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Topics:
Medical Oncology • Internal Medicine • Myeloproliferative Neoplasms • Hematology • Benign Hematology
In a patient with progressive thrombocytosis but negative MPN mutations on peripheral blood, what are your diagnostic and treatment recommendations?
Do you ever recheck JAK2/CALR/MPL/BCR-ABL? Would you recommend a bone marrow biopsy? Is cytoreductive therapy indicated?
Answer from: Medical Oncologist at Academic Institution
I agree with Dr. @Aaron T. Gerds. A bone marrow biopsy is helpful in a case like the one described as morphology can be informative in distinguishing triple negative ET vs pre-MF vs MF and also CML. I agree with NGS panel to see if there are clonal markers identified, testing for BCR-ABL is critical...
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Answer from: Medical Oncologist at Community Practice
It may be worth doing a broader look for clonality. A bone marrow biopsy can evaluate for morphologic and immunohistochemical evidence (megakaryocytic morphology and pSTAT5 staining, or even ringed sideroblasts in instances of MDS/MPN-RS-T) and cytogenetics can identify clonality. A wider NGS panel ...