Myelofibrosis overview: Difference between revisions
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==Overview== | ==Overview== | ||
[[Myelofibrosis]] is a [[Blood|hematological]] disorder in which the [[bone marrow]] is replaced with [[collagen|collagenous connective tissue]] and progressive [[fibrosis]], replacing the [[bone marrow]] with a [[scar tissue]] and hence disrupting the normal production of [[Blood cell|blood cells]] which leads to [[pancytopenia]].<ref name="pmid27539616">{{cite journal |vauthors=Shantzer L, Berger K, Pu JJ |title=Primary myelofibrosis and its targeted therapy |journal=Ann. Hematol. |volume=96 |issue=4 |pages=531–535 |date=April 2017 |pmid=27539616 |doi=10.1007/s00277-016-2785-9 |url=}}</ref> It is also classified as a [[Myeloproliferative neoplasm|myeloproliferative disorder]].<ref name="overviewofmyelofibrosis1">Myelofibrosis. Dr Henry Knipe ◉ and Dr Yuranga Weerakkody et al. Radiopaedia 2016. http://radiopaedia.org/articles/myelofibrosis. Accessed on March 7, 2016</ref> The term [[myelofibrosis]] alone usually refers to '''[[Primary myelofibrosis|primary myelofibrosis (PMF)]]''', also known as [[Chronic (medical)|chronic]] [[idiopathic]] [[myelofibrosis]] (CIMF); the terms [[idiopathic]] and primary mean that the [[disease]] is of unknown or spontaneous origin. This is in contrast with [[myelofibrosis]] that develops secondary to [[polycythemia vera]], [[essential thrombocythemia]], [[leukemia]], or [[lymphoma]] ('''secondary [[myelofibrosis]]'''). [[Myelofibrosis]] is a form of [[myeloid metaplasia]], which refers to a change in [[Cell (biology)|cell]] type in the [[blood]]-forming [[Tissue (biology)|tissue]] of the [[bone marrow]], and often the two terms are used synonymously. [[Gene|Genes]] involved in the [[pathogenesis]] of [[myelofibrosis]] include ''[[JAK2]]'', ''[[Calreticulin|CALR]]'', and ''[[Myeloproliferative leukemia virus oncogene|MPL]]''.<ref name="TefferiLasho2014">{{cite journal|last1=Tefferi|first1=A|last2=Lasho|first2=T L|last3=Finke|first3=C M|last4=Knudson|first4=R A|last5=Ketterling|first5=R|last6=Hanson|first6=C H|last7=Maffioli|first7=M|last8=Caramazza|first8=D|last9=Passamonti|first9=F|last10=Pardanani|first10=A|title=CALR vs JAK2 vs MPL-mutated or triple-negative myelofibrosis: clinical, cytogenetic and molecular comparisons|journal=Leukemia|volume=28|issue=7|year=2014|pages=1472–1477|issn=0887-6924|doi=10.1038/leu.2014.3}}</ref> [[Myelofibrosis]] must be differentiated from other [[Disease|diseases]] that cause diffuse [[bone]] [[sclerosis]], such as [[sickle cell disease]], [[hyperthyroidism]], [[dysplasia|sclerosing bone dysplasia]], [[bone metastasis|osteoblastic metastases]], and [[Paget's disease]].<ref name="myelofibrosisdiffdiagnsosiseradio1">Differential diagnosis of myelofibrosis. Dr Henry Knipe and Dr Yuranga Weerakkody et al. Radiopaedia 2016. http://radiopaedia.org/articles/myelofibrosis. Accessed on March 10, 2016</ref><ref name="Diffusebonysclerosisdifferentialdiagnosis1">Diffuse bony sclerosis: differential diagnosis. Dr Craig Hacking and Dr Yuranga Weerakkody et al. Radiopaedia 2016. http://radiopaedia.org/articles/diffuse-bony-sclerosis-differential-diagnosis. Accessed on March 10, 2016</ref> [[Myelofibrosis]] must be differentiated from other [[Disease|diseases]] that cause [[splenomegaly]], such as [[anemia]], [[CML]], [[polycythemia rubra vera]], [[cirrhosis]], [[infections]], [[neoplastic]], and [[lipid storage disorder|lipid storage disorders]].<ref name="myelofibrosisdiffdiagnsosiseradio1">Differential diagnosis of myelofibrosis. Dr Henry Knipe and Dr Yuranga Weerakkody et al. Radiopaedia 2016. http://radiopaedia.org/articles/myelofibrosis. Accessed on March 10, 2016</ref><ref name="splenomegalydiffdiagnosisradio1">Splenomegaly. Dr Henry Knipe and A.Prof Frank Gaillard et al. Radiopaedia 2016. http://radiopaedia.org/''Italic text''articles/splenomegaly. Accessed on March 11, 2016</ref> The [[prevalence]] of [[myelofibrosis]] is approximately 1 per 100,000 individuals worldwide. [[Myelofibrosis]] is a [[disease]] that tends to affect the middle-aged and elderly population. The [[mean]] age at [[diagnosis]] is 60 years.<ref name="epidemiologyofmyelofibrosis1radio1">Epidemiology of myelofibrosis. Dr Henry Knipe and Dr Yuranga Weerakkody et al. Radiopaedia 2016. http://radiopaedia.org/articles/myelofibrosis. Accessed on March 8, 2016</ref> [[Male|Males]] are more commonly affected with [[myelofibrosis]] than [[females]]. The [[male]] to [[female]] ratio is approximately 1.5 to 1.<ref name="pmid22212965">{{cite journal| author=Tefferi A, Lasho TL, Jimma T, Finke CM, Gangat N, Vaidya R et al.| title=One thousand patients with primary myelofibrosis: the mayo clinic experience. | journal=Mayo Clin Proc | year= 2012 | volume= 87 | issue= 1 | pages= 25-33 | pmid=22212965 | doi=10.1016/j.mayocp.2011.11.001 | pmc=PMC3538387 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22212965 }} </ref> [[Myelofibrosis]] usually affects individuals of the Ashkenazi Jews race. African American, Latin American, and Asian individuals are less likely to develop [[myelofibrosis]].<ref name="racemf1">Causes. The physician's guide to myelofibrosis 2016. http://nordphysicianguides.org/wp-content/uploads/2012/11/NORD_Physician_Guide_to_Myelofibrosis.pdf. Accessed on March 14, 2016</ref> Common [[Risk factor|risk factors]] in the development of [[myelofibrosis]] may be age, [[myeloproliferative disorder|other myeloproliferative disorders]], [[radiation]], or industrial chemical exposure.<ref name="riskfactorsofmyelofibrosismayoclinic1">Risk factors for myelofibrosis. Mayo clinic 2016. http://www.mayoclinic.org/diseases-conditions/myelofibrosis/basics/risk-factors/con-20027210. Accessed on March 7, 2016</ref> [[Myelofibrosis]] has a very indolent course. If left untreated, [[myelofibrosis]] may progress to develop [[acute myelogenous leukemia]], [[Blood clots|thrombohemorrhagic events]], and [[Bone marrow failure|progressive marrow failure]]. Common [[Complication (medicine)|complications]] of [[myelofibrosis]] include [[infections]], [[bleeding]], [[hepatic failure]], [[heart failure]], and [[gout]].<ref name="complicatnmf1">Complications of myelofibrosis. US National Library of Medicine 2016. https://www.nlm.nih.gov/medlineplus/ency/article/000531.htm. Accessed on March 7, 2016</ref><ref name="KelleYıldız2015">{{cite journal|last1=Kelle|first1=Bayram|last2=Yıldız|first2=Fatih|last3=Paydas|first3=Semra|last4=Bagır|first4=Emine Kılıc|last5=Ergin|first5=Melek|last6=Kozanoglu|first6=Erkan|title=Coexistence of hypertrophic osteoarthropathy and myelofibrosis|journal=Revista Brasileira de Reumatologia (English Edition)|year=2015|issn=22555021|doi=10.1016/j.rbre.2014.11.004}}</ref><ref name="diseaseoverviewmf1">Disease overview of primary myelofibrosis. National cancer institute 2016. http://www.cancer.gov/types/myeloproliferative/hp/chronic-treatment-pdq#section/_9. Accessed on March 10, 2016</ref><ref name="complmf1radio1">Complications of primary myelofibrosis. Dr Henry Knipe and Dr Yuranga Weerakkody et al. Radiopaedia 2016. http://radiopaedia.org/articles/myelofibrosis. Accessed on March 10, 2016</ref> [[Prognosis]] is generally poor and the [[median]] survival for [[myelofibrosis]] is 3.5 years to 5.5 years, but patients younger than 55 years have a [[median]] survival of 11 years.<ref name="diseaseoverviewmf1">Disease overview of primary myelofibrosis. National cancer institute 2016. http://www.cancer.gov/types/myeloproliferative/hp/chronic-treatment-pdq#section/_9. Accessed on March 10, 2016</ref> According to the [[World Health Organization|World Health Organization (WHO)]] [[Diagnosis|diagnostic criteria]] for [[Myelofibrosis|primary myelofibrosis]], [[polycythemia vera]], and [[essential thrombocythemia]], the [[diagnosis]] of [[Myelofibrosis|primary myelofibrosis]] is made when all three of the following major [[Diagnosis|diagnostic criteria]] and at least two minor criteria are met.<ref name="diagnosticcriteriamyelofibrosis1">World Health Organization (WHO) Diagnostic Criteria for Primary Myelofibrosis (PMF), Polycythemia Vera (PV), and Essential Thrombocythemia (ET). MPN Connect 2016. http://www.mpnconnect.com/pdf/who-diagnostic-criteria-myelofibrosis.pdf. Accessed on March 8, 2016</ref><ref name="pmid17488875">{{cite journal| author=Tefferi A, Thiele J, Orazi A, Kvasnicka HM, Barbui T, Hanson CA et al.| title=Proposals and rationale for revision of the World Health Organization diagnostic criteria for polycythemia vera, essential thrombocythemia, and primary myelofibrosis: recommendations from an ad hoc international expert panel. | journal=Blood | year= 2007 | volume= 110 | issue= 4 | pages= 1092-7 | pmid=17488875 | doi=10.1182/blood-2007-04-083501 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17488875 }} </ref> [[Symptom|Symptoms]] of [[myelofibrosis]] include [[abdominal pain|left upper quadrant abdominal pain]], [[bruising]], [[bleeding|easy bleeding]], [[Anemia|pale skin]], and [[infection|frequent infections]].<ref name="symptomsofmyelofibrosis1">Symptoms of myelofibrosis. US National Library of Medicine 2016. https://www.nlm.nih.gov/medlineplus/ency/article/000531.htm. Accessed on March 7, 2016</ref><ref name="cancercanadiansymptomsidiopathicmyelofibrosis1">Symptoms of idiopathic myelofibrosis. Canadian cancer society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/leukemia/leukemia/idiopathic-myelofibrosis/?region=on. Accessed on March 9, 2016</ref><ref name="symptoimmfgovcNCER1">Symptoms of primary myelofibrosis include pain below the ribs on the left side and feeling very tired. National cancer institute 2016. http://www.cancer.gov/types/myeloproliferative/patient/chronic-treatment-pdq#section/_234. Accessed on March 10, 2016</ref> Common [[physical examination]] findings of [[myelofibrosis]] include [[pallor]], [[petechiae]], [[lymphadenopathy]], [[hepatomegaly]], and [[splenomegaly]].<ref name="symptoimmfgovcNCER1">Symptoms of primary myelofibrosis include pain below the ribs on the left side and feeling very tired. National cancer institute 2016. http://www.cancer.gov/types/myeloproliferative/patient/chronic-treatment-pdq#section/_234. Accessed on March 10, 2016</ref> [[Medical laboratory|Laboratory]] findings consistent with the [[diagnosis]] of [[myelofibrosis]] include [[anemia|decreased red blood cells]], [[Normocytic normochromic anemia|normochromic normocytic anemia]], tear-drop shaped [[Red blood cell|RBCs]], [[thrombocytopenia]], and raised levels of [[lactate dehydrogenase]].<ref name="cancercaidiopathicmyelofibrosisdx1">Diagnosis of idiopathic myelofibrosis. Canadian cancer society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/leukemia/leukemia/idiopathic-myelofibrosis/?region=on. Accessed on March 9, 2016</ref> [[X-rays|X-ray]] may be helpful in the [[diagnosis]] of [[myelofibrosis]]. Findings on [[X-rays|x-ray]] suggestive of [[myelofibrosis]] include [[osteosclerosis]] at different sites of the body, which tends to be [[diffuse]] and devoid of architectural distortion.<ref name="radiographicfeaturesofprimarymf1radiopaedia1">Radiographic features of primary myelofibrosis. Dr Henry Knipe and Dr Yuranga Weerakkody et al. Radiopaedia 2016. http://radiopaedia.org/articles/myelofibrosis. Accessed on March 10, 2016</ref> [[Computed tomography|CT scan]] and [[Magnetic resonance imaging|MRI]] may be helpful in the [[diagnosis]] of [[myelofibrosis]]. Findings on [[Computed tomography|CT scan]] suggestive of [[myelofibrosis]] include [[bone sclerosis|diffuse bone sclerosis]]. | [[Myelofibrosis]] is a [[Blood|hematological]] disorder in which the [[bone marrow]] is replaced with [[collagen|collagenous connective tissue]] and progressive [[fibrosis]], replacing the [[bone marrow]] with a [[scar tissue]] and hence disrupting the normal production of [[Blood cell|blood cells]] which leads to [[pancytopenia]].<ref name="pmid27539616">{{cite journal |vauthors=Shantzer L, Berger K, Pu JJ |title=Primary myelofibrosis and its targeted therapy |journal=Ann. Hematol. |volume=96 |issue=4 |pages=531–535 |date=April 2017 |pmid=27539616 |doi=10.1007/s00277-016-2785-9 |url=}}</ref> It is also classified as a [[Myeloproliferative neoplasm|myeloproliferative disorder]].<ref name="overviewofmyelofibrosis1">Myelofibrosis. Dr Henry Knipe ◉ and Dr Yuranga Weerakkody et al. Radiopaedia 2016. http://radiopaedia.org/articles/myelofibrosis. Accessed on March 7, 2016</ref> The term [[myelofibrosis]] alone usually refers to '''[[Primary myelofibrosis|primary myelofibrosis (PMF)]]''', also known as [[Chronic (medical)|chronic]] [[idiopathic]] [[myelofibrosis]] (CIMF); the terms [[idiopathic]] and primary mean that the [[disease]] is of unknown or spontaneous origin. This is in contrast with [[myelofibrosis]] that develops secondary to [[polycythemia vera]], [[essential thrombocythemia]], [[leukemia]], or [[lymphoma]] ('''secondary [[myelofibrosis]]'''). [[Myelofibrosis]] is a form of [[myeloid metaplasia]], which refers to a change in [[Cell (biology)|cell]] type in the [[blood]]-forming [[Tissue (biology)|tissue]] of the [[bone marrow]], and often the two terms are used synonymously. [[Gene|Genes]] involved in the [[pathogenesis]] of [[myelofibrosis]] include ''[[JAK2]]'', ''[[Calreticulin|CALR]]'', and ''[[Myeloproliferative leukemia virus oncogene|MPL]]''.<ref name="TefferiLasho2014">{{cite journal|last1=Tefferi|first1=A|last2=Lasho|first2=T L|last3=Finke|first3=C M|last4=Knudson|first4=R A|last5=Ketterling|first5=R|last6=Hanson|first6=C H|last7=Maffioli|first7=M|last8=Caramazza|first8=D|last9=Passamonti|first9=F|last10=Pardanani|first10=A|title=CALR vs JAK2 vs MPL-mutated or triple-negative myelofibrosis: clinical, cytogenetic and molecular comparisons|journal=Leukemia|volume=28|issue=7|year=2014|pages=1472–1477|issn=0887-6924|doi=10.1038/leu.2014.3}}</ref> [[Myelofibrosis]] must be differentiated from other [[Disease|diseases]] that cause diffuse [[bone]] [[sclerosis]], such as [[sickle cell disease]], [[hyperthyroidism]], [[dysplasia|sclerosing bone dysplasia]], [[bone metastasis|osteoblastic metastases]], and [[Paget's disease]].<ref name="myelofibrosisdiffdiagnsosiseradio1">Differential diagnosis of myelofibrosis. Dr Henry Knipe and Dr Yuranga Weerakkody et al. Radiopaedia 2016. http://radiopaedia.org/articles/myelofibrosis. Accessed on March 10, 2016</ref><ref name="Diffusebonysclerosisdifferentialdiagnosis1">Diffuse bony sclerosis: differential diagnosis. Dr Craig Hacking and Dr Yuranga Weerakkody et al. Radiopaedia 2016. http://radiopaedia.org/articles/diffuse-bony-sclerosis-differential-diagnosis. Accessed on March 10, 2016</ref> [[Myelofibrosis]] must be differentiated from other [[Disease|diseases]] that cause [[splenomegaly]], such as [[anemia]], [[CML]], [[polycythemia rubra vera]], [[cirrhosis]], [[infections]], [[neoplastic]], and [[lipid storage disorder|lipid storage disorders]].<ref name="myelofibrosisdiffdiagnsosiseradio1">Differential diagnosis of myelofibrosis. Dr Henry Knipe and Dr Yuranga Weerakkody et al. Radiopaedia 2016. http://radiopaedia.org/articles/myelofibrosis. Accessed on March 10, 2016</ref><ref name="splenomegalydiffdiagnosisradio1">Splenomegaly. Dr Henry Knipe and A.Prof Frank Gaillard et al. Radiopaedia 2016. http://radiopaedia.org/''Italic text''articles/splenomegaly. Accessed on March 11, 2016</ref> The [[prevalence]] of [[myelofibrosis]] is approximately 1 per 100,000 individuals worldwide. [[Myelofibrosis]] is a [[disease]] that tends to affect the middle-aged and elderly population. The [[mean]] age at [[diagnosis]] is 60 years.<ref name="epidemiologyofmyelofibrosis1radio1">Epidemiology of myelofibrosis. Dr Henry Knipe and Dr Yuranga Weerakkody et al. Radiopaedia 2016. http://radiopaedia.org/articles/myelofibrosis. Accessed on March 8, 2016</ref> [[Male|Males]] are more commonly affected with [[myelofibrosis]] than [[females]]. The [[male]] to [[female]] ratio is approximately 1.5 to 1.<ref name="pmid22212965">{{cite journal| author=Tefferi A, Lasho TL, Jimma T, Finke CM, Gangat N, Vaidya R et al.| title=One thousand patients with primary myelofibrosis: the mayo clinic experience. | journal=Mayo Clin Proc | year= 2012 | volume= 87 | issue= 1 | pages= 25-33 | pmid=22212965 | doi=10.1016/j.mayocp.2011.11.001 | pmc=PMC3538387 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22212965 }} </ref> [[Myelofibrosis]] usually affects individuals of the Ashkenazi Jews race. African American, Latin American, and Asian individuals are less likely to develop [[myelofibrosis]].<ref name="racemf1">Causes. The physician's guide to myelofibrosis 2016. http://nordphysicianguides.org/wp-content/uploads/2012/11/NORD_Physician_Guide_to_Myelofibrosis.pdf. Accessed on March 14, 2016</ref> Common [[Risk factor|risk factors]] in the development of [[myelofibrosis]] may be age, [[myeloproliferative disorder|other myeloproliferative disorders]], [[radiation]], or industrial chemical exposure.<ref name="riskfactorsofmyelofibrosismayoclinic1">Risk factors for myelofibrosis. Mayo clinic 2016. http://www.mayoclinic.org/diseases-conditions/myelofibrosis/basics/risk-factors/con-20027210. Accessed on March 7, 2016</ref> [[Myelofibrosis]] has a very indolent course. If left untreated, [[myelofibrosis]] may progress to develop [[acute myelogenous leukemia]], [[Blood clots|thrombohemorrhagic events]], and [[Bone marrow failure|progressive marrow failure]]. Common [[Complication (medicine)|complications]] of [[myelofibrosis]] include [[infections]], [[bleeding]], [[hepatic failure]], [[heart failure]], and [[gout]].<ref name="complicatnmf1">Complications of myelofibrosis. US National Library of Medicine 2016. https://www.nlm.nih.gov/medlineplus/ency/article/000531.htm. Accessed on March 7, 2016</ref><ref name="KelleYıldız2015">{{cite journal|last1=Kelle|first1=Bayram|last2=Yıldız|first2=Fatih|last3=Paydas|first3=Semra|last4=Bagır|first4=Emine Kılıc|last5=Ergin|first5=Melek|last6=Kozanoglu|first6=Erkan|title=Coexistence of hypertrophic osteoarthropathy and myelofibrosis|journal=Revista Brasileira de Reumatologia (English Edition)|year=2015|issn=22555021|doi=10.1016/j.rbre.2014.11.004}}</ref><ref name="diseaseoverviewmf1">Disease overview of primary myelofibrosis. National cancer institute 2016. http://www.cancer.gov/types/myeloproliferative/hp/chronic-treatment-pdq#section/_9. Accessed on March 10, 2016</ref><ref name="complmf1radio1">Complications of primary myelofibrosis. Dr Henry Knipe and Dr Yuranga Weerakkody et al. Radiopaedia 2016. http://radiopaedia.org/articles/myelofibrosis. Accessed on March 10, 2016</ref> [[Prognosis]] is generally poor and the [[median]] survival for [[myelofibrosis]] is 3.5 years to 5.5 years, but patients younger than 55 years have a [[median]] survival of 11 years.<ref name="diseaseoverviewmf1">Disease overview of primary myelofibrosis. National cancer institute 2016. http://www.cancer.gov/types/myeloproliferative/hp/chronic-treatment-pdq#section/_9. Accessed on March 10, 2016</ref> According to the [[World Health Organization|World Health Organization (WHO)]] [[Diagnosis|diagnostic criteria]] for [[Myelofibrosis|primary myelofibrosis]], [[polycythemia vera]], and [[essential thrombocythemia]], the [[diagnosis]] of [[Myelofibrosis|primary myelofibrosis]] is made when all three of the following major [[Diagnosis|diagnostic criteria]] and at least two minor criteria are met.<ref name="diagnosticcriteriamyelofibrosis1">World Health Organization (WHO) Diagnostic Criteria for Primary Myelofibrosis (PMF), Polycythemia Vera (PV), and Essential Thrombocythemia (ET). MPN Connect 2016. http://www.mpnconnect.com/pdf/who-diagnostic-criteria-myelofibrosis.pdf. Accessed on March 8, 2016</ref><ref name="pmid17488875">{{cite journal| author=Tefferi A, Thiele J, Orazi A, Kvasnicka HM, Barbui T, Hanson CA et al.| title=Proposals and rationale for revision of the World Health Organization diagnostic criteria for polycythemia vera, essential thrombocythemia, and primary myelofibrosis: recommendations from an ad hoc international expert panel. | journal=Blood | year= 2007 | volume= 110 | issue= 4 | pages= 1092-7 | pmid=17488875 | doi=10.1182/blood-2007-04-083501 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17488875 }} </ref> [[Symptom|Symptoms]] of [[myelofibrosis]] include [[abdominal pain|left upper quadrant abdominal pain]], [[bruising]], [[bleeding|easy bleeding]], [[Anemia|pale skin]], and [[infection|frequent infections]].<ref name="symptomsofmyelofibrosis1">Symptoms of myelofibrosis. US National Library of Medicine 2016. https://www.nlm.nih.gov/medlineplus/ency/article/000531.htm. Accessed on March 7, 2016</ref><ref name="cancercanadiansymptomsidiopathicmyelofibrosis1">Symptoms of idiopathic myelofibrosis. Canadian cancer society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/leukemia/leukemia/idiopathic-myelofibrosis/?region=on. Accessed on March 9, 2016</ref><ref name="symptoimmfgovcNCER1">Symptoms of primary myelofibrosis include pain below the ribs on the left side and feeling very tired. National cancer institute 2016. http://www.cancer.gov/types/myeloproliferative/patient/chronic-treatment-pdq#section/_234. Accessed on March 10, 2016</ref> Common [[physical examination]] findings of [[myelofibrosis]] include [[pallor]], [[petechiae]], [[lymphadenopathy]], [[hepatomegaly]], and [[splenomegaly]].<ref name="symptoimmfgovcNCER1">Symptoms of primary myelofibrosis include pain below the ribs on the left side and feeling very tired. National cancer institute 2016. http://www.cancer.gov/types/myeloproliferative/patient/chronic-treatment-pdq#section/_234. Accessed on March 10, 2016</ref> [[Medical laboratory|Laboratory]] findings consistent with the [[diagnosis]] of [[myelofibrosis]] include [[anemia|decreased red blood cells]], [[Normocytic normochromic anemia|normochromic normocytic anemia]], tear-drop shaped [[Red blood cell|RBCs]], [[thrombocytopenia]], and raised levels of [[lactate dehydrogenase]].<ref name="cancercaidiopathicmyelofibrosisdx1">Diagnosis of idiopathic myelofibrosis. Canadian cancer society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/leukemia/leukemia/idiopathic-myelofibrosis/?region=on. Accessed on March 9, 2016</ref> [[X-rays|X-ray]] may be helpful in the [[diagnosis]] of [[myelofibrosis]]. Findings on [[X-rays|x-ray]] suggestive of [[myelofibrosis]] include [[osteosclerosis]] at different sites of the body, which tends to be [[diffuse]] and devoid of architectural distortion.<ref name="radiographicfeaturesofprimarymf1radiopaedia1">Radiographic features of primary myelofibrosis. Dr Henry Knipe and Dr Yuranga Weerakkody et al. Radiopaedia 2016. http://radiopaedia.org/articles/myelofibrosis. Accessed on March 10, 2016</ref> [[Computed tomography|CT scan]] and [[Magnetic resonance imaging|MRI]] may be helpful in the [[diagnosis]] of [[myelofibrosis]]. Findings on [[Computed tomography|CT scan]] suggestive of [[myelofibrosis]] include [[bone sclerosis|diffuse bone sclerosis]]. Findings on [[Magnetic resonance imaging|MRI]] suggestive of [[myelofibrosis]] include [[diffuse]] decrease [[bone marrow]] signal intensity. [[Bone marrow biopsy]] is the [[imaging]] modality of choice for [[myelofibrosis]]. A [[bone marrow]] [[biopsy]] will reveal [[collagen]] [[fibrosis]] that has replaced the [[bone marrow]]. Other [[Diagnosis|diagnostic]] studies for [[myelofibrosis]] include ''[[JAK2]]'' [[mutation]] analysis testing and [[bone scan]]. [[Blood transfusion|Red blood cell transfusion]], [[danazol]] therapy, or [[thalidomide]] are recommended for [[Patient|patients]] who develop [[anemia]]. [[Ruxolitinib]], an [[Enzyme inhibitor|inhibitor]] of ''[[Janus kinase 1|JAK1]]'' and ''[[JAK2]]'', can reduce the [[splenomegaly]] and the debilitating [[Symptom|symptoms]] of [[weight loss]], [[fatigue]], and [[night sweats]] for [[Patient|patients]] with ''[[Janus kinase 2|JAK2]]''-positive or ''[[Janus kinase 2|JAK2]]''-negative primary [[myelofibrosis]], post–[[Essential thrombocytosis|essential thrombocythemia]] [[myelofibrosis]], or post–[[polycythemia vera]] [[myelofibrosis]]. [[Hydroxyurea]], [[chemotherapy]], [[radiotherapy]], or [[splenectomy]] are recommended for [[Patient|patients]] who develop [[splenomegaly]]. [[Surgery]] is not the [[first-line treatment]] option for [[Patient|patients]] with [[myelofibrosis]]. [[Splenectomy]] is usually reserved for [[Patient|patients]] with massive [[splenomegaly]] unresponsive to conservative treatment. The only known [[cure]] is [[allogeneic stem cell transplantation]], but this approach involves significant risks. | ||
==Historical Perspective== | ==Historical Perspective== | ||
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==Pathophysiology== | ==Pathophysiology== | ||
[[Myelofibrosis]] is a [[Clone (cell biology)|clonal]] [[Cancer|neoplastic]] disorder of [[hematopoiesis]], the formation of [[blood]] [[Cell (biology)|cellular]] components. It is one of the [[myleoproliferative disorders]], diseases of the [[bone marrow]] in which excess [[Cell (biology)|cells]] are produced. [[Gene|Genes]] involved in the [[pathogenesis]] of [[myelofibrosis]] include ''[[JAK2]]'', ''[[Calreticulin|CALR]]'', and ''[[Myeloproliferative leukemia virus oncogene|MPL]]''. | [[Myelofibrosis]] is a [[Clone (cell biology)|clonal]] [[Cancer|neoplastic]] disorder of [[hematopoiesis]], the formation of [[blood]] [[Cell (biology)|cellular]] components. It is one of the [[myleoproliferative disorders]], diseases of the [[bone marrow]] in which excess [[Cell (biology)|cells]] are produced. [[Gene|Genes]] involved in the [[pathogenesis]] of [[myelofibrosis]] include ''[[JAK2]]'', ''[[Calreticulin|CALR]]'', and ''[[Myeloproliferative leukemia virus oncogene|MPL]]''. | ||
==Causes== | ==Causes== | ||
Common causes of [[myelofibrosis]] include [[mutation|genetic mutations]]. The [[Gene|genes]] involved are listed [[myelofibrosis pathophysiology|'''here''']]. | Common causes of [[myelofibrosis]] include [[mutation|genetic mutations]]. The [[Gene|genes]] involved are listed [[myelofibrosis pathophysiology|'''here''']]. | ||
==Differentiating Myelofibrosis from other Diseases== | ==Differentiating Myelofibrosis from other Diseases== | ||
[[Myelofibrosis]] must be differentiated from other [[Disease|diseases]] that cause [[diffuse]] [[bone]] [[sclerosis]], such as [[sickle cell disease]], [[hyperthyroidism]], [[dysplasia|sclerosing bone dysplasia]], [[bone metastasis|osteoblastic metastases]], and [[Paget's disease]]. | [[Myelofibrosis]] must be differentiated from other [[Disease|diseases]] that cause [[diffuse]] [[bone]] [[sclerosis]], such as [[sickle cell disease]], [[hyperthyroidism]], [[dysplasia|sclerosing bone dysplasia]], [[bone metastasis|osteoblastic metastases]], and [[Paget's disease]]. [[Myelofibrosis]] must be differentiated from other [[Disease|diseases]] that cause [[splenomegaly]], such as [[anemia]], [[CML]], [[polycythemia rubra vera]], [[cirrhosis]], [[infections]], [[neoplastic]], and [[lipid storage disorder|lipid storage disorders]]. | ||
==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
The [[prevalence]] of [[myelofibrosis]] is approximately 1 per 100,000 individuals worldwide. [[Myelofibrosis]] is a [[disease]] that tends to affect the middle-aged and elderly population. The [[mean]] age at diagnosis is 60 years. | The [[prevalence]] of [[myelofibrosis]] is approximately 1 per 100,000 individuals worldwide. [[Myelofibrosis]] is a [[disease]] that tends to affect the middle-aged and elderly population. The [[mean]] age at diagnosis is 60 years. [[Male|Males]] are more commonly affected with [[myelofibrosis]] than [[Female|females]]. The [[male]] to [[female]] ratio is approximately 1.5 to 1. [[Myelofibrosis]] usually affects individuals of the Ashkenazi Jews race. African American, Latin American, and Asian individuals are less likely to develop [[myelofibrosis]]. | ||
==Risk Factors== | ==Risk Factors== | ||
| Line 28: | Line 28: | ||
==Natural History, Complications and Prognosis== | ==Natural History, Complications and Prognosis== | ||
[[Myelofibrosis]] has a very indolent course. If left untreated, [[myelofibrosis]] may progress to develop [[acute myelogenous leukemia]], [[Blood clots|thrombohemorrhagic events]], and [[Bone marrow failure|progressive marrow failure]]. Common [[Complication (medicine)|complications]] of [[myelofibrosis]] include [[infections]], [[bleeding]], [[hepatic failure]], [[heart failure]], and [[gout]]. | [[Myelofibrosis]] has a very indolent course. If left untreated, [[myelofibrosis]] may progress to develop [[acute myelogenous leukemia]], [[Blood clots|thrombohemorrhagic events]], and [[Bone marrow failure|progressive marrow failure]]. Common [[Complication (medicine)|complications]] of [[myelofibrosis]] include [[infections]], [[bleeding]], [[hepatic failure]], [[heart failure]], and [[gout]]. [[Prognosis]] is generally poor and the [[median]] survival for [[myelofibrosis]] is 3.5 years to 5.5 years, but patients younger than 55 years have a [[median]] survival of 11 years. | ||
==Diagnosis== | ==Diagnosis== | ||
===Diagnostic | ===Diagnostic Study of Choice=== | ||
According to the [[World Health Organization|World Health Organization (WHO)]] [[Diagnosis|diagnostic]] criteria for [[Myelofibrosis|primary myelofibrosis]], [[polycythemia vera]], and [[essential thrombocythemia]], the [[diagnosis]] of [[Myelofibrosis|primary myelofibrosis]] is made when all three of the major [[Diagnosis|diagnostic]] criteria and at least two minor criteria are met. | According to the [[World Health Organization|World Health Organization (WHO)]] [[Diagnosis|diagnostic]] criteria for [[Myelofibrosis|primary myelofibrosis]], [[polycythemia vera]], and [[essential thrombocythemia]], the [[diagnosis]] of [[Myelofibrosis|primary myelofibrosis]] is made when all three of the major [[Diagnosis|diagnostic]] criteria and at least two minor criteria are met. | ||
=== | ===History and Symptoms=== | ||
[[Symptom|Symptoms]] of [[myelofibrosis]] include [[abdominal pain|left upper quadrant abdominal pain]], [[bruising]], [[bleeding|easy bleeding]], [[Anemia|pale skin]], and [[infection|frequent infections]]. | |||
[[Symptom|Symptoms]] of [[myelofibrosis]] include [[abdominal pain|left upper quadrant abdominal pain]], [[bruising]], [[bleeding|easy bleeding]], [[Anemia|pale skin]], and [[infection|frequent infections]]. | |||
===Physical Examination=== | ===Physical Examination=== | ||
Common [[physical examination]] findings of [[myelofibrosis]] include [[pallor]], [[petechiae]], [[lymphadenopathy]], [[hepatomegaly]], and [[splenomegaly]]. | Common [[physical examination]] findings of [[myelofibrosis]] include [[pallor]], [[petechiae]], [[lymphadenopathy]], [[hepatomegaly]], and [[splenomegaly]]. | ||
===Laboratory Findings=== | ===Laboratory Findings=== | ||
[[Medical laboratory|Laboratory]] findings consistent with the [[diagnosis]] of [[myelofibrosis]] include [[anemia|decreased red blood cells]], [[Normocytic normochromic anemia|normochromic normocytic anemia]], tear-drop shaped [[Red blood cell|RBCs]], [[thrombocytopenia]], and raised levels of [[lactate dehydrogenase]]. | [[Medical laboratory|Laboratory]] findings consistent with the [[diagnosis]] of [[myelofibrosis]] include [[anemia|decreased red blood cells]], [[Normocytic normochromic anemia|normochromic normocytic anemia]], tear-drop shaped [[Red blood cell|RBCs]], [[thrombocytopenia]], and raised levels of [[lactate dehydrogenase]]. | ||
===Electrocardiogram=== | |||
===X Ray=== | ===X Ray=== | ||
[[X-rays|X-ray]] may be helpful in the [[diagnosis]] of [[myelofibrosis]]. Findings on [[X-rays|x-ray]] suggestive of [[myelofibrosis]] include [[osteosclerosis]] at different sites of the body, which tends to be [[diffuse]] and devoid of architectural distortion. | [[X-rays|X-ray]] may be helpful in the [[diagnosis]] of [[myelofibrosis]]. Findings on [[X-rays|x-ray]] suggestive of [[myelofibrosis]] include [[osteosclerosis]] at different sites of the body, which tends to be [[diffuse]] and devoid of architectural distortion. | ||
===CT=== | ===CT=== | ||
[[Computed tomography|CT scan]] may be helpful in the [[diagnosis]] of [[myelofibrosis]]. Findings on [[Computed tomography|CT scan]] suggestive of [[myelofibrosis]] include [[bone sclerosis|diffuse bone sclerosis]]. | [[Computed tomography|CT scan]] may be helpful in the [[diagnosis]] of [[myelofibrosis]]. Findings on [[Computed tomography|CT scan]] suggestive of [[myelofibrosis]] include [[bone sclerosis|diffuse bone sclerosis]]. | ||
===MRI=== | ===MRI=== | ||
[[Magnetic resonance imaging|MRI]] may be helpful in the [[diagnosis]] of [[myelofibrosis]]. Findings on [[Magnetic resonance imaging|MRI]] suggestive of [[myelofibrosis]] include [[diffuse]] decrease [[bone marrow]] signal intensity | [[Magnetic resonance imaging|MRI]] may be helpful in the [[diagnosis]] of [[myelofibrosis]]. Findings on [[Magnetic resonance imaging|MRI]] suggestive of [[myelofibrosis]] include [[diffuse]] decrease [[bone marrow]] signal intensity. | ||
===Echocardiography or Ultrasound=== | |||
===Other Imaging Findings=== | ===Other Imaging Findings=== | ||
There are no other [[imaging]] findings associated with [[myelofibrosis]]. | There are no other [[imaging]] findings associated with [[myelofibrosis]]. | ||
===Other Diagnostic Studies=== | ===Other Diagnostic Studies=== | ||
Other [[Diagnosis|diagnostic]] studies for [[myelofibrosis]] include ''[[JAK2]]'' [[mutation]] analysis testing and [[bone scan]]. | Other [[Diagnosis|diagnostic]] studies for [[myelofibrosis]] include ''[[JAK2]]'' [[mutation]] analysis testing and [[bone scan]]. [[Bone marrow]] [[biopsy]] is the [[imaging]] modality of choice for [[myelofibrosis]]. A [[bone marrow]] [[biopsy]] will reveal [[collagen]] [[fibrosis]] that has replaced the [[bone marrow]]. | ||
==Treatment== | ==Treatment== | ||
Revision as of 05:48, 4 January 2019
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Myelofibrosis Microchapters |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2]
Overview
Myelofibrosis is a hematological disorder in which the bone marrow is replaced with collagenous connective tissue and progressive fibrosis, replacing the bone marrow with a scar tissue and hence disrupting the normal production of blood cells which leads to pancytopenia.[1] It is also classified as a myeloproliferative disorder.[2] The term myelofibrosis alone usually refers to primary myelofibrosis (PMF), also known as chronic idiopathic myelofibrosis (CIMF); the terms idiopathic and primary mean that the disease is of unknown or spontaneous origin. This is in contrast with myelofibrosis that develops secondary to polycythemia vera, essential thrombocythemia, leukemia, or lymphoma (secondary myelofibrosis). Myelofibrosis is a form of myeloid metaplasia, which refers to a change in cell type in the blood-forming tissue of the bone marrow, and often the two terms are used synonymously. Genes involved in the pathogenesis of myelofibrosis include JAK2, CALR, and MPL.[3] Myelofibrosis must be differentiated from other diseases that cause diffuse bone sclerosis, such as sickle cell disease, hyperthyroidism, sclerosing bone dysplasia, osteoblastic metastases, and Paget's disease.[4][5] Myelofibrosis must be differentiated from other diseases that cause splenomegaly, such as anemia, CML, polycythemia rubra vera, cirrhosis, infections, neoplastic, and lipid storage disorders.[4][6] The prevalence of myelofibrosis is approximately 1 per 100,000 individuals worldwide. Myelofibrosis is a disease that tends to affect the middle-aged and elderly population. The mean age at diagnosis is 60 years.[7] Males are more commonly affected with myelofibrosis than females. The male to female ratio is approximately 1.5 to 1.[8] Myelofibrosis usually affects individuals of the Ashkenazi Jews race. African American, Latin American, and Asian individuals are less likely to develop myelofibrosis.[9] Common risk factors in the development of myelofibrosis may be age, other myeloproliferative disorders, radiation, or industrial chemical exposure.[10] Myelofibrosis has a very indolent course. If left untreated, myelofibrosis may progress to develop acute myelogenous leukemia, thrombohemorrhagic events, and progressive marrow failure. Common complications of myelofibrosis include infections, bleeding, hepatic failure, heart failure, and gout.[11][12][13][14] Prognosis is generally poor and the median survival for myelofibrosis is 3.5 years to 5.5 years, but patients younger than 55 years have a median survival of 11 years.[13] According to the World Health Organization (WHO) diagnostic criteria for primary myelofibrosis, polycythemia vera, and essential thrombocythemia, the diagnosis of primary myelofibrosis is made when all three of the following major diagnostic criteria and at least two minor criteria are met.[15][16] Symptoms of myelofibrosis include left upper quadrant abdominal pain, bruising, easy bleeding, pale skin, and frequent infections.[17][18][19] Common physical examination findings of myelofibrosis include pallor, petechiae, lymphadenopathy, hepatomegaly, and splenomegaly.[19] Laboratory findings consistent with the diagnosis of myelofibrosis include decreased red blood cells, normochromic normocytic anemia, tear-drop shaped RBCs, thrombocytopenia, and raised levels of lactate dehydrogenase.[20] X-ray may be helpful in the diagnosis of myelofibrosis. Findings on x-ray suggestive of myelofibrosis include osteosclerosis at different sites of the body, which tends to be diffuse and devoid of architectural distortion.[21] CT scan and MRI may be helpful in the diagnosis of myelofibrosis. Findings on CT scan suggestive of myelofibrosis include diffuse bone sclerosis. Findings on MRI suggestive of myelofibrosis include diffuse decrease bone marrow signal intensity. Bone marrow biopsy is the imaging modality of choice for myelofibrosis. A bone marrow biopsy will reveal collagen fibrosis that has replaced the bone marrow. Other diagnostic studies for myelofibrosis include JAK2 mutation analysis testing and bone scan. Red blood cell transfusion, danazol therapy, or thalidomide are recommended for patients who develop anemia. Ruxolitinib, an inhibitor of JAK1 and JAK2, can reduce the splenomegaly and the debilitating symptoms of weight loss, fatigue, and night sweats for patients with JAK2-positive or JAK2-negative primary myelofibrosis, post–essential thrombocythemia myelofibrosis, or post–polycythemia vera myelofibrosis. Hydroxyurea, chemotherapy, radiotherapy, or splenectomy are recommended for patients who develop splenomegaly. Surgery is not the first-line treatment option for patients with myelofibrosis. Splenectomy is usually reserved for patients with massive splenomegaly unresponsive to conservative treatment. The only known cure is allogeneic stem cell transplantation, but this approach involves significant risks.
Historical Perspective
The first description of primary myelofibrosis (PMF) is credited to a German surgeon, Gustav Heuck, who described the concept in 1879. Additional work and discoveries started to get documented at the beginning of the twentieth century. The substantial contribution came from Max Askanazy, a German pathologist and Herbert Assmann, an Internistfrom Germany. The condition was given several pseudonyms before the International Working Group for Myelofibrosis Research and Treatment decided in 2006 to use the term primary myelofibrosis (PMF).
Classification
Myelofibrosis is subclassified into primary and secondary types with the primary type being more common and a high proportion of the cases resulting from mutations in the Janus kinase 2 (JAK2) gene. It can be secondary to a variety of malignant, non-malignant, and hematologic conditions. It can also be secondary to malignancies, infections, toxins, autoimmune, and endocrine diseases.
Pathophysiology
Myelofibrosis is a clonal neoplastic disorder of hematopoiesis, the formation of blood cellular components. It is one of the myleoproliferative disorders, diseases of the bone marrow in which excess cells are produced. Genes involved in the pathogenesis of myelofibrosis include JAK2, CALR, and MPL.
Causes
Common causes of myelofibrosis include genetic mutations. The genes involved are listed here.
Differentiating Myelofibrosis from other Diseases
Myelofibrosis must be differentiated from other diseases that cause diffuse bone sclerosis, such as sickle cell disease, hyperthyroidism, sclerosing bone dysplasia, osteoblastic metastases, and Paget's disease. Myelofibrosis must be differentiated from other diseases that cause splenomegaly, such as anemia, CML, polycythemia rubra vera, cirrhosis, infections, neoplastic, and lipid storage disorders.
Epidemiology and Demographics
The prevalence of myelofibrosis is approximately 1 per 100,000 individuals worldwide. Myelofibrosis is a disease that tends to affect the middle-aged and elderly population. The mean age at diagnosis is 60 years. Males are more commonly affected with myelofibrosis than females. The male to female ratio is approximately 1.5 to 1. Myelofibrosis usually affects individuals of the Ashkenazi Jews race. African American, Latin American, and Asian individuals are less likely to develop myelofibrosis.
Risk Factors
Common risk factors in the development of myelofibrosis may be age, other myeloproliferative disorders, radiation, or industrial chemical exposure.
Natural History, Complications and Prognosis
Myelofibrosis has a very indolent course. If left untreated, myelofibrosis may progress to develop acute myelogenous leukemia, thrombohemorrhagic events, and progressive marrow failure. Common complications of myelofibrosis include infections, bleeding, hepatic failure, heart failure, and gout. Prognosis is generally poor and the median survival for myelofibrosis is 3.5 years to 5.5 years, but patients younger than 55 years have a median survival of 11 years.
Diagnosis
Diagnostic Study of Choice
According to the World Health Organization (WHO) diagnostic criteria for primary myelofibrosis, polycythemia vera, and essential thrombocythemia, the diagnosis of primary myelofibrosis is made when all three of the major diagnostic criteria and at least two minor criteria are met.
History and Symptoms
Symptoms of myelofibrosis include left upper quadrant abdominal pain, bruising, easy bleeding, pale skin, and frequent infections.
Physical Examination
Common physical examination findings of myelofibrosis include pallor, petechiae, lymphadenopathy, hepatomegaly, and splenomegaly.
Laboratory Findings
Laboratory findings consistent with the diagnosis of myelofibrosis include decreased red blood cells, normochromic normocytic anemia, tear-drop shaped RBCs, thrombocytopenia, and raised levels of lactate dehydrogenase.
Electrocardiogram
X Ray
X-ray may be helpful in the diagnosis of myelofibrosis. Findings on x-ray suggestive of myelofibrosis include osteosclerosis at different sites of the body, which tends to be diffuse and devoid of architectural distortion.
CT
CT scan may be helpful in the diagnosis of myelofibrosis. Findings on CT scan suggestive of myelofibrosis include diffuse bone sclerosis.
MRI
MRI may be helpful in the diagnosis of myelofibrosis. Findings on MRI suggestive of myelofibrosis include diffuse decrease bone marrow signal intensity.
Echocardiography or Ultrasound
Other Imaging Findings
There are no other imaging findings associated with myelofibrosis.
Other Diagnostic Studies
Other diagnostic studies for myelofibrosis include JAK2 mutation analysis testing and bone scan. Bone marrow biopsy is the imaging modality of choice for myelofibrosis. A bone marrow biopsy will reveal collagen fibrosis that has replaced the bone marrow.
Treatment
Medical Therapy
Red blood cell transfusion, danazol therapy, or thalidomide are recommended for patients who develop anemia. Ruxolitinib, an inhibitor of JAK1 and JAK2, can reduce the splenomegaly and the debilitating symptoms of weight loss, fatigue, and night sweats for patients with JAK2-positive or JAK2-negative primary myelofibrosis, post–essential thrombocythemia myelofibrosis, or post–polycythemia vera myelofibrosis.[22] Hydroxyurea, chemotherapy, radiotherapy, or splenectomy are recommended for patients who develop splenomegaly.[22]
Surgery
Surgery is not the first-line treatment option for patients with myelofibrosis. Splenectomy is usually reserved for patients with massive splenomegaly unresponsive to conservative treatment. The only known cure is allogeneic stem cell transplantation, but this approach involves significant risks.
Primary Prevention
There are no established measures for the primary prevention of myelofibrosis. Avoidance of radiation may be helpful, as radiation exposure can induce bone marrow fibrosis.
Secondary Prevention
There are no established measures for the secondary prevention of myelofibrosis.
References
- ↑ Shantzer L, Berger K, Pu JJ (April 2017). "Primary myelofibrosis and its targeted therapy". Ann. Hematol. 96 (4): 531–535. doi:10.1007/s00277-016-2785-9. PMID 27539616.
- ↑ Myelofibrosis. Dr Henry Knipe ◉ and Dr Yuranga Weerakkody et al. Radiopaedia 2016. http://radiopaedia.org/articles/myelofibrosis. Accessed on March 7, 2016
- ↑ Tefferi, A; Lasho, T L; Finke, C M; Knudson, R A; Ketterling, R; Hanson, C H; Maffioli, M; Caramazza, D; Passamonti, F; Pardanani, A (2014). "CALR vs JAK2 vs MPL-mutated or triple-negative myelofibrosis: clinical, cytogenetic and molecular comparisons". Leukemia. 28 (7): 1472–1477. doi:10.1038/leu.2014.3. ISSN 0887-6924.
- ↑ 4.0 4.1 Differential diagnosis of myelofibrosis. Dr Henry Knipe and Dr Yuranga Weerakkody et al. Radiopaedia 2016. http://radiopaedia.org/articles/myelofibrosis. Accessed on March 10, 2016
- ↑ Diffuse bony sclerosis: differential diagnosis. Dr Craig Hacking and Dr Yuranga Weerakkody et al. Radiopaedia 2016. http://radiopaedia.org/articles/diffuse-bony-sclerosis-differential-diagnosis. Accessed on March 10, 2016
- ↑ Splenomegaly. Dr Henry Knipe and A.Prof Frank Gaillard et al. Radiopaedia 2016. http://radiopaedia.org/Italic textarticles/splenomegaly. Accessed on March 11, 2016
- ↑ Epidemiology of myelofibrosis. Dr Henry Knipe and Dr Yuranga Weerakkody et al. Radiopaedia 2016. http://radiopaedia.org/articles/myelofibrosis. Accessed on March 8, 2016
- ↑ Tefferi A, Lasho TL, Jimma T, Finke CM, Gangat N, Vaidya R; et al. (2012). "One thousand patients with primary myelofibrosis: the mayo clinic experience". Mayo Clin Proc. 87 (1): 25–33. doi:10.1016/j.mayocp.2011.11.001. PMC 3538387. PMID 22212965.
- ↑ Causes. The physician's guide to myelofibrosis 2016. http://nordphysicianguides.org/wp-content/uploads/2012/11/NORD_Physician_Guide_to_Myelofibrosis.pdf. Accessed on March 14, 2016
- ↑ Risk factors for myelofibrosis. Mayo clinic 2016. http://www.mayoclinic.org/diseases-conditions/myelofibrosis/basics/risk-factors/con-20027210. Accessed on March 7, 2016
- ↑ Complications of myelofibrosis. US National Library of Medicine 2016. https://www.nlm.nih.gov/medlineplus/ency/article/000531.htm. Accessed on March 7, 2016
- ↑ Kelle, Bayram; Yıldız, Fatih; Paydas, Semra; Bagır, Emine Kılıc; Ergin, Melek; Kozanoglu, Erkan (2015). "Coexistence of hypertrophic osteoarthropathy and myelofibrosis". Revista Brasileira de Reumatologia (English Edition). doi:10.1016/j.rbre.2014.11.004. ISSN 2255-5021.
- ↑ 13.0 13.1 Disease overview of primary myelofibrosis. National cancer institute 2016. http://www.cancer.gov/types/myeloproliferative/hp/chronic-treatment-pdq#section/_9. Accessed on March 10, 2016
- ↑ Complications of primary myelofibrosis. Dr Henry Knipe and Dr Yuranga Weerakkody et al. Radiopaedia 2016. http://radiopaedia.org/articles/myelofibrosis. Accessed on March 10, 2016
- ↑ World Health Organization (WHO) Diagnostic Criteria for Primary Myelofibrosis (PMF), Polycythemia Vera (PV), and Essential Thrombocythemia (ET). MPN Connect 2016. http://www.mpnconnect.com/pdf/who-diagnostic-criteria-myelofibrosis.pdf. Accessed on March 8, 2016
- ↑ Tefferi A, Thiele J, Orazi A, Kvasnicka HM, Barbui T, Hanson CA; et al. (2007). "Proposals and rationale for revision of the World Health Organization diagnostic criteria for polycythemia vera, essential thrombocythemia, and primary myelofibrosis: recommendations from an ad hoc international expert panel". Blood. 110 (4): 1092–7. doi:10.1182/blood-2007-04-083501. PMID 17488875.
- ↑ Symptoms of myelofibrosis. US National Library of Medicine 2016. https://www.nlm.nih.gov/medlineplus/ency/article/000531.htm. Accessed on March 7, 2016
- ↑ Symptoms of idiopathic myelofibrosis. Canadian cancer society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/leukemia/leukemia/idiopathic-myelofibrosis/?region=on. Accessed on March 9, 2016
- ↑ 19.0 19.1 Symptoms of primary myelofibrosis include pain below the ribs on the left side and feeling very tired. National cancer institute 2016. http://www.cancer.gov/types/myeloproliferative/patient/chronic-treatment-pdq#section/_234. Accessed on March 10, 2016
- ↑ Diagnosis of idiopathic myelofibrosis. Canadian cancer society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/leukemia/leukemia/idiopathic-myelofibrosis/?region=on. Accessed on March 9, 2016
- ↑ Radiographic features of primary myelofibrosis. Dr Henry Knipe and Dr Yuranga Weerakkody et al. Radiopaedia 2016. http://radiopaedia.org/articles/myelofibrosis. Accessed on March 10, 2016
- ↑ 22.0 22.1 Treatment overview of primary myelofibrosis. National cancer institute 2016. http://www.cancer.gov/types/myeloproliferative/hp/chronic-treatment-pdq#section/_9. Accessed on March 10, 2016