Hasselbalch Hans Carl
Department of Hematology, Roskilde Hospital, University of Copenhagen, Køgevej 7-13, 4000 Roskilde, Denmark.
Leuk Res. 2014 Oct;38(10):1230-6. doi: 10.1016/j.leukres.2014.07.006. Epub 2014 Jul 22.
Recent studies have provided evidence that the Philadelphia-negative chronic myeloproliferative neoplasms, essential thrombocythemia, polycythemia vera and myelofibrosis (MPNs), may be preceded or accompanied by chronic inflammation and are associated with an increased risk of second cancers, both hematological and non-hematological. Thrombocythemia is one of the hallmarks in the early stages of these neoplasms. Several non-hematological cancers are associated with reactive thrombocythemia, which has been shown to have a major negative impact upon survival. In regard to treatment of MPNs a "wait and watch" strategy is recommended in patients with low-risk disease. Another strategy implies early treatment with interferon-alpha2 (IFN) to prohibit clonal evolution. Based upon experimental and clinical studies of the important role of platelets for cancer invasiveness and metastasis it is herein argued, that these detrimental platelet effects further support the "Early Interferon Concept" in MPNs to normalize elevated leukocyte and platelet counts. In the context of the known increased risk of second cancer in MPNs the prevailing "wait and watch" strategy is seriously challenged, when taking into account that this strategy may actually worsen prognosis of second cancers in MPNs due to elevated platelet counts, enhancing cancer invasiveness and its metastatic potential.
最近的研究表明，费城染色体阴性的慢性骨髓增殖性肿瘤，即原发性血小板增多症、真性红细胞增多症和骨髓纤维化（MPNs），可能在慢性炎症之前出现或与之伴随，并与血液系统和非血液系统第二癌症的风险增加相关。血小板增多症是这些肿瘤早期阶段的特征之一。几种非血液系统癌症与反应性血小板增多症相关，反应性血小板增多症已被证明对生存有重大负面影响。关于MPNs的治疗，对于低风险疾病患者，建议采用“观察等待”策略。另一种策略是早期使用α2干扰素（IFN）进行治疗，以阻止克隆进化。基于血小板在癌症侵袭和转移中的重要作用的实验和临床研究，本文认为，这些有害的血小板效应进一步支持了MPNs中的“早期干扰素概念”，以使升高的白细胞和血小板计数恢复正常。考虑到MPNs中已知的第二癌症风险增加，当考虑到这种“观察等待”策略实际上可能由于血小板计数升高而恶化MPNs中第二癌症的预后，增强癌症侵袭性及其转移潜能时，这种普遍的“观察等待”策略受到了严峻挑战。
