The impact of JAK2 and MPL mutations on diagnosis and prognosis of splanchnic vein thrombosis: a report on 241 cases.
Myeloproliferative diseases (MPDs) represent the commonest cause of splanchnic vein thrombosis (SVT), including Budd-Chiari syndrome (BCS) and portal vein thrombosis (PVT), but their diagnosis is hampered by changes secondary to portal hypertension, while their influence in the outcome of SVT remains unclear. We assessed the diagnostic and prognostic value of JAK2 and MPL515 mutations in 241 SVT patients (104 BCS, 137 PVT). JAK2V617F was found in 45% of BCS and 34% of PVT, while JAK2 exon 12 and MPL515 mutations were not detected. JAK2V617F was found in 96.5% of patients with bone marrow (BM) changes specific for MPD and endogenous erythoid colonies, but also in 58% of those with only one feature and in 7% of those with neither feature. Stratifying MPD diagnosis first on JAK2V617F detection would have avoided BM investigations in 40% of the patients. In BCS, presence of MPD carried significantly poorer baseline prognostic features, required hepatic decompression procedures earlier, but had no impact on 5-year survival. Our results suggest that JAK2V617F testing should replace BM investigations as initial test for MPD in patients with SVT. Underlying MPD is associated with severe forms of BCS, but current therapy appears to offset deleterious effects of MPD on the medium-term outcome.
Kiladjian
Jean-Jacques
JJ
Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Service d'Hématologie Clinique, and Université Paris 13, Bobigny, France. jean-jacques.kiladjian@avc.aphp.fr
Cervantes
Francisco
F
Leebeek
Franck W G
FW
Marzac
Christophe
C
Cassinat
Bruno
B
Chevret
Sylvie
S
Cazals-Hatem
Dominique
D
Plessier
Aurélie
A
Garcia-Pagan
Juan-Carlos
JC
Darwish Murad
Sarwa
S
Raffa
Sebastian
S
Janssen
Harry L A
HL
Gardin
Claude
C
Cereja
Sophie
S
Tonetti
Carole
C
Giraudier
Stéphane
S
Condat
Bertrand
B
Casadevall
Nicole
N
Fenaux
Pierre
P
Valla
Dominique C
DC
D000328:Adult; D001856:Bone Marrow Examination; D006502:Budd-Chiari Syndrome / Q000150:complications; D005260:Female; D006801:Humans; D053614:Janus Kinase 2 / Q000235:genetics*; D008297:Male; D008875:Middle Aged; D009154:Mutation; D009196:Myeloproliferative Disorders / Q000150:complications; D011379:Prognosis; D053628:Receptors, Thrombopoietin / Q000235:genetics*; D012189:Retrospective Studies; D013152:Splanchnic Circulation / Q000235:genetics*; D020246:Venous Thrombosis / Q000235:genetics* / Q000401:mortality
D053628:Receptors, Thrombopoietin; C082218:MPL protein, human; D053614:Janus Kinase 2