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2016 ; 5
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English Wikipedia
Recent advances in understanding myelofibrosis and essential thrombocythemia
#MMPMID27134742
Vainchenker W
; Constantinescu SN
; Plo I
F1000Res
2016[]; 5
(ä): ä PMID27134742
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The classic BCR-ABL-negative myeloproliferative neoplasms (MPNs), a form of
chronic malignant hemopathies, have been classified into polycythemia vera (PV),
essential thrombocythemia (ET), and primary myelofibrosis (PMF). ET and PMF are
two similar disorders in their pathogenesis, which is marked by a key role of the
megakaryocyte (MK) lineage. Whereas ET is characterized by MK proliferation, PMF
is also associated with aberrant MK differentiation (myelodysplasia), leading to
the release of cytokines in the marrow environment, which causes the development
of myelofibrosis. Thus, PMF is associated with both myeloproliferation and
different levels of myelodysplastic features. MPNs are mostly driven by mutated
genes called MPN drivers, which abnormally activate the cytokine receptor/JAK2
pathway and their downstream effectors. The recent discovery of CALR mutations
has closed a gap in our knowledge and has shown that this mutated endoplasmic
reticulum chaperone activates the thrombopoietin receptor MPL and JAK2. These
genetic studies have shown that there are two main types of MPNs: JAK2V617F-MPNs,
including ET, PV, and PMF, and the MPL-/CALR-MPNs, which include only ET and PMF.
These MPN driver mutations are associated with additional mutations in genes
involved in epigenetics, splicing, and signaling, which can precede or follow the
acquisition of MPN driver mutations. They are involved in clonal expansion or
phenotypic changes or both, leading to myelofibrosis or leukemic transformation
or both. Only a few patients with ET exhibit mutations in non-MPN drivers,
whereas the great majority of patients with PMF harbor one or several mutations
in these genes. However, the entire pathogenesis of ET and PMF may also depend on
other factors, such as the patient's constitutional genetics, the bone marrow
microenvironment, the inflammatory response, and age. Recent advances allowed a
better stratification of these diseases and new therapeutic approaches with the
development of JAK2 inhibitors.