa F, Gentile P, Gozzi F, Caltabiano R, Koufopoulos N, Asaturova A, Cimino L, Cavazza A, Orcioni GF, Ascani S. Chronic myeloproliferative neoplasms with concomitant CALR mutation and BCR::ABL1 translocation: diagnostic and therapeutic implications of a rare hybrid disease. Front Cell Dev Biol 2024; 12:1391078. [PMID: 38596359 PMCID: PMC11002177 DOI: 10.3389/fcell.2024.1391078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 03/12/2024] [Indexed: 04/11/2024] Open
Abstract
Myeloproliferative neoplasms (MPNs) are subdivided into Philadelphia (Ph) chromosome-positive chronic myeloid leukemia (CML) and Ph-negative MPNs. BCR::ABL1 translocation is essential for the development and diagnosis of CML; on the other hand, the majority of Ph-negative MPNs are characterized by generally mutually exclusive mutations of Janus kinase 2 (JAK2), calreticulin (CALR), or thrombopoietin receptor/myeloproliferative leukemia (MPL). CALR mutations have been described essentially in JAK2 and MPL wild-type essential thrombocythemia and primary myelofibrosis. Rarely coexisting CALR and MPL mutations have been found in Ph-negative MPNs. BCR::ABL1 translocation and JAK2 mutations were initially considered mutually exclusive genomic events, but a discrete number of cases with the combination of these genetic alterations have been reported. The presence of BCR::ABL1 translocation with a coexisting CALR mutation is even more uncommon. Herein, starting from a routinely diagnosed case of CALR-mutated primary myelofibrosis subsequently acquiring BCR::ABL1 translocation, we performed a comprehensive review of the literature, discussing the clinicopathologic and molecular features, as well as the outcome and treatment of cases with BCR::ABL1 and CALR co-occurrence.
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Affiliation(s)
- Magda Zanelli
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Valentina Fragliasso
- Laboratory of Translational Research, Azienda USL-IRCCS di Reggio Emilia, Reggio Emila, Italy
| | - Giuseppe Gaetano Loscocco
- Department of Experimental and Clinical Medicine, CRIMM, Center of Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
- Doctorate School GenOMec, University of Siena, Siena, Italy
| | | | - Giuseppe Broggi
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia” Anatomic Pathology, University of Catania, Catania, Italy
| | - Maurizio Zizzo
- Surgical Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Palicelli
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Stefano Ricci
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Elisa Ambrogi
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giovanni Martino
- Pathology Unit, Azienda Ospedaliera Santa Maria di Terni, University of Perugia, Terni, Italy
- Hematology, Centro di Ricerca Emato-Oncologica-C.R.E.O., University of Perugia, Perugia, Italy
| | - Sara Aversa
- Pathology Unit, Azienda Ospedaliera Santa Maria di Terni, University of Perugia, Terni, Italy
| | - Francesca Coppa
- Pathology Unit, Azienda Ospedaliera Santa Maria di Terni, University of Perugia, Terni, Italy
| | - Pietro Gentile
- Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Fabrizio Gozzi
- Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Rosario Caltabiano
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia” Anatomic Pathology, University of Catania, Catania, Italy
| | - Nektarios Koufopoulos
- Second Department of Pathology, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Aleksandra Asaturova
- Pathology Department, FSBI “National Medical Research Centre for Ostetrics, Gynecology and Perinatology Named After Academician V.I Kulakov” of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Luca Cimino
- Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Alberto Cavazza
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Stefano Ascani
- Pathology Unit, Azienda Ospedaliera Santa Maria di Terni, University of Perugia, Terni, Italy
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Tsilimidos G, Blum S. Comment on: JAK2 V617F-mutated polycythemia vera developing in a patient with a 20-year-long chronic myeloid leukemia at the time of first molecular response. Ann Hematol 2023; 102:2619-2620. [PMID: 37256305 DOI: 10.1007/s00277-023-05297-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 05/23/2023] [Indexed: 06/01/2023]
Affiliation(s)
- Gerasimos Tsilimidos
- Service and Central Laboratory of Haematology, Department of Oncology and Department of Laboratory Medicine and Pathology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.
| | - Sabine Blum
- Service and Central Laboratory of Haematology, Department of Oncology and Department of Laboratory Medicine and Pathology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
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3
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Tosoni L, Fabbro D, Pizzano U, Mullai R, Morelli G, Franzoni A, Damante G, Toffoletti E, Damiani D, Fanin R, Tiribelli M. JAK2 V617F-mutated polycythemia vera developing in a patient with a 20-year-long chronic myeloid leukemia at the time of first molecular response. Ann Hematol 2023; 102:1279-1280. [PMID: 36947213 DOI: 10.1007/s00277-023-05187-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 03/18/2023] [Indexed: 03/23/2023]
Affiliation(s)
- Luca Tosoni
- Division of Hematology and Bone Marrow Transplantation, Azienda Sanitaria Universitaria Friuli Centrale, P.Le S. M. Misericordia 15, 33100, Udine, Italy
| | - Dora Fabbro
- Institute of Medical Genetics, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Umberto Pizzano
- Division of Hematology and Bone Marrow Transplantation, Azienda Sanitaria Universitaria Friuli Centrale, P.Le S. M. Misericordia 15, 33100, Udine, Italy
| | - Rikard Mullai
- Division of Hematology and Bone Marrow Transplantation, Azienda Sanitaria Universitaria Friuli Centrale, P.Le S. M. Misericordia 15, 33100, Udine, Italy
| | - Gianluca Morelli
- Division of Hematology and Bone Marrow Transplantation, Azienda Sanitaria Universitaria Friuli Centrale, P.Le S. M. Misericordia 15, 33100, Udine, Italy
| | - Alessandra Franzoni
- Institute of Medical Genetics, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Giuseppe Damante
- Institute of Medical Genetics, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Eleonora Toffoletti
- Division of Hematology and Bone Marrow Transplantation, Azienda Sanitaria Universitaria Friuli Centrale, P.Le S. M. Misericordia 15, 33100, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Daniela Damiani
- Division of Hematology and Bone Marrow Transplantation, Azienda Sanitaria Universitaria Friuli Centrale, P.Le S. M. Misericordia 15, 33100, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Renato Fanin
- Division of Hematology and Bone Marrow Transplantation, Azienda Sanitaria Universitaria Friuli Centrale, P.Le S. M. Misericordia 15, 33100, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Mario Tiribelli
- Division of Hematology and Bone Marrow Transplantation, Azienda Sanitaria Universitaria Friuli Centrale, P.Le S. M. Misericordia 15, 33100, Udine, Italy.
- Department of Medicine, University of Udine, Udine, Italy.
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Wang Y, Ran F, Lin J, Zhang J, Ma D. Genetic and Clinical Characteristics of Patients with Philadelphia-Negative Myeloproliferative Neoplasm Carrying Concurrent Mutations in JAK2V617F, CALR, and MPL. Technol Cancer Res Treat 2023; 22:15330338231154092. [PMID: 36744404 PMCID: PMC9905029 DOI: 10.1177/15330338231154092] [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] [Indexed: 02/07/2023] Open
Abstract
Simultaneous mutations in Janus kinase 2 (JAK2), calreticulin, and myeloproliferative leukemia (MPL) genes are generally not considered for characterizing Philadelphia-negative myeloproliferative neoplasms (MPNs), leading to misdiagnosis. Sanger sequencing and quantitative polymerase chain reaction were used to detect gene mutations in patients with MPN. We retrospectively screened the data of patients with double mutations in our center and from the PubMed database. Two patients tested positive for both JAK2V617F and CALR mutations (2/352 0.57%) in our center, while data of 35 patients from the PubMed database, including 26 patients with essential thrombocythemia (ET), 6 with primary myelofibrosis (PMF), 2 with unexplained thrombosis, and 1 with polycythemia vera were screened for double mutations. Among these mutations, co-mutation of JAKV617F-CALR constituted the majority (80.0%), when compared with JAKV617F-MPL (17.1%) and CALR-MPL (2.9%) mutations. Moreover, patients with concurrent mutational myeloproliferative neoplasm (MPN) were relatively older (P = .010) with significantly higher platelet counts than their counterparts with single gene mutations (P < .001). The occurrence of palpable splenomegaly (P < .001) and leukocyte count (P = .041) were also significantly different between patients with single and simultaneous gene mutations. These 4 risk factors also showed significant test effectiveness in the ET and PMF cohorts (P < .05). In terms of clinical characteristics of patients with ET, those with JAK2V617F-CALR mutation had higher but normal hemoglobin levels (P = .0151) than those carrying JAK2V617F-MPL mutation. From a clinical perspective, patients with multiple mutational MPN are different from those with single gene mutations. The poor treatment response by patients in our center and unfavorable indicators for patients with co-mutations in published literature indicate that customized treatment may be the best choice for patients with MPN carrying co-mutations.
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Affiliation(s)
- Yan Wang
- Department of Hematology, Affiliated Hospital of Guizhou Medical University, Guizhou Provincial Institute of Hematological Malignancies, Guiyang, China
| | - Fei Ran
- Department of Clinical Laboratory Medicine, Guizhou Provincial People's Hospital, Guiyang, China
| | - Jin Lin
- Jiangxi Province Key Laboratory of Laboratory Medicine, Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jing Zhang
- Jiangxi Province Key Laboratory of Laboratory Medicine, Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Dan Ma
- Department of Hematology, Affiliated Hospital of Guizhou Medical University, Guizhou Provincial Institute of Hematological Malignancies, Guiyang, China,State Key Laboratory of Functions and Applications of Medicinal Plants, Guizhou Medical University, Guiyang, China,Dr Dan Ma, Department of Hematology, Affiliated Hospital of Guizhou Medical University; 28 Guiyi Street, Yunyan District, Guiyang, Guizhou 550004, China.
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5
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Huo L, Xie J, Wang Q, Shen H, Ding Z, Wen L, Zeng Z, Xu Y, Ruan C, Chen S, Xue M. Insights from a rare myeloproliferative neoplasm with coexisting BCR-ABL1 fusion gene, CALR, and TET2 mutations treated with nilotinib and ruxolitinib. Clin Case Rep 2023; 11:e6801. [PMID: 36703773 PMCID: PMC9871410 DOI: 10.1002/ccr3.6801] [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: 01/04/2022] [Revised: 09/04/2022] [Accepted: 12/13/2022] [Indexed: 01/26/2023] Open
Abstract
Myeloproliferative neoplasms (MPNs) with concurrent BCR-ABL1 fusion gene and CALR mutation are especially rare. We report a patient with coexisting BCR-ABL1 fusion gene, CALR, and TET2 mutations who was treated with the combination of the second-generation TKI nilotinib and JAK1/JAK2 inhibitor ruxolitinib.
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Affiliation(s)
- Li Huo
- Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, NHC Key Laboratory of Thrombosis and HemostasisThe First Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Jundan Xie
- Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, NHC Key Laboratory of Thrombosis and HemostasisThe First Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Qian Wang
- Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, NHC Key Laboratory of Thrombosis and HemostasisThe First Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Hongjie Shen
- Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, NHC Key Laboratory of Thrombosis and HemostasisThe First Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Zixuan Ding
- Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, NHC Key Laboratory of Thrombosis and HemostasisThe First Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Lijun Wen
- Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, NHC Key Laboratory of Thrombosis and HemostasisThe First Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Zhao Zeng
- Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, NHC Key Laboratory of Thrombosis and HemostasisThe First Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Yi Xu
- Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, NHC Key Laboratory of Thrombosis and HemostasisThe First Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Changgeng Ruan
- Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, NHC Key Laboratory of Thrombosis and HemostasisThe First Affiliated Hospital of Soochow UniversitySuzhouChina,Collaborative Innovation Center of HematologySoochow UniversitySuzhouChina
| | - Suning Chen
- Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, NHC Key Laboratory of Thrombosis and HemostasisThe First Affiliated Hospital of Soochow UniversitySuzhouChina,Collaborative Innovation Center of HematologySoochow UniversitySuzhouChina
| | - Mengxing Xue
- Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, NHC Key Laboratory of Thrombosis and HemostasisThe First Affiliated Hospital of Soochow UniversitySuzhouChina
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Geng H, Zheng Z, Wang S. BCR::ABL1-positive chronic myeloid leukaemia with CALR mutation. Clin Exp Pharmacol Physiol 2023; 50:425-427. [PMID: 36636958 DOI: 10.1111/1440-1681.13749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 12/18/2022] [Accepted: 12/23/2022] [Indexed: 01/14/2023]
Affiliation(s)
- Haili Geng
- Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fujian Medical Center of Hematology, Fuzhou, Fujian, China
| | - Zhengjin Zheng
- Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fujian Medical Center of Hematology, Fuzhou, Fujian, China
| | - Shaoyuan Wang
- Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fujian Medical Center of Hematology, Fuzhou, Fujian, China
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Zhang Y, Bi H, Wang Y, Chen L, Pan J, Xu P, Wang W, Yang S. BCR-ABL1 is a secondary event after JAK2V617F in a patient with essential thrombocythemia who develop chronic myeloid leukemia. BLOOD SCIENCE 2022; 4:199-204. [PMID: 36518237 PMCID: PMC9742103 DOI: 10.1097/bs9.0000000000000129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/13/2022] [Indexed: 06/17/2023] Open
Abstract
Several cases such as myeloproliferative neoplasms (MPN) with the coexistence of JAK2 and BCR-ABL have been reported. However, cases of transformation of essential thrombocythemia (ET) into chronic myeloid leukemia (CML) during the disease progression were rarely reported. Here, we report the case of a patient with JAK2 V617F- positive ET who subsequently acquired BCR-ABL1, which transformed the disease into CML after 10 years from the initial diagnosis. In this study, we dynamically monitored JAK2 V617F and BCR-ABL and observed multiple gene mutations, including IDH2, IDH1, ASXL1, KRAS, and RUNX1. It is important to be aware of this potentially clone evolution in disease progression.
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Affiliation(s)
- Yanqing Zhang
- Department of Hematology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, P. R. China
| | - Hailiang Bi
- Department of Hematology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, P. R. China
| | - Ying Wang
- The Seventh Affiliated Hospital, Sun Yat-sen of University, Shenzhen, Guangdong, P. R. China
| | - Long Chen
- Department of Hematology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, P. R. China
| | - Jiaqi Pan
- Department of Hematology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, P. R. China
| | - Ping Xu
- Department of Hematology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, P. R. China
| | - Wei Wang
- Department of Hematology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, P. R. China
| | - Shaobin Yang
- Department of Molecular Biology Laboratory, Tianjin SINO-US-Diagnostics Co. Ltd, Tianjin, P. R. China
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Soriani S, Lauricella C, Frungillo N, De Troia BB, Motta V, Cesana C, Guido V, De Canal G, De Paoli E, Veronese S, Bonoldi E, Romitti L. Concomitant JAK2 V617F mutation and rare e1a2 BCR-ABL1 transcript isoform in a patient with Myeloproliferative Neoplasm. CURRENT PROBLEMS IN CANCER: CASE REPORTS 2022. [DOI: 10.1016/j.cpccr.2022.100151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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A Rare Co-Occurrence of Triple Mutations in JAK2, CALR, and MPL in the Same Patient with Myelofibrosis. Case Rep Hematol 2022; 2022:4579122. [PMID: 35237453 PMCID: PMC8885281 DOI: 10.1155/2022/4579122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 11/08/2021] [Accepted: 12/21/2021] [Indexed: 11/17/2022] Open
Abstract
Background. The diagnosis and prognostication of myeloproliferative neoplasm rely on the presence of driver mutations in JAK2, calreticulin (CALR), and MPL mutations. In the past, the presence of these mutations was thought to be mutually exclusive. Since then, there have been multiple reports of the presence of dual mutations. The presence of all three driver mutations in the same patient with myelofibrosis has not been previously described. Case. A 73-year-old female underwent a hematological workup in our facility after a routine hemogram performed prior to complex ophthalmological surgery revealed severe thrombocytosis. A comprehensive workup including an NGS panel for MPN driver mutations demonstrated that she had a calreticulin type-1 mutation, a JAK2 exon 14 (JAK2L611S) mutation, and an abnormal hotspot variant for MPL with VAF1%. A bone marrow biopsy confirmed a myeloproliferative neoplasm with grade 2 reticulin fibrosis suggesting primary myelofibrosis. Molecular profiling of bone marrow confirmed the previously noted mutations and an MPLW515R mutation. The patient was started on treatment with hydroxyurea and aspirin with improvement in platelet count and resolution of anemia. Discussion. The clinical significance of the presence of multiple driver mutations in the same patient is not well understood at this time. There have been 11 publications between 2014 and 2020 that have described dual mutations of JAK2V617F, MPL, and CALR mutations. The JAK2 exon 14 mutation noted, in this case, is JAK2L611S which has not previously been reported in MPN and only reported in 5 cases in the COSMIC database. The JAK2 exon 14 mutation identified in this case is not an established driver mutation for myeloproliferative neoplasm, and its clinical implication remains unknown. Conclusions. The above case in addition to recent case reports and case series supports the use of broader NGS sequencing panels for diagnosis and prognostication of MPN. These mutations should not be considered mutually exclusive. The clinical behavior and prognosis of the subgroup with multiple mutations need to be studied in larger series.
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Frikha R, Turki F, Kassar O, Elloumi M, Kamoun H. Co-existence of BCR-ABL and JAK2V617F mutation in resistant chronic myeloid leukemia in the imatinib era: Is there a correlation? J Oncol Pharm Pract 2021; 27:1784-1789. [PMID: 33567976 DOI: 10.1177/1078155221991646] [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] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Diagnoses of myeloproliferative disorder is based on molecular marker. Chronic Myeloid Leukemia and Myeloproliferative neoplasms were considered mutually exclusive and co-existence of BCR/ABL1 and JAK2 mutation is a rare phenomenon. CASE REPORT Here, we present two cases of co-existence of BCR-ABL and JAK2V617F positivity. We characterize the course of the disease, mainly the minimal residual disease.Management and outcome: The two cases was initially managed as Chronic Myeloid Leukemia and treated by TKI inhibitors. The first one was diagnosed in 2010. He started the first line of TKI, and then switched to second line without obtaining a major molecular response. Hence he was tested for JAK2V617F mutation and positivity was diagnosed. The second patient showed Chronic Myeloid Leukemia phenotype with coexistence of BCR/ABL1 and JAK2 mutation at diagnosis. Molecular monitoring reveals a high BCR-ABL1 transcript level (20%) at the last follow-up (12 months). DISCUSSION Ours results highlight that JAK2V617F/BCR-ABL double positivity may be a potential marker of resistance in Chronic Myeloid Leukemia and clonal molecular analysis is mandatory to elucidate the mechanism. Moreover, the combination of JAK and TKI inhibitors might be effective and potentially be guided by molecular monitoring of minimal residual disease.
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Affiliation(s)
- Rim Frikha
- Department of Medical Genetics, University Hospital of Sfax, Sfax, Tunisia
| | - Fatma Turki
- Department of Medical Genetics, University Hospital of Sfax, Sfax, Tunisia
| | - Olfa Kassar
- Department of Haematology, University Hospital of Sfax, Sfax, Tunisia
| | - Moez Elloumi
- Department of Haematology, University Hospital of Sfax, Sfax, Tunisia
| | - Hassen Kamoun
- Department of Medical Genetics, University Hospital of Sfax, Sfax, Tunisia
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11
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Jang MA, Seo MY, Choi KJ, Hong DS. A Rare Case of Essential Thrombocythemia with Coexisting JAK2 and MPL Driver Mutations. J Korean Med Sci 2020; 35:e168. [PMID: 32537949 PMCID: PMC7295601 DOI: 10.3346/jkms.2020.35.e168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 04/13/2020] [Indexed: 01/14/2023] Open
Abstract
Philadelphia-negative (Ph-) classical myeloproliferative neoplasms (MPNs) include polycythemia vera, essential thrombocythemia (ET), and primary myelofibrosis. Somatic driver mutations in the JAK2, CALR, and MPL genes serve as major diagnostic criteria of the Ph- MPNs and these mutations occur in a mutually exclusive manner. In this report, we describe the first case of ET harboring double mutations in JAK2 V617F and MPL. For MPL, the patient had multiple clones of MPL mutations: c.1543_1546delinsAGGG (p.Trp515_Gln516delinsArgGlu) and c.1546C>G (p.Gln516Glu). The JAK2 V617F allele burden in our patient is very low (4%) compared to the relatively high (17%-78%) allele frequency of MPL mutations. The low JAK2 mutant burden might be explained by preexisting clonal hematopoiesis before overt signs of MPNs, followed by the acquisition of a second oncogenic mutation of CALR or MPL leading to the MPN phenotype. This highlights that screening for a second driver mutation should be considered in patients with a low JAK2 mutant burden by reporting a 57-year-old Korean man with ET.
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Affiliation(s)
- Mi Ae Jang
- Department of Laboratory Medicine and Genetics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea.
| | - Mi Yeon Seo
- Department of Laboratory Medicine and Genetics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Kyoung Jin Choi
- Department of Laboratory Medicine and Genetics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Dae Sik Hong
- Division of Hematology & Oncology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
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Ong J, Lin JI, Mitchell H, Morgan S, Perkins AC. Clinical acceleration of JAK2 p.V617F driven myeloproliferative disease due to a new uncommon homozygous MPL p.Y591D mutation. Haematologica 2020; 105:e428-e431. [PMID: 32499240 DOI: 10.3324/haematol.2020.250969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Jeremy Ong
- Department of Pathology, Alfred Health, Melbourne, Australia.,Department of Clinical Haematology, Alfred Health, Melbourne, Australia
| | - Jane I Lin
- Department of Pathology, Alfred Health, Melbourne, Australia
| | - Helen Mitchell
- Australian Centre for Blood Diseases, Monash University, Melbourne, Australia
| | - Susan Morgan
- Department of Clinical Haematology, Alfred Health, Melbourne, Australia
| | - Andrew C Perkins
- Australian Centre for Blood Diseases, Monash University, Melbourne, Australia .,Department of Clinical Haematology, Alfred Health, Melbourne, Australia
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Mutation profiles of classic myeloproliferative neoplasms detected by a customized next-generation sequencing-based 50-gene panel. JOURNAL OF BIO-X RESEARCH 2020. [DOI: 10.1097/jbr.0000000000000061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Langabeer SE. Concurrent chronic myeloid leukemia and CALR-mutated myeloproliferative neoplasm. EXCLI JOURNAL 2020; 19:86-88. [PMID: 32038118 PMCID: PMC7003640 DOI: 10.17179/excli2019-2063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 01/06/2020] [Indexed: 01/07/2023]
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Liu C, Hu R, Du Z, Abecasis M, Wang C. Atypical myeloproliferative neoplasm with concurrent BCR-ABL1 fusion and CALR mutation: A case report and literature review. Medicine (Baltimore) 2020; 99:e18811. [PMID: 32000382 PMCID: PMC7004640 DOI: 10.1097/md.0000000000018811] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Concurrent calreticulin (CALR) mutation and BCR-ABL1 fusion are extremely rare in chronic myelogenous leukemia; to date, only 12 cases have been reported. PATIENT CONCERNS A 57-year-old male who had an 11-year history of essential thrombocytosis presented to our hospital with leukocytosis and marked splenomegaly for 3 months. DIAGNOSES Chronic myelogenous leukemia with myeloid fibrosis arising on the background of essential thrombocytosis harboring both BCR-ABL1 fusion and type-1 like CALR mutation. INTERVENTIONS Imatinib was started at 300 mg daily and increased to 400 mg daily after 3 months; interferon was added after 12 months. OUTCOMES Partial cytogenetic response was achieved after 3 months of imatinib therapy and complete cytogenetic response was achieved after 1 year of treatment. However, CALR mutation was still present with a stable mutational allele burden. LESSONS In this case report and review of additional 12 cases with simultaneous presence of CALR-mutation and BCR-ABL1 fusion, we highlighted the importance of integrating clinical, morphological, and molecular genetic data for classifying atypical myeloid neoplasms.
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MESH Headings
- Antineoplastic Agents/pharmacology
- Antineoplastic Agents/therapeutic use
- Calreticulin/genetics
- Fusion Proteins, bcr-abl/genetics
- Genes, abl
- Humans
- Imatinib Mesylate/pharmacology
- Imatinib Mesylate/therapeutic use
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Male
- Middle Aged
- Protein-Tyrosine Kinases/antagonists & inhibitors
- Thrombocythemia, Essential/complications
- Thrombocythemia, Essential/genetics
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Affiliation(s)
- Chunshui Liu
- Department of Hematology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Ruiping Hu
- Department of Hematology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Zhonghua Du
- Department of Hematology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Manuel Abecasis
- Department of Hematology, Instituto Português de Oncologia de Francisco Gentil, Lisbon, Portugal
| | - Cong Wang
- Department of Hematology, The First Hospital of Jilin University, Changchun, Jilin, China
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Ye MT, Wang Y, Wang SA, Pemmaraju N, Daver N, Verstovsek S, Zhang Y, Zuo Z, Medeiros LJ, You MJ. Concurrent JAK2 V617F and MPL W515L in myelodysplastic/myeloproliferative neoplasm with ring sideroblasts and thrombocytosis. Leuk Lymphoma 2019; 61:963-966. [PMID: 31750750 DOI: 10.1080/10428194.2019.1691202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Matthew T Ye
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yi Wang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Hematology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjing, China
| | - Sa A Wang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Naveen Pemmaraju
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Naval Daver
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Srdan Verstovsek
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yizhuo Zhang
- Department of Pediatric Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, China
| | - Zhuang Zuo
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M James You
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Kelkar K, Ramanan V, Anand S, Ranade S, Patil K, Agarwal M, Phadke N. Co-occurrence of CALR and MPL somatic mutations in an Indian patient with a Philadelphia-negative myeloproliferative neoplasm. J Hematop 2019. [DOI: 10.1007/s12308-019-00359-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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18
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Shi XB, Jiang JF, Jin FX, Cheng W. Coexistence of breakpoint cluster region-Abelson1 rearrangement and Janus kinase 2 V617F mutation in chronic myeloid leukemia: A case report. World J Clin Cases 2019; 7:1087-1092. [PMID: 31123683 PMCID: PMC6511928 DOI: 10.12998/wjcc.v7.i9.1087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 03/21/2019] [Accepted: 03/26/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The Janus kinase 2 (JAK2) V617F mutation is common in patients with breakpoint cluster region-Abelson1 (BCR-ABL1)-negative myeloproliferative neoplasms, including polycythemia vera, essential thrombocythemia and primary myelofibrosis, but is rarely detected in BCR-ABL1-positive chronic myeloid leukemia (CML) patients. Here, we report a CML patient with both a BCR-ABL1 rearrangement and JAK2 V617F mutation.
CASE SUMMARY A 45-year-old Chinese woman was admitted to our department with a history of significant thrombocytosis for 20 d. Color Doppler ultrasound examination showed mild splenomegaly. Bone marrow aspiration revealed a karyotype of 46, XX, t(9;22)(q34;q11.2) in 20/20 metaphases by cytogenetic analysis, rearrangement of BCR-ABL1 (32.31%) by fluorescent polymerase chain reaction (PCR) and mutation of JAK2 V617F (10%) by PCR and Sanger DNA sequencing. The patient was diagnosed with CML and JAK2 V617F mutation. Following treatment with imatinib for 3 mo, the patient had an optimal response and BCR-ABL1 (IS) was 0.143%, while the mutation rate of JAK2 V617F rose to 15%.
CONCLUSION Emphasis should be placed on the detection of JAK2 mutation when CML is diagnosed to distinguish JAK2 mutation-positive CML and formulate treatment strategies.
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Affiliation(s)
- Xue-Bing Shi
- Department of Hematology and Oncology, Tongling People’s Hospital, Tongling 244000, Anhui Province, China
| | - Ji-Fa Jiang
- Department of Hematology and Oncology, Tongling People’s Hospital, Tongling 244000, Anhui Province, China
| | - Feng-Xiang Jin
- Department of Hematology and Oncology, Tongling People’s Hospital, Tongling 244000, Anhui Province, China
| | - Wei Cheng
- Department of Hematology and Oncology, Tongling People’s Hospital, Tongling 244000, Anhui Province, China
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