Myeloproliferative Neoplasms (MPN): Recent Advances, Current Practices and Future Perspectives

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Hematology".

Deadline for manuscript submissions: 30 April 2025 | Viewed by 4580

Special Issue Editor


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Guest Editor
Faculty of Science, Medicine and Health, Graduate School of Medicine, University of Wollongong, Wollongong, NSW 2522, Australia
Interests: nutritional deficiency anaemias; myeloproliferative neoplasms; indolent/low-grade lymphoproliferative disorders; plasma cell dyscrasias

Special Issue Information

Dear Colleagues,

During the last two decades, our understanding of the pathogenesis of Ph-ve chronic myeloproliferative neoplasms.

(MPN: polycythemia vera, essential thrombocythemia and myelofibrosis) has increased significantly. Treatment of patients with MPN has also improved with the introduction of long-acting interferons for cytoreduction and use of JAK-2 inhibitor therapy for symptom relief in patients with myelofibrosis. Risk assessment and prevention of thrombosis have been the focus for several studies. Despite these advances, there are several areas of uncertainty in the management of MPN patients, e.g., dosage schedules for hydroxyurea therapy; indication for the use of aspirin for thromboprophylaxis; dosage schedules for aspirin prophylaxis; choice of JAK-2 inhibitor therapy and the use of cytoreductive therapy in conjunction with JAK-2 inhibitor therapy in patients with myelofibrosis.

The proposed Special Issue aims to record all the recent developments and current management practices, as well as outline possible areas of future research to improve clinical outcomes in patients with MPN.

Suggested Topics:

  • Pathogenesis of MPN and diagnosis in the era of molecular studies;
  • Risk assessment for thrombosis and initiation of thromboprophylaxis;
  • Prognosis and treatment of patients with polycythemia vera;
  • Prognosis and treatment of patients with essential thrombocythemia;
  • Prognosis and treatment of patients with myelofibrosis;
  • Long-term complications in patients with MPN.

Prof. Dr. Arumugam Manoharan
Guest Editor

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Keywords

  • diagnosis
  • pathogenesis
  • prognosis
  • thromboprophylaxis
  • treatment

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Published Papers (4 papers)

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Research

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9 pages, 1517 KiB  
Article
Translation, Cultural Adaptation, and Validation into Romanian of the Myeloproliferative Neoplasm Symptom Assessment Form—Total Symptom Score (MPN-SAF TSS or MPN-10) Questionnaire
by Mihnea-Alexandru Găman, Robyn Marie Scherber, Iulia Ursuleac, Ana Manuela Crişan, Sorina Nicoleta Bădeliţă, Bogdan Octavian Ionescu, Alexandra Elena Ghiaur, Melen Brînză, Nicoleta Pîrciulescu, Toma Octavian Lascăr, Camelia Cristina Diaconu, Amelia Maria Găman and Daniel Coriu
J. Clin. Med. 2024, 13(11), 3284; https://doi.org/10.3390/jcm13113284 - 2 Jun 2024
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Abstract
Background: Patients with myeloproliferative neoplasms (MPNs) experience a high disease-related symptom burden. A specific instrument to evaluate quality of life (QoL), i.e., the MPN Symptom Assessment Form Total Symptom Score (MPN-SAF TSS; MPN-10), was developed. We conducted the translation, cultural adaptation, and validation [...] Read more.
Background: Patients with myeloproliferative neoplasms (MPNs) experience a high disease-related symptom burden. A specific instrument to evaluate quality of life (QoL), i.e., the MPN Symptom Assessment Form Total Symptom Score (MPN-SAF TSS; MPN-10), was developed. We conducted the translation, cultural adaptation, and validation into Romanian of the MPN-10. Methods: We translated the MPN-10 and tested its psychometric properties. Results: We recruited 180 MPN patients: 66 polycythemia vera (36.67%), 61 essential thrombocythemia (33.89%), 51 primary and secondary myelofibrosis (SMF) (28.33%), and 2 MPN-unclassifiable (1.11%). The mean TSS was 19.51 ± 16.51 points. Fatigue, inactivity, and concentration problems were the most cumbersome symptoms. We detected scoring differences between MPN subtypes regarding weight loss (p < 0.001), fatigue (p = 0.006), early satiety (p = 0.007), night sweats (p = 0.047), pruritus (p = 0.05), and TSS (p = 0.021). There were strong positive associations between TSS and inactivity, fatigue, and concentration problems, and moderate negative correlations between QoL scores and all MPN-10 items. Cronbach’s α internal consistency coefficient was 0.855. The Kaiser–Meyer–Olkin construct validity test result was 0.870 and the Bartlett Sphericity Test was significant (p < 0.001). Symptom scores were loaded into one single factor according to the exploratory factor analysis. Conclusions: The Romanian MPN-10 version displayed excellent psychometric properties and is a reliable instrument for assessing symptom burden and QoL in Romanian MPN patients. Full article
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Review

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26 pages, 1685 KiB  
Review
Myeloproliferative Neoplasms: Challenging Dogma
by Jerry L. Spivak
J. Clin. Med. 2024, 13(22), 6957; https://doi.org/10.3390/jcm13226957 - 19 Nov 2024
Viewed by 530
Abstract
Myeloproliferative neoplasms, polycythemia vera, essential thrombocytosis, and primary myelofibrosis are a unique group of clonal hematopoietic stem cell neoplasms that share somatic, gain-in-function driver mutations in JAK2, CALR, and MPL. As a consequence, these disorders exhibit similar phenotypic features, the [...] Read more.
Myeloproliferative neoplasms, polycythemia vera, essential thrombocytosis, and primary myelofibrosis are a unique group of clonal hematopoietic stem cell neoplasms that share somatic, gain-in-function driver mutations in JAK2, CALR, and MPL. As a consequence, these disorders exhibit similar phenotypic features, the most common of which are the ceaseless production of normal erythrocytes, myeloid cells, platelets alone or in combination, extramedullary hematopoiesis, myelofibrosis, and a potential for leukemic transformation. In the case of polycythemia vera and essential thrombocytosis, however, prolonged survival is possible. With an incidence value in the range of 0.5–2.0/100,000, myeloproliferative neoplasms are rare disorders, but they are not new disorders, and after a century of scrutiny, their clinical features and natural histories are well-defined, though their individual management continues to be controversial. With respect to polycythemia vera, there has been a long-standing dispute between those who believe that the suppression of red blood cell production by chemotherapy is superior to phlebotomy to prevent thrombosis, and those who do not. With respect to essential thrombocytosis, there is a similar dispute about the role of platelets in veinous thrombosis, and the role of chemotherapy in preventing thrombosis by suppressing platelet production. Linked to these disputes is another: whether therapy with hydroxyurea promotes acute leukemia in disorders with a substantial possibility of longevity. The 21st century revealed new insights into myeloproliferative neoplasms with the discovery of their three somatic, gain-of-function driver mutations. Almost immediately, this triggered changes in the diagnostic criteria for myeloproliferative neoplasms and their therapy. Most of these changes, however, conflicted with prior well-validated, phenotypically driven diagnostic criteria and the management of these disorders. The aim of this review is to examine these conflicts and demonstrate how genomic discoveries in myeloproliferative neoplasms can be used to effectively complement the known phenotypic features of these disorders for their diagnosis and management. Full article
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13 pages, 757 KiB  
Review
Thrombotic, Cardiovascular, and Microvascular Complications of Myeloproliferative Neoplasms and Clonal Hematopoiesis (CHIP): A Narrative Review
by Andrew I. Schafer and Douglas L. Mann
J. Clin. Med. 2024, 13(20), 6084; https://doi.org/10.3390/jcm13206084 - 12 Oct 2024
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Abstract
The most common causes of morbidity and mortality in the myeloproliferative neoplasms (MPNs), with the exception of myelofibrosis, are venous and arterial thrombosis, as well as more recently discovered cardiovascular disease (CVD). Clonal hematopoiesis of indeterminate potential (CHIP) is the subclinical finding in [...] Read more.
The most common causes of morbidity and mortality in the myeloproliferative neoplasms (MPNs), with the exception of myelofibrosis, are venous and arterial thrombosis, as well as more recently discovered cardiovascular disease (CVD). Clonal hematopoiesis of indeterminate potential (CHIP) is the subclinical finding in an individual of somatic mutations that are also found in clinically overt MPNs and other myeloid malignancies. The prevalence of “silent” CHIP increases with age. CHIP can transform into a clinically overt MPN at an estimated rate of 0.5 to 1% per year. It is likely, therefore, but not proven, that many, if not all, MPN patients had antecedent CHIP, possibly for many years. Moreover, both individuals with asymptomatic CHIP, as well as clinically diagnosed patients with MPN, can develop thrombotic complications. An unexpected and remarkable discovery during the last few years is that even CHIP (as well as MPNs) are significant, independent risk factors for CVD. This review discusses up-to-date information on the types of thrombotic and cardiovascular complications that are found in CHIP and MPN patients. A systemic inflammatory state (that is often subclinical) is most likely to be a major mediator of adverse reciprocal bone marrow–cardiovascular interplay that may fuel the development of progression of MPNs, including its thrombotic and vascular complications, as well as the worsening of cardiovascular disease, possibly in a “vicious cycle”. Translating this to clinical practice for hematologists and oncologists who treat MPN patients, attention should now be paid to ensuring that cardiovascular risk factors are controlled and minimized, either by the patient’s cardiologist or primary care physician or by the hematologist/oncologist herself or himself. This review is intended to cover the clinical aspects of thrombosis and cardiovascular complications in the MPN, accompanied by pathobiological comments. Full article
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15 pages, 442 KiB  
Review
Impact of Phlebotomy on Quality of Life in Low-Risk Polycythemia Vera
by Nathan Visweshwar, Bradley Fletcher, Michael Jaglal, Damian A. Laber, Ankita Patel, Jennifer Eatrides, Geetha Rajasekharan Rathnakumar, Keshav Visweswaran Iyer, Irmel Ayala and Arumugam Manoharan
J. Clin. Med. 2024, 13(16), 4952; https://doi.org/10.3390/jcm13164952 - 22 Aug 2024
Viewed by 1675
Abstract
Polycythemia vera is an indolent myeloproliferative disorder that predisposes patients to venous and arterial thrombosis and can transform into myelofibrosis and acute myeloid leukemia. Consistent phlebotomy prevents life-threatening cerebrovascular and coronary artery disease and prolongs survival in low-risk polycythemia vera (patients under 60 [...] Read more.
Polycythemia vera is an indolent myeloproliferative disorder that predisposes patients to venous and arterial thrombosis and can transform into myelofibrosis and acute myeloid leukemia. Consistent phlebotomy prevents life-threatening cerebrovascular and coronary artery disease and prolongs survival in low-risk polycythemia vera (patients under 60 years without thrombosis). However, despite its effectiveness in preventing serious complications, phlebotomy does not necessarily enhance the quality of life (QoL). This review assesses QoL issues associated with low-risk PV, explores alternative management strategies such as erythrocytapheresis, and discusses the roles of hydroxyurea, peginterferon, ruxolitinib, and other novel agents in potentially improving disease management and patient outcomes. Full article
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Planned Papers

The below list represents only planned manuscripts. Some of these manuscripts have not been received by the Editorial Office yet. Papers submitted to MDPI journals are subject to peer-review.

Title: The Myeloproliferative Neoplasms: Challenging Dogma
Authors: Jerry L. Spivak
Affiliation: Johns Hopkins University School of Medicine
Abstract: The myeloproliferative neoplasms, polycythemia vera, essential thrombocytosis and primary myelofibrosis are a unique group of clonal hematopoietic stem cell neoplasms which share somatic, gain-in-function driver mutations in JAK2, CALR and MPL. As a consequence, these disorders exhibit similar phenotypic features, the most common of which are the ceaseless production of normal erythrocytes, myeloid cells, and platelets alone or in combination, extramedullary hematopoiesis, myelofibrosis, and a potential leukemic transformation. In the case of polycythemia vera and essential thrombocytosis, however, prolonged survival is possible. With an incidence of 0.5 – 2.0/100,000, the myeloproliferative neoplasms are rare disorders, but they are not new disorders, and after a century of scrutiny, their clinical features and natural histories are well-defined, though their individual management continues to be controversial. With respect to polycythemia vera, there has been a long-standing dispute between those who believe suppression of red blood cell production by chemotherapy is superior to phlebotomy to prevent thrombosis, and those who do not. With respect to essential thrombocytosis, there is a similar dispute about the role of platelets in thrombosis, and the role of chemotherapy in their suppression. Linked to these disputes is another: whether therapy with hydroxyurea promotes acute leukemia in disorders with a substantial chance of longevity. The 21st century brought new insight into the myeloproliferative neoplasms with the discovery of their three somatic, gain-of-function driver mutations. Almost immediately, this triggered changes in the diagnostic criteria for the myeloproliferative neoplasms and their therapy. Most of these changes, however, conflicted with the prior well-validated phenotypically-driven diagnostic criteria and management of these disorders. The aim of this review is to examine these conflicts and demonstrate how the genomic discoveries in the myeloproliferative neoplasms can be used to effectively complement the known phenotypic features of these disorders in their diagnosis and management.

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