| 词条 | Myeloproliferative neoplasm | ||
| 释义 |
| name = Myeloproliferative neoplasm | synonyms = Myeloproliferative diseases (MPDs) | image = | caption = | pronounce = | field = Hematology and oncology | symptoms = | complications = | onset = | duration = | types = | causes = | risks = | diagnosis = | differential = | prevention = | treatment = | medication = | prognosis = | frequency = | deaths = }} The myeloproliferative neoplasms (MPNs), previously myeloproliferative diseases (MPDs), are a group of diseases of the bone marrow in which excess cells are produced. They are related to, and may evolve into, myelodysplastic syndrome and acute myeloid leukemia, although the myeloproliferative diseases on the whole have a much better prognosis than these conditions. The concept of myeloproliferative disease was first proposed in 1951 by the hematologist William Dameshek.[1] In the most recent World Health Organization classification of hematologic malignancies, this group of diseases was renamed from "myeloproliferative diseases" to "myeloproliferative neoplasms".[2] This reflects the underlying clonal genetic changes that are a salient feature of this group of disease. The increased numbers of blood cells may not cause any symptoms, but a number of medical problems or symptoms may occur. The risk of thrombosis is increased in some types of MPN. ClassificationAlthough a malignant neoplasm like other cancers, MPNs are classified within the hematological neoplasms. There are four main myeloproliferative diseases, which can be further categorized by the presence of the Philadelphia chromosome:{{citation needed|date=February 2014}}
In 2008, the World Health Organization listed these diagnoses as types of MPD:[3]
CausesAll MPNs arise from precursors of the myeloid lineages in the bone marrow. The lymphoid lineage may produce similar diseases, the lymphoproliferative disorders (acute lymphoblastic leukemia, lymphomas, chronic lymphocytic leukemia and multiple myeloma). Most Philadelphia chromosome negative cases have an activating JAK2 or MPL mutation.[4] Mutations in CALR have been found in the majority of JAK2 and MPL-negative essential thrombocythemia and myelofibrosis.[5][6] In 2005, the discovery of the JAK2V617F mutation provided the first evidence that a fraction of persons with these disorders have a common molecular pathogenesis.[7][8][9][10] Patients with JAK2V617F-negative polycythemia vera are instead positive for another class of activating JAK2 mutations - the JAK2 exon 12 mutations.[11] A subset may additionally have mutations in the genes LNK, CBL, TET2, ASXL1, IDH, IKZF1 or EZH2; the pathogenetic contribution of these mutations is being studied.{{citation needed|date=February 2014}} DiagnosisDepending on the nature of the myeloproliferative neoplasm, diagnostic tests may include red cell mass determination (for polycythemia), bone marrow aspirate and trephine biopsy, arterial oxygen saturation and carboxyhaemoglobin level, neutrophil alkaline phosphatase level, vitamin B12 (or B12 binding capacity), serum urate[12] or direct sequencing of the patient's DNA.[13] According to the WHO Classification of Hematopoietic and Lymphoid Neoplasms 2008 myeloproliferative neoplasms are divided into categories by diagnostic characteristics as follows:[3] Chronic myeloid leukemiaChronic myeloid leukemia (CML) with the defining translocation t(9;22);Philadelphia chromosome Essential thrombocythemiaEssential thrombocythemia (ET) is associated with the JAK2 V617F mutation in up to 55% of cases[14] and with an MPL (thrombopoietin receptor) mutation in up to 5% of cases:[15]
These disorders are still being revised according to more specific genetic mutations and how often patients end in a fibrotic marrow event. Polycythemia veraPolycythemia vera (PV) is associated most often with the JAK2 V617F mutation in greater than 95% of cases, whereas the remainder have a JAK2 exon 12 mutation:
Primary myelofibrosisPrimary myelofibrosis (PMF) is associated with the JAK2V617F mutation in up to 50% of cases, the JAK2 exon 12 mutations in 1-2% of cases, and the MPL (thrombopoietin receptor) mutation in up to 5% of cases:
TreatmentWhile investigational drug therapies exist, no curative drug treatment exists for any of the MPDs. The goal of treatment for ET and PV is prevention of thrombohemorrhagic complications. The goal of treatment for MF is amelioration of anemia, splenomegaly, and other symptoms. Low-dose aspirin is effective in PV and ET. Tyrosine kinase inhibitors like imatinib have improved the prognosis of CML patients to near-normal life expectancy.[4] Recently, a JAK2 inhibitor, namely ruxolitinib, has been approved for use in primary myelofibrosis.[16] Trials of these inhibitors are in progress for the treatment of the other myeloproliferative neoplasms. References1. ^{{cite journal | author = Dameshek W | title = Some speculations on the myeloproliferative syndromes | journal = Blood | volume = 6 | issue = 4 | pages = 372–5 | year = 1951 | pmid = 14820991}} 2. ^{{cite journal |vauthors=Tefferi A, Vainchenker W |title=Myeloproliferative neoplasms: molecular pathophysiology, essential clinical understanding, and treatment strategies |journal=J. Clin. Oncol. |volume=29 |issue=5 |pages=573–82 |date=February 2011 |pmid=21220604 |doi=10.1200/JCO.2010.29.8711}}2 3. ^1 {{cite journal | doi=10.1182/blood-2009-03-209262 | title=The 2008 revision of the World Health Organization (WHO) classification of myeloid neoplasms and acute leukemia: Rationale and important changes | year=2009 | last1=Vardiman | first1=J. W. | last2=Thiele | first2=J. | last3=Arber | first3=D. A. | last4=Brunning | first4=R. D. | last5=Borowitz | first5=M. J. | last6=Porwit | first6=A. | last7=Harris | first7=N. L. | last8=Le Beau | first8=M. M. | last9=Hellström-Lindberg | first9=E. | last10=Tefferi | first10=A. | last11=Bloomfield | first11=C. D. | journal=Blood | volume=114 | issue=5 | pages=937–51 | pmid=19357394}} 4. ^1 {{cite journal |vauthors=Tefferi A, Vainchenker W |title=Myeloproliferative neoplasms: molecular pathophysiology, essential clinical understanding, and treatment strategies |journal=J. Clin. Oncol. |volume=29 |issue=5 |pages=573–82 |date=February 2011 |pmid=21220604 |doi=10.1200/JCO.2010.29.8711}} 5. ^Klampfl T, Gisslinger H, Harutyunyan AS, et al. Somatic mutations of calreticulin in myeloproliferative neoplasms. N Engl J Med 2013;369:2379-2390 6. ^Nangalia J, Massie CE, Baxter EJ, et al. Somatic CALR mutations in myeloproliferative neoplasms with nonmutated JAK2. N Engl J Med 2013;369:2391-2405 7. ^{{cite journal |vauthors=Baxter EJ, Scott LM, Campbell PJ, etal | title = Acquired mutation of the tyrosine kinase JAK2 in human myeloproliferative disorders | journal = Lancet | volume = 365 | pages = 1054–1061 | year = 2005 | pmid = 15781101 | issue = 9464 | doi = 10.1016/S0140-6736(05)71142-9}} 8. ^{{cite journal |vauthors=James C, Ugo V, Le Couedic JP, etal | title = A unique clonal JAK2 mutation leading to constitutive signalling causes polycythaemia vera | journal = Nature | volume = 434 | issue = 7037 | pages = 1144–1148 | year = 2005 | pmid = 15793561 | doi = 10.1038/nature03546}} 9. ^{{cite journal |vauthors=Levine RL, Wadleigh M, Cools J, etal | title = Activating mutation in the tyrosine kinase JAK2 in polycythemia vera, essential thrombocythemia, and myeloid metaplasia with myelofibrosis | journal = Cancer Cell | volume = 7 | issue = 4 | pages = 387–397 | year = 2005 | pmid = 15837627 | doi = 10.1016/j.ccr.2005.03.023}} 10. ^{{cite journal |vauthors=Kralovics R, Passamonti F, Buser AS, etal | title = A gain-of-function mutation of JAK2 in myeloproliferative disorders | journal = N Engl J Med | volume = 352 | issue = 17 | pages = 1779–1790 | year = 2005 | pmid = 15858187 | doi = 10.1056/NEJMoa051113}} 11. ^{{cite journal |vauthors=Scott LM, Tong W, Levine RL, etal | title = JAK2 exon 12 mutations in polycythemia vera and idiopathic erythrocytosis | journal = N. Engl. J. Med. | volume = 356 | issue = 5 | pages = 459–68 | year = 2007 | pmid = 17267906 | doi = 10.1056/NEJMoa065202 | pmc = 2873834}} 12. ^{{cite book |author1=Levene, Malcolm I. |author2=Lewis, S. M. |author3=Bain, Barbara J. |author4=Imelda Bates |title=Dacie & Lewis Practical Haematology |publisher=W B Saunders |location=London |year= 2001|isbn=0-443-06377-X |page=586}} 13. ^{{cite journal |vauthors=Magor GW, Tallack MR, Klose NM, Taylor D, Korbie D, Mollee P, Trau M, Perkins AC |title=Rapid Molecular Profiling of Myeloproliferative Neoplasms Using Targeted Exon Resequencing of 86 Genes Involved in JAK-STAT Signaling and Epigenetic Regulation |journal=The Journal of Molecular Diagnostics |volume=18 |issue=5 |pages=707–718 |date=September 2016 |pmid=27449473 |doi=10.1016/j.jmoldx.2016.05.006}} 14. ^{{cite journal |vauthors=Campbell PJ, Scott LM, Buck G, etal | title = Definition of subtypes of essential thrombocythaemia and relation to polycythaemia vera based on JAK2 V617F mutation status: a prospective study | journal = Lancet | volume = 366 | issue = 9501 | pages = 1945–1953 | year = 2005 | pmid = 16325696 | doi = 10.1016/S0140-6736(05)67785-9}} 15. ^{{cite journal |vauthors=Beer PA, Campbell PJ, Scott LM, Bench AJ, Erber WN, Bareford D, Wilkins BS, Reilly JT, Hasselbalch HC, Bowman R, Wheatley K, Buck G, Harrison CN, Green AR |title=MPL mutations in myeloproliferative disorders: analysis of the PT-1 cohort |journal=Blood |volume=112 |issue=1 |pages=141–9 |date=July 2008 |pmid=18451306 |doi=10.1182/blood-2008-01-131664}} 16. ^{{cite journal |vauthors=Tibes R, Bogenberger JM, Benson KL, Mesa RA |title=Current outlook on molecular pathogenesis and treatment of myeloproliferative neoplasms |journal=Mol Diagn Ther |volume=16 |issue=5 |pages=269–83 |date=October 2012 |pmid=23023734 |doi=10.1007/s40291-012-0006-3}} External links{{Medical resources| ICD10 = {{ICD10|D|47|1|d|37}} | ICD9 = {{ICD9|205.1}}, {{ICD9|238.4}}, {{ICD9|289.89}}, {{ICD9|289.9}} | ICDO = 9950/0-9964/3 | OMIM = | DiseasesDB = | MedlinePlus = | eMedicineSubj = | eMedicineTopic = | MeshID = D009196 }}
1 : Myeloid neoplasia |
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