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Home » Hematology » Myeloproliferative disorder. Diagnosis and treatment. 4
Myeloproliferative disorder. Diagnosis and treatment. 4
Myeloproliferative disorder treatment is reviewed by top hematology oncology expert. Four types of myeloproliferative disorders. Treatment of myeloproliferative disease depends on genetic mutations. How do Bcr-Abl fusion protein, JAK2, CALR and MPL gene mutations affect therapy choice? How does Rapid Heme Panel of 95 genetic tests help to personalize treatment of myeloproliferative disorder? Myeloproliferative disorder treatment begins with correct molecular diagnosis. JAK2, calreticulin, Philadelphia chromosome mutations give rise to different subtypes of myeloproliferative disease. Dr. Aric Parnes, MD. Expansion of red blood cell lineage causes polycythemia vera. Dr. Anton Titov, MD. Treatment of polycythemia vera is with bloodletting or chemotherapy. Video interview with top expert in hematology oncology. Myeloproliferative disorder treatment is personalized for each patient. Expansion of fibroblasts in the bone marrow causes myelofibrosis. Chemotherapy regimens in myelofibrosis treatment depend on exact genetic mutation identified. Medical second opinion helps to make sure myeloproliferative disorder diagnosis is correct and complete. Medical second opinion also helps to choose the best treatment for myeloproliferative disease. Thrombocytosis (essential thrombocythemia) treatment can also be done by JAK2 inhibitor Ruxolitinib. Myeloproliferative disorder treatment is advancing rapidly. Dr. Aric Parnes, MD. “Rapid Heme Panel” is a new genetic diagnostic test. It quickly and cheaply tests for 95 genetic mutations common in blood disorders, including myeloproliferative disease. Myeloproliferative disorder treatment. Chronic myelogenous leukemia treatment. Dr. Anton Titov, MD. Myeloproliferative diseases is a collection of several neoplastic disorders. Their incidence is increasing. What are myeloproliferative disorders? How are they diagnosed? What is current treatment of myeloproliferative disorders? Dr. Aric Parnes, MD Hematologist, Harvard Medical School. There are four myeloproliferative diseases. Each disorder reflects a specific blood cell line. CML is chronic myelogenous leukemia. It is a myeloproliferative disorder. Patient’s white blood cell counts are high. Dr. Anton Titov, MD. CML is a disease that can be treated the medication Gleevec. Dr. Aric Parnes, MD. Yes. Imatinib was the tyrosine kinase inhibitor that targets Bcr-Abl Philadelphia chromosome fusion protein. Sometimes the red blood cells are elevated. We call this myeloproliferative disease polycythemia vera. Sometimes the platelets are elevated. Then we call this essential thrombocythemia. The fourth myeoloproliferative disorder is really different than the others. This is called primary myelofibrosis or idiopathic myelofibrosis. Fibroblasts in the bone marrow are making fibrous tissue. scar tissue replaces normal bone marrow in myelofibrosis. In the first three myeloproliferative disorders there is a proliferation of blood cells production. The blood counts decline in myelofibrosis. Dr. Anton Titov, MD. Because in myelofibrosis proliferating fibroblasts crowd out normal hematopoietic cells? Dr. Aric Parnes, MD. Exactly, yes. There is a a great increase in our understanding of myeloproliferative diseases in the last 10 years. Earlier we did not have any specific tests for these disorders. Dr. Aric Parnes, MD. Now we know that JAK2 mutation is responsible for 95% of polycythemia vera cases. JAK2 mutation is also responsible for 50% of essential thrombocythemia and 50% of primary myelofibrosis cases. Diagnostic test for JAK2 mutation was developed. There is also now a JAK2 inhibitor medication. It is called Ruxolitinib. Unfortunately, it doesn’t work very well. Ruxolitinib is only approved for myelofibrosis. Ruxolitinib helps to relieve symptoms of myelofibrosis. But it does not stop the myeloproliferative disease progression. We have already mentioned specific targeted therapy by imatinib (Gleevec) in chronic myelogenous leukemia, CML. This medication targets Philadelphia chromosome (Bcr-Abl fusion protein). Philadelphia chromosome-positive chronic myelogenous leukemia is a distinct disease entity. Its symptoms are quite specific. They reflect blood hyperviscosity from high white blood cell counts in CML. CML has typical leukemia complications. Other cases of chronic myelogenous leukemia do not have Philadelphia chromosome by molecular analysis. Dr. Aric Parnes, MD. We refer to this type of leukemia as Bcr-Abl negative myeloproliferative diseases. Last year at the American Society of Hematology meeting two research laboratories reported important discoveries. They found the cause of those essential thrombocythemia and idiopathic myelofibrosis cases this do not have JAK2 mutation. Mutations in calreticulin (CALR) gene cause that significant share of myeloproliferative disorders that are JAK2 negative. The third gene that also has role in myeloproliferative diseases, especially primary myelofibrosis, is called MPL (thrombopoietin receptor gene). We talked about myelodysplastic syndrome. Dr. Anton Titov, MD. We already discussed our Rapid Heme Panel. It is a molecular test this screens for 95 genetic mutations. These mutations are frequent in blood cancers. now we included JAK2, CALR and MPL gene mutations in our Rapid Heme Panel. This allows us to analyze 95 mutations for all myeloproliferative diseases in one test. Dr. Anton Titov, MD. Your rapid heme panel analyzes 95 genetic mutations. They are frequent in blood cancers. This allows a precise molecular diagnosis. This allows correct identification of exact causes of hematologic disorders. Diagnosis is based not only on clinical symptoms and blood smear study under microscope. Precise molecular diagnosis of hematologic malignancy or non-malignant disorder allows to select the best treatment for specific patient. Dr. Aric Parnes, MD. That is right. That is right. Before we discovered a role of all these genes in myeloproliferative disorders, we did not have diagnostic tests. Dr. Aric Parnes, MD. Now we do have good diagnostic tests for many blood diseases. We hope to develop targeted therapies for them. Myeloproliferative disorder treatment. Dr. Anton Titov, MD. Video interview with top expert in hematology. CML, polycythemia vera, essential thrombocythemia, myelofibrosis therapy. Myeloproliferative disorder treatment is reviewed by top hematology oncology expert. How personalized treatment of myeloproliferative disease depends on specific mutations? How Bcr-Abl fusion protein, JAK2, CALR and MPL gene mutations affect therapy choice? How Rapid Heme Panel of 95 genetic tests helps to personalize treatment of myeloproliferative disorder?
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