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Making sense of the myelodysplastic/myeloproliferative neoplasms overlap syndromes

Tiu, Ramon V.a,b,c,*; Sekeres, Mikkael A.a,c,*

Current Opinion in Hematology:
doi: 10.1097/MOH.0000000000000021
MYELOID DISEASE: Edited by Martin S. Tallman
Abstract

Purpose of review: Myelodysplastic/myeloproliferative neoplasms (MDS/MPNs), including chronic myelomonocytic leukemia, atypical chronic myeloid leukemia, MDS/MPN-Unclassifiable, ring sideroblasts associated with marked thrombocytosis, and juvenile myelomonocytic leukemia, are clonal hematologic diseases characterized by myeloid dysplasia, proliferation, and absence of the molecular lesions BCR/ABL, PDGFRA, PDGFRB, and FGFR1. There are currently no US Food and Drug Administration approved therapies for all MDS/MPN subtypes. Advances in the understanding of the biologic and molecular drivers of these diseases will help in diagnosis, prognosis, and therapeutics. This review article summarizes the molecular aspects of MDS/MPNs and provides an overview of classic and emerging therapies.

Recent findings: Next generation sequencing has provided new insights into the genetic nature of MDS/MPNs. Molecular mutations such as TET2, CBL, SETBP1, CSF3R, and SF3B1 are relevant as diagnostic and prognostic biomarkers. Hematopoietic cell transplantation, although potentially curative, is applicable to only a small proportion of patients. Attempts to standardize response and outcomes criteria specific to MDS/MPN and clinical trials using novel agents focused on MDS/MPN patients are underway.

Summary: MDS/MPNs have clinicopathologic features of both MDS and MPN diseases. Emerging molecular data support the distinctive disease biology of each of these morphologic entities, and will serve as the foundation to develop effective therapeutics that can ameliorate disease-related complications and lead to better outcomes.

Author Information

aDepartment of Translational Hematology and Oncology Research

bCleveland Clinic Taussig Cancer Institute

cLeukemia Program, Department of Hematologic Oncology and Blood Disorders, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA

*Both authors contributed equally to the writing of this article.

Correspondence to Mikkael A. Sekeres, MD, MS, Director, Leukemia Program, Professor of Medicine, Cleveland Clinic Taussig Cancer Institute, 9500 Euclid Avenue R35, Cleveland, OH 44195, USA. Tel: +1 216 445 9353; fax: +1 216 636 0636; e-mail: sekerem@ccf.org

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins