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Smallbone P, Louw A, Purtill D. Laboratory methods of monitoring disease response after allogeneic haematopoietic stem cell transplantation for myelofibrosis. Pathology 2024; 56:24-32. [PMID: 38071159 DOI: 10.1016/j.pathol.2023.10.003] [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] [Received: 07/08/2023] [Revised: 09/10/2023] [Accepted: 10/06/2023] [Indexed: 01/24/2024]
Abstract
The era of molecular prognostication in myelofibrosis has allowed comprehensive assessment of disease risk and informed decisions regarding allogeneic haematopoietic stem cell transplantation (HSCT). However, monitoring disease response after transplantation is difficult, and limited by disease and sample-related factors. The emergence of laboratory techniques sensitive enough to monitor measurable residual disease is promising in predicting molecular and haematological relapse and guiding management. This paper summarises the existing literature regarding methods for detecting and monitoring disease response after HSCT in myelofibrosis and explores the therapeutic use of measurable residual disease (MRD) assays in transplant recipients. Laboratory assessment of disease response in myelofibrosis post-allogeneic transplant is limited by disease and treatment characteristics and by the sensitivity of available conventional molecular assays. The identification of MRD has prognostic implications and may allow early intervention to prevent relapse. Further applicability is limited by mutation-specific assay variability, a lack of standardisation and sample considerations.
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Affiliation(s)
- Portia Smallbone
- Department of Haematology, Fiona Stanley Hospital, Perth, WA, Australia; PathWest, Fiona Stanley Hospital, Perth, WA, Australia.
| | - Alison Louw
- PathWest, Fiona Stanley Hospital, Perth, WA, Australia
| | - Duncan Purtill
- Department of Haematology, Fiona Stanley Hospital, Perth, WA, Australia; PathWest, Fiona Stanley Hospital, Perth, WA, Australia
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A case of JAK2V617F-positive essential thrombocythemia where allele burden was reduced by a PD-1 inhibitor. Int J Hematol 2021; 113:606-610. [PMID: 33389657 DOI: 10.1007/s12185-020-03046-x] [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: 08/26/2020] [Revised: 11/14/2020] [Accepted: 11/17/2020] [Indexed: 10/22/2022]
Abstract
The Janus kinase/signal transducers and activators of transcription signaling pathway induces programmed death ligand-1 (PD-L1) expression. JAK2 mutation at position 617 (JAK2V617) is a frequent driver of myeloproliferative neoplasms (MPN) through PD-L1 expression. Although PD-1 inhibitors should be effective against MPN with JAK2V617F mutation, this has not yet been reported in humans. Thus, we assessed the efficacy of a PD-1 inhibitor in a lung cancer patient with JAK2V617F-positive essential thrombocythemia (ET). A 71-year-old man was diagnosed with ET, and with lung carcinoma 3 years later. After right lobectomy and postoperative chemotherapy, pembrolizumab [a PD-1 inhibitor (200 mg, every 3 weeks)] was initiated for refractory lung carcinoma. Lung cancer progression did not occur for 1.5 years under treatment. Most megakaryocytes were PD-L1-positive, and after pembrolizumab initiation, platelet count remained below 45 × 104/μL without the need for other cytoreductive therapies for ET. The JAK2V617F allele burden gradually decreased from 11.5% at diagnosis to 2.9% after 17 months of pembrolizumab treatment. Other peripheral blood lineages did not decrease, and pembrolizumab treatment was continued without any adverse events. This is the first report demonstrating the effectiveness of pembrolizumab in an MPN patient with JAK2V617F mutation.
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Fontanelli G, Baratè C, Ciabatti E, Guerrini F, Grassi S, Del Re M, Morganti R, Petrini I, Arici R, Barsotti S, Metelli MR, Danesi R, Galimberti S. Real-Time PCR and Droplet Digital PCR: two techniques for detection of the JAK2(V617F) mutation in Philadelphia-negative chronic myeloproliferative neoplasms. Int J Lab Hematol 2015; 37:766-73. [PMID: 26189968 DOI: 10.1111/ijlh.12404] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 06/19/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Philadelphia-negative chronic myeloproliferative neoplasms (MPNs) are clonal disorders that present JAK2(V617F) mutation in 50-95% of cases. The main objective of this study was the comparison of two PCR methods, real-time (qPCR) and droplet digital PCR (DD-PCR) for detection of the JAK2(V617F) mutation, to assess analytic sensitivity, specificity, and feasibility of the two methods. METHODS Ninety-nine patients with MPN of 225 presenting the JAK2(V617F) mutation by qPCR have been evaluated by DD-PCR also. RESULTS We demonstrated an absolute concordance in terms of specificity between the two methods, DD-PCR showing a higher sensitivity (half a log higher than qPCR). As expected, a progressive increase of mutant allele burden was observed from essential thrombocythemia (ET) to polycythemia vera (PV) and primary myelofibrosis (PMF) to secondary myelofibrosis (SMF). CONCLUSION In conclusion, our study showed that DD-PCR could represent a new and promising technological evolution for detection of JAK2 mutation in MPNs.
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Affiliation(s)
- G Fontanelli
- U.O. Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - C Baratè
- U.O. Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - E Ciabatti
- U.O. Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,GenOMEC, University of Siena, Siena, Italy
| | - F Guerrini
- U.O. Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - S Grassi
- U.O. Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - M Del Re
- U.O. Pharmacology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - R Morganti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - I Petrini
- Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - R Arici
- U.O. Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - S Barsotti
- U.O. Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - M R Metelli
- U.O. Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - R Danesi
- U.O. Pharmacology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - S Galimberti
- U.O. Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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