Recent advances in understanding myelofibrosis and essential thrombocythemia [version 1; referees: 2 approved]
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...
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
F1000 Research Ltd
2016-04-01
|
| Series: | F1000Research |
| Subjects: | |
| Online Access: | http://f1000research.com/articles/5-700/v1 |
| _version_ | 1818384047473164288 |
|---|---|
| author | William Vainchenker Stefan N. Constantinescu Isabelle Plo |
| author_facet | William Vainchenker Stefan N. Constantinescu Isabelle Plo |
| author_sort | William Vainchenker |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-14T03:16:03Z |
| format | Article |
| id | doaj.art-4c654a951245461186ba57e80b5a5c5b |
| institution | Directory Open Access Journal |
| issn | 2046-1402 |
| language | English |
| last_indexed | 2024-12-14T03:16:03Z |
| publishDate | 2016-04-01 |
| publisher | F1000 Research Ltd |
| record_format | Article |
| series | F1000Research |
| spelling | doaj.art-4c654a951245461186ba57e80b5a5c5b2022-12-21T23:19:07ZengF1000 Research LtdF1000Research2046-14022016-04-01510.12688/f1000research.8081.18692Recent advances in understanding myelofibrosis and essential thrombocythemia [version 1; referees: 2 approved]William Vainchenker0Stefan N. Constantinescu1Isabelle Plo2Universite Paris-Saclay, Gustave Roussy, Paris, Francede Duve Institute, Université catholique de Louvain, Brussels, BelgiumUniversite Paris-Saclay, Gustave Roussy, Paris, FranceThe 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.http://f1000research.com/articles/5-700/v1Anemias & Hypocellular Marrow DisordersCell SignalingHematopoietic Stem CellsLeukemia & Proliferative Disorders of Hematic CellsLeukocyte Signaling & Gene ExpressionMedical Genetics |
| spellingShingle | William Vainchenker Stefan N. Constantinescu Isabelle Plo Recent advances in understanding myelofibrosis and essential thrombocythemia [version 1; referees: 2 approved] F1000Research Anemias & Hypocellular Marrow Disorders Cell Signaling Hematopoietic Stem Cells Leukemia & Proliferative Disorders of Hematic Cells Leukocyte Signaling & Gene Expression Medical Genetics |
| title | Recent advances in understanding myelofibrosis and essential thrombocythemia [version 1; referees: 2 approved] |
| title_full | Recent advances in understanding myelofibrosis and essential thrombocythemia [version 1; referees: 2 approved] |
| title_fullStr | Recent advances in understanding myelofibrosis and essential thrombocythemia [version 1; referees: 2 approved] |
| title_full_unstemmed | Recent advances in understanding myelofibrosis and essential thrombocythemia [version 1; referees: 2 approved] |
| title_short | Recent advances in understanding myelofibrosis and essential thrombocythemia [version 1; referees: 2 approved] |
| title_sort | recent advances in understanding myelofibrosis and essential thrombocythemia version 1 referees 2 approved |
| topic | Anemias & Hypocellular Marrow Disorders Cell Signaling Hematopoietic Stem Cells Leukemia & Proliferative Disorders of Hematic Cells Leukocyte Signaling & Gene Expression Medical Genetics |
| url | http://f1000research.com/articles/5-700/v1 |
| work_keys_str_mv | AT williamvainchenker recentadvancesinunderstandingmyelofibrosisandessentialthrombocythemiaversion1referees2approved AT stefannconstantinescu recentadvancesinunderstandingmyelofibrosisandessentialthrombocythemiaversion1referees2approved AT isabelleplo recentadvancesinunderstandingmyelofibrosisandessentialthrombocythemiaversion1referees2approved |