The Classic Myeloproliferative Neoplasms

Myeloproliferative Neoplasm: A Diagnostic Approach to Bone Marrow Evaluation

October 2011

In the evaluation of a bone marrow specimen, the initial review process centers on whether or not the bone marrow morphology is diagnostic of a myeloproliferative neoplasm or not or whether it has equivocal findings. After making the decision of whether or not the bone marrow represents a myeloproliferative neoplasm, then JAK2 V617F studies are the next critical step. If JAK2 is positive, this finding, together with the bone marrow studies confirms the diagnosis of a myeloproliferative neoplasm. If the JAK2 study is negative, then whether to proceed with JAK2 exon 12 sequencing is dependent on whether there is suspicion for PV or not on the basis of CBC and serum erythropoietin values. Finally, MPL exon 10 sequencing should only be for those cases with equivocal bone marrow morphology where there is suspicion for a myeloproliferative neoplasm and a negative JAK2 V617F assay.

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Diagnostic Bone Marrow Evaluation

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• Introduction
• Optimizing Laboratory Testing for Hematologic Disorders Series
• Goals for Today's Presentation
• Example of a Recent MPN Referral
• Why Do We Have Test Utilization Issues?
• Why Do We Have Test Utilization Issues?
• So What Should We Do?
• WHO Classification
• Important Laboratory Assays in the MPNs
• JAK2 V617F Background
• JAK2 V617F Background
• Question #1 — JAK2 V617F
• JAK2 V617F
• JAK2 V617F at Mayo Clinic
• Conclusion #1 — JAK2 V617F
• JAK2 Exon 12 Sequencing Background
• Question #2 — JAK2 Exon 12 Sequencing
• JAK2 Exon 12 Sequencing: When Not to Use
• JAK2 Exon 12 Sequencing
• Conclusion #2 — JAK2 Exon 12 Sequencing
• MPL Exon 10 Sequencing Studies: Background
• Question #3 — MPL Exon 10 Sequencing
• MPL Exon 10 Sequencing: When to Use
• MPL Exon 10 Sequencing: When Not to Use
• MPL Exon 10 Sequencing
• Conclusion #3 — MPL Exon 10 Sequencing
• Roles of Other Assays in Classic MPN
• Summary
• Myeloproliferative Neoplasm: A Diagnostic Approach to Peripheral Blood Evaluation
• Myeloproliferative Neoplasm: A Diagnostic Approach to Bone Marrow Evaluation
• Implementing a Utilization Approach
• Questions