Zhang Jin, Shen Kefeng, Xiao Min, Huang Jinjin, Wang Jin, Wang Yaqin, Hong Zhenya
Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Department of Clinical Immunology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
Front Genet. 2023 Jun 16;14:1198834. doi: 10.3389/fgene.2023.1198834. eCollection 2023.
JAK2, CALR, and MPL gene mutations are recognized as driver mutations of myeloproliferative neoplasms (MPNs). MPNs without these mutations are called triple-negative (TN) MPNs. Recently, novel mutation loci were continuously discovered using next-generation sequencing (NGS), along with continued discussion and modification of the traditional TN MPN. Novel pathogenic mutations were discovered by targeted NGS in 4 patients who were diagnosed as JAK2 unmutated polycythaemia vera (PV) or TN MPN. Cases 1, 2, and 3 were of patients with PV, essential thrombocythemia (ET), and primary myelofibrosis (PMF); NGS detected JAK2 p.H538_K539delinsQL (uncommon), CALR p.E380Rfs51 (novel), and MPL p.W515_Q516del (novel) mutations. Case 4 involved a patient with PMF; JAK2, CALR, or MPL mutations were not detected by qPCR or NGS, but a novel mutation SH2B3 p.S337Ffs3, which is associated with the JAK/STAT signal transduction pathway, was found by NGS. NGS, a more multidimensional and comprehensive gene mutation detection, is required for patients suspected of having MPN to detect non-canonical driver variants and avoid the misdiagnosis of TN MPN. SH2B3 p.S337Ffs*3 can drive MPN occurrence, and SH2B3 mutation may also be a driver mutation of MPN.
JAK2、CALR和MPL基因突变被认为是骨髓增殖性肿瘤(MPN)的驱动基因突变。没有这些突变的MPN被称为三阴性(TN)MPN。近年来,随着新一代测序(NGS)技术的不断发展,新的突变位点不断被发现,传统TN MPN的定义也在持续讨论和修订。通过靶向NGS在4例被诊断为JAK2未突变型真性红细胞增多症(PV)或TN MPN的患者中发现了新的致病突变。病例1、2和3分别为PV、原发性血小板增多症(ET)和原发性骨髓纤维化(PMF)患者;NGS检测到JAK2 p.H538_K539delinsQL(不常见)、CALR p.E380Rfs51(新发现)和MPL p.W515_Q516del(新发现)突变。病例4为一名PMF患者;qPCR或NGS未检测到JAK2、CALR或MPL突变,但通过NGS发现了一种与JAK/STAT信号转导通路相关的新突变SH2B3 p.S337Ffs3。对于疑似MPN的患者,需要更全面、多维的NGS基因突变检测来发现非典型驱动变异,避免TN MPN的误诊。SH2B3 p.S337Ffs*3可驱动MPN的发生,SH2B3突变也可能是MPN的驱动突变。