Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota.
Am J Hematol. 2016 Jan;91(1):50-8. doi: 10.1002/ajh.24221.
Myeloproliferative neoplasms (MPN) are clonal stem cell diseases, first conceptualized in 1951 by William Dameshek, and historically included chronic myeloid leukemia (CML), polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF). In 1960, Nowell and Hungerford discovered an invariable association between the Philadelphia chromosome (subsequently shown to harbor the causal BCR-ABL1 mutation) and CML; accordingly, the term MPN is primarily reserved for PV, ET, and PMF, although it includes other related clinicopathologic entities, according to the World Health Organization (WHO) classification system. In 2005, William Vainchenker and others described a Janus kinase 2 mutation (JAK2V617F) in MPN and this was followed by a series of additional descriptions of mutations that directly or indirectly activate JAK-STAT: JAK2 exon 12, myeloproliferative leukemia virus oncogene (MPL) and calreticulin (CALR) mutations. The discovery of these, mostly mutually exclusive, "driver" mutations has contributed to revisions of the WHO diagnostic criteria and risk stratification in MPN. Mutations other than JAK2, CALR and MPL have also been described in MPN and shown to provide additional prognostic information. From the standpoint of treatment, over the last 50 years, Louis Wasserman from the Unites States and Tiziano Barbui from Italy had skillfully organized and led a number of important clinical trials, whose results form the basis for current treatment strategies in MPN. More recently, allogeneic stem cell transplant, as a potentially curative treatment modality, and JAK inhibitors, as palliative drugs, have been added to the overall therapeutic armamentarium in myelofibrosis. In the current review, I will summarize the important advances made in the last 10 years regarding the science and practice of MPN.
骨髓增殖性肿瘤(MPN)是克隆性干细胞疾病,由 William Dameshek 于 1951 年首次提出概念,历史上包括慢性髓系白血病(CML)、真性红细胞增多症(PV)、特发性血小板增多症(ET)和原发性骨髓纤维化(PMF)。1960 年,Nowell 和 Hungerford 发现费城染色体(随后显示携带致病的 BCR-ABL1 突变)与 CML 之间存在不变的关联;因此,根据世界卫生组织(WHO)分类系统,MPN 主要保留用于 PV、ET 和 PMF,尽管它还包括其他相关的临床病理实体。2005 年,William Vainchenker 等人在 MPN 中描述了一种 Janus 激酶 2 突变(JAK2V617F),随后又描述了一系列直接或间接激活 JAK-STAT 的突变:JAK2 外显子 12、骨髓增殖性白血病病毒癌基因(MPL)和钙网蛋白(CALR)突变。这些“驱动”突变的发现,大多数是相互排斥的,促进了 WHO 诊断标准和 MPN 风险分层的修订。除了 JAK2、CALR 和 MPL 以外,在 MPN 中也描述了其他突变,并显示它们提供了额外的预后信息。从治疗的角度来看,在过去的 50 年里,美国的 Louis Wasserman 和意大利的 Tiziano Barbui 巧妙地组织并领导了许多重要的临床试验,其结果构成了 MPN 目前治疗策略的基础。最近,同种异体干细胞移植作为一种潜在的治愈性治疗方式,以及 JAK 抑制剂作为姑息性药物,已被添加到骨髓纤维化的整体治疗武器库中。在本综述中,我将总结过去 10 年在 MPN 的科学和实践方面取得的重要进展。