CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2015; 36(01): 3-16
DOI: 10.4103/0971-5851.151770
POSITION PAPER

Myeloproliferative neoplasms working group consensus recommendations for diagnosis and management of primary myelofibrosis, polycythemia vera, and essential thrombocythemia

M. B. Agarwal
Department of Hematology, Bombay Hospital Institute of Medical Sciences, India
,
Hemant Malhotra
Division of Medical Oncology, RK Birla Cancer Center, SMS Medical College Hospital, Jaipur, Rajasthan, India
,
Prantar Chakrabarti
Department of Hematology, NRS Medical College, Kolkata, West Bengal, India
,
Neelam Varma
Department of Hematology and Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Vikram Mathews
Department of Hematology, Christian Medical College, Vellore, Tamil Nadu, India
,
Jina Bhattacharyya
Department of Clinical Hematology, Guwahati Medical College and Hospital, Assam, India
,
Tulika Seth
Department of Hematology, All India Institute of Medical Sciences, Delhi Cantonment, India
,
K. Gayathri
Department of Hematopathology, Lifeline Tapadia Diagnostic Centre, Hyderabad, Telangana, India
,
Hari Menon
Department of Medical Oncology, Tata Memorial Hospital,, Mumbai, Maharashtra, India
,
P. G. Subramanian
Hematopathology Laboratory, Tata Memorial Hospital, Mumbai, Maharashtra, India
,
Ajay Sharma
Department of Hematology and Center for Stem Cell Transplantation and Research, Army Research and Referral Hospital, Delhi Cantonment, Delhi, India
,
Maitreyee Bhattacharyya
Institute of Hematology and Transfusion Medicine, Medical College, Kolkata, West Bengal, India
,
Jay Mehta
Centre of Excellence in Histopathology, SRL Diagnostics, Dadar, Mumbai, Maharashtra, India
,
A. K. Vaid
13Cancer Institute-Division of Medical Oncology and Haemotology, Medanta-The Medicity, New Delhi, India
,
Sandeep Shah
Department of Medical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
,
Shyam Aggarwal
Department of Medical Oncology, Sir Ganga Ram Hospital, New Delhi, India
,
P. K. Gogoi
East India Hematological Centre, Rajgarh Road, Guwahati, Assam,, India
,
Reena Nair
Department of Clinical Hematology, Tata Medical Centre, Kolkata, West Bengal,, India
,
Usha Agarwal
18Ashirwad Hematology Centre, Dadar, Mumbai, Maharashtra, India
,
Subhash Varma
19Pathology, Christian Medical College, Vellore, Tamil Nadu, India
,
S. V. S. S. Prasad
Division of Medical Oncology, Apollo Cancer Hospitals, Hyderabad, Telangana, India
,
Marie Therese Manipadam
Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
› Author Affiliations

E X E C U T I V E S U M M A R Y

According to the 2008 revision of the World Health Organization (WHO) classification of myeloid malignancies, philadelphia chromosome (Ph)-negative myeloproliferative neoplasms (MPNs) include clonal, hematologic disorders such as polycythemia vera, primary myelofibrosis, and essential thrombocythemia. Recent years have witnessed major advances in the understanding of the molecular pathophysiology of these rare subgroups of chronic, myeloproliferative disorders. Identification of somatic mutations in genes associated with pathogenesis and evolution of these myeloproliferative conditions (Janus Kinase 2; myeloproliferative leukemia virus gene; calreticulin) led to substantial changes in the international guidelines for diagnosis and treatment of Ph-negative MPN during the last few years. The MPN-Working Group (MPN-WG), a panel of hematologists with expertise in MPN diagnosis and treatment from various parts of India, examined applicability of this latest clinical and scientific evidence in the context of hematology practice in India. This manuscript summarizes the consensus recommendations formulated by the MPN-WG that can be followed as a guideline for management of patients with Ph-negative MPN in the context of clinical practice in India.



Publication History

Article published online:
12 July 2021

© 2015. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 
  • References

  • 1 Tefferi A, Vainchenker W. Myeloproliferative neoplasms: Molecular pathophysiology, essential clinical understanding, and treatment strategies. J Clin Oncol 2011;29:573-82.
  • 2 Cervantes F, Tassies D, Salgado C, Rovira M, Pereira A, Rozman C. Acute transformation in nonleukemic chronic myeloproliferative disorders: Actuarial probability and main characteristics in a series of 218 patients. Acta Haematol 1991;85:124-7.
  • 3 Mesa RA, Niblack J, Wadleigh M, Verstovsek S, CamorianoJ, Barnes S, et al. The burden of fatigue and quality of life in myeloproliferative disorders (MPDs): An international Internet-based survey of 1179 MPD patients. Cancer 2007;109:68-76.
  • 4 Moulard O, Mehta J, Fryzek J, Olivares R, Iqbal U, Mesa RA. Epidemiology of myelofibrosis, essential thrombocythemia, and polycythemia vera in the European Union. Eur J Haematol 2014;92:289-97.
  • 5 Mehta J, Wang H, Iqbal SU, Mesa R. Epidemiology of myeloproliferative neoplasms in the United States. Leuk Lymphoma 2014;55:595-600.
  • 6 Scott LM, Tong W, Levine RL, Scott MA, Beer PA, Stratton MR, et al. JAK2 exon 12 mutations in polycythemia vera and idiopathic erythrocytosis. N Engl J Med 2007;356:459-68.
  • 7 Oh ST, Simonds EF, Jones C, Hale MB, Goltsev Y, Gibbs KD Jr, et al. Novel mutations in the inhibitory adaptor protein LNK drive JAK-STAT signaling in patients with myeloproliferative neoplasms. Blood 2010;116:988-92.
  • 8 Pikman Y, Lee BH, Mercher T, McDowell E, Ebert BL, Gozo M, et al. MPLW515L is a novel somatic activating mutation in myelofibrosis with myeloid metaplasia. PLoS Med 2006;3:e270.
  • 9 Andersen CL, Andreasson B, Hasselbalch H, Hultcrantz M, Knutsen H, Lindgren M, et al. Nordic guidelines on the diagnosis and treatment of patients with Myeloproliferative Neoplasms. January 2013. Available from: http://www.nmpn.org/index.php/guidelines/1-nmpn-guidelines-2013/file. [Last accessed on 2014 Dec 04].
  • 10 Barbui T, Barosi G, Birgegard G, Cervantes F, Finazzi G, Griesshammer M, et al. Philadelphia-negative classical myeloproliferative neoplasms: Critical concepts and management recommendations from European LeukemiaNet. J Clin Oncol 2011;29:761-70.
  • 11 Cervantes F, Dupriez B, Pereira A, Passamonti F, Reilly JT, Morra E, et al. New prognostic scoring system for primary myelofibrosis based on a study of the International Working Group for Myelofibrosis Research and Treatment. Blood 2009;113:2895-901.
  • 12 Passamonti F, Cervantes F, Vannucchi AM, Morra E, Rumi E, Pereira A, et al. A dynamic prognostic model to predict survival in primary myelofibrosis: A study by the IWG-MRT (International Working Group for Myeloproliferative Neoplasms Research and Treatment). Blood 2010;115:1703-8.
  • 13 Gangat N, Caramazza D, Vaidya R, George G, Begna K, Schwager S, et al. DIPSS plus: A refined Dynamic International Prognostic Scoring System for primary myelofibrosis that incorporates prognostic information from karyotype, platelet count, and transfusion status. J Clin Oncol 2011;29:392-7.
  • 14 Huang J, Tefferi A. Erythropoiesis stimulating agents have limited therapeutic activity in transfusion-dependent patients with primary myelofibrosis regardless of serum erythropoietin level. Eur J Haematol 2009;83:154-5.
  • 15 Hasselbalch HC, Clausen NT, Jensen BA. Successful treatment of anemia in idiopathic myelofibrosis with recombinant human erythropoietin. Am J Hematol 2002;70:92-9.
  • 16 Thapaliya P, Tefferi A, Pardanani A, Steensma DP, Camoriano J, Wu W, et al. International working group for myelofibrosis research and treatment response assessment and long-term follow-up of 50 myelofibrosis patients treated with thalidomide-prednisone based regimens. Am J Hematol 2011;86:96-8.
  • 17 Barosi G, Rosti V, Vannucchi AM. Therapeutic approaches in myelofibrosis. Expert Opin Pharmacother 2011;12:1597-611.
  • 18 Löfvenberg E, Wahlin A. Management of polycythaemia vera, essential thrombocythaemia and myelofibrosis with hydroxyurea. Eur J Haematol 1988;41:375-81.
  • 19 Manoharan A. Management of myelofibrosis with intermittent hydroxyurea. Br J Haematol 1991;77:252-4.
  • 20 Verstovsek S, Mesa RA, Gotlib J, Levy RS, Gupta V, DiPersio JF, et al. A double-blind, placebo-controlled trial of ruxolitinib for myelofibrosis. N Engl J Med 2012;366:799-807.
  • 21 Harrison C, Kiladjian JJ, Al-Ali HK, Gisslinger H, Waltzman R, Stalbovskaya V, et al. JAK inhibition with ruxolitinib versus best available therapy for myelofibrosis. N Engl J Med 2012;366:787-98.
  • 22 Mead A, Clark R, Chacko J, Knapper S, Yin J, Milojkovic D, et al. Response to ruxolitinib in patients with intermediate-1, intermediate-2 and high-risk myelofibrosis: Results of the UK Robust trial. Haematologica 2014;99 suppl 1:414. [Abstract].
  • 23 Cervantes F. How I treat myelofibrosis. Blood 2014;124:2635-42.
  • 24 Jakavi. Summary of Product Characteristics last updated on the eMC: 29/11/2013. Available from: http://www.medicines.org.uk/emc/medicine/26991/SPC/Jakavi+5 g,+15 mg+and+20mg+Tablets/#INDICATIONS. [Last accessed on 2014 Jul 01].
  • 25 Jakavi [package insert]. 18 December 2013. Novartis India Limited, Mumbai, India.
  • 26 Mesa RA, Cortes J. Optimizing management of ruxolitinib in patients with myelofibrosis: The need for individualized dosing. J Hematol Oncol 2013;6:79.
  • 27 Mesa RA, Nagorney DS, Schwager S, Allred J, Tefferi A. Palliative goals, patient selection, and perioperative platelet management: Outcomes and lessons from 3 decades of splenectomy for myelofibrosis with myeloid metaplasia at the Mayo Clinic. Cancer 2006;107:361-70.
  • 28 Evrot E, Ebel N, Romanet V, Roelli C, Andraos R, Qian Z, et al. JAK1/2 and Pan-deacetylase inhibitor combination therapy yields improved efficacy in preclinical mouse models of JAK2V617F-driven disease. Clin Cancer Res 2013;19:6230-41.
  • 29 Ribarg V, Harrison CN, Heidel FH, Kiladjian JJ, Acharyya S, Mu S, et al. A phase 1b, dose-finding study of ruxolitinib plus panobinostat in patients with primary myelofibrosis (PMF), post-polycythemia vera MF (PPV-MF), or post-essential thrombocythemia MF (PET-MF): Identification of the recommended phase 2 dose. Blood 2013;122:4045.
  • 30 Ballen KK, Shrestha S, Sobocinski KA, Zhang MJ, Bashey A, Bolwell BJ, et al. Outcome of transplantation for myelofibrosis. Biol Blood Marrow Transplant 2010;16:358-67.
  • 31 Abelsson J, Merup M, Birgegård G, WeisBjerrum O, Brinch L, Brune M, et al. The outcome of allo-HSCT for 92 patients with myelofibrosis in the Nordic countries. Bone Marrow Transplant 2012;47:380-6.
  • 32 Barbui T, Thiele J, Passamonti F, Rumi E, Boveri E, Ruggeri M, et al. Survival and disease progression in essential thrombocythemia are significantly influenced by accurate morphologic diagnosis: An international study. J Clin Oncol 2011;29:3179-84.
  • 33 Carobbio A, Thiele J, Passamonti F, Rumi E, Ruggeri M, Rodeghiero F, et al. Risk factors for arterial and venous thrombosis in WHO-defined essential thrombocythemia: An international study of 891 patients. Blood 2011;117:5857-9.
  • 34 Tefferi A, Cervantes F, Mesa R, Passamonti F, Verstovsek S, Vannucchi AM, et al. Revised response criteria for myelofibrosis: International Working Group-Myeloproliferative Neoplasms Research and Treatment (IWG-MRT) and European LeukemiaNet (ELN) consensus report. Blood 2013;122:1395-8.
  • 35 Emanuel RM, Dueck AC, Geyer HL, Kiladjian JJ, Slot S, et al. Myeloproliferative neoplasm (MPN) symptom assessment form total symptom score: Prospective international assessment of an abbreviated symptom burden scoring system among patients with MPNs. J Clin Oncol 2012;30:4098-103.
  • 36 Finazzi G, Barbui T. Evidence and expertise in the management of polycythemia vera and essential thrombocythemia. Leukemia 2008;22:1494-502.
  • 37 Marchioli R, Finazzi G, Specchia G, Cacciola R, Cavazzina R, Cilloni D, et al. Cardiovascular events and intensity of treatment in polycythemia vera. N Engl J Med 2013;368:22-33.
  • 38 Landolfi R, Marchioli R, Kutti J, Gisslinger H, Tognoni G, Patrono C, et al. Efficacy and safety of low-dose aspirin in polycythemia vera. N Engl J Med 2004;350:114-24.
  • 39 Najean Y, Rain JD. Treatment of polycythemia vera: Use of 32P alone or in combination with maintenance therapy using hydroxyurea in 461 patients greater than 65 years of age. The French Polycythemia Study Group. Blood 1997;89:2319-27.
  • 40 Kiladjian JJ, Rain JD, Bernard JF, Briere J, Chomienne C, Fenaux P. Long-term incidence of hematological evolution in three French prospective studies of hydroxyurea and pipobroman in polycythemia vera and essential thrombocythemia. Semin Thromb Hemost 2006;32:417-21.
  • 41 Verstovsek S, Passamonti F, Rambaldi A, Barosi G, Rosen PJ, Rumi E, et al. A phase 2 study of ruxolitinib, an oral JAK1 and JAK2 Inhibitor, in patients with advanced polycythemia vera who are refractory or intolerant to hydroxyurea. Cancer 2014;120:513-20.
  • 42 Verstovsek S, Kiladjian JJ, Griesshammer M, Masszi T, Durrant STS, Passamonti F, et al. Results of a prospective, randomized, open-label phase 3 study of ruxolitinib (RUX) in polycythemia vera (PV) patients resistant to or intolerant of hydroxyurea (HU): The RESPONSE trial. J Clin Oncol 2014;32 suppl:5s. (abstr 7026).
  • 43 Barosi G, Birgegard G, Finazzi G, Griesshammer M, Harrison C, Hasselbalch HC, et al. Response criteria for essential thrombocythemia and polycythemia vera: Result of a European LeukemiaNet consensus conference. Blood 2009;113:4829-33.
  • 44 Cortelazzo S, Finazzi G, Ruggeri M, Vestri O, Galli M, Rodeghiero F, et al. Hydroxyurea for patients with essential thrombocythemia and a high risk of thrombosis. N Engl J Med 1995;332:1132-6.
  • 45 Barbui T, Barosi G, Grossi A, Gugliotta L, Liberato LN, Marchetti M, et al. Practice guidelines for the therapy of essential thrombocythemia. A statement from the Italian Society of Hematology, the Italian Society of Experimental Hematology and the Italian Group for Bone Marrow Transplantation. Haematologica 2004;89:215-32.
  • 46 Budde U, Schaefer G, Mueller N, Egli H, Dent J, Ruggeri Z, et al. Acquired von Willebrand′s disease in the myeloproliferative syndrome. Blood 1984;64:981-5.
  • 47 Greist A. The role of blood component removal in essential and reactive thrombocytosis. Ther Apher 2002;6:36-44.
  • 48 Björkholm M, Derolf AR, Hultcrantz M, Kristinsson SY, Ekstrand C, Goldin LR, et al. Treatment-related risk factors for transformation to acute myeloid leukemia and myelodysplastic syndromes in myeloproliferative neoplasms. J Clin Oncol 2011;29:2410-5.
  • 49 Kundranda MN, Tibes R, Mesa RA. Transformation of a chronic myeloproliferative neoplasm to acute myelogenous leukemia: Does anything work? Curr Hematol Malig Rep 2012;7:78-86.
  • 50 Thepot S, Itzykson R, Seegers V, Raffoux E, Quesnel B, Chait Y, et al. Treatment of progression of Philadelphia-negative myeloproliferative neoplasms to myelodysplastic syndrome or acute myeloid leukemia by azacitidine: A report on 54 cases on the behalf of the Groupe Francophone des Myelodysplasies (GFM). Blood 2010;116:3735-42.
  • 51 Griesshammer M, Struve S, Harrison CM. Essential thrombocythemia/polycythemia vera and pregnancy: The need for an observational study in Europe. Semin Thromb Hemost 2006;32:422-9.
  • 52 Harrison CN, Robinson SE. Myeloproliferative disorders in pregnancy. Hematol Oncol Clin North Am 2011;25:261-75, vii.
  • 53 Barbui T, Finazzi G. Special issues in myeloproliferative neoplasms. Curr Hematol Malig Rep 2011;6:28-35.