A Rare Case of Essential Thrombocythemia with Coexisting JAK2 and MPL Driver Mutations.

Journal of Korean Medical Science
Mi Ae JangDae Sik Hong

Abstract

Philadelphia-negative (Ph-) classical myeloproliferative neoplasms (MPNs) include polycythemia vera, essential thrombocythemia (ET), and primary myelofibrosis. Somatic driver mutations in the JAK2, CALR, and MPL genes serve as major diagnostic criteria of the Ph- MPNs and these mutations occur in a mutually exclusive manner. In this report, we describe the first case of ET harboring double mutations in JAK2 V617F and MPL. For MPL, the patient had multiple clones of MPL mutations: c.1543_1546delinsAGGG (p.Trp515_Gln516delinsArgGlu) and c.1546C>G (p.Gln516Glu). The JAK2 V617F allele burden in our patient is very low (4%) compared to the relatively high (17%-78%) allele frequency of MPL mutations. The low JAK2 mutant burden might be explained by preexisting clonal hematopoiesis before overt signs of MPNs, followed by the acquisition of a second oncogenic mutation of CALR or MPL leading to the MPN phenotype. This highlights that screening for a second driver mutation should be considered in patients with a low JAK2 mutant burden by reporting a 57-year-old Korean man with ET.

References

Jul 2, 2015·Journal of Korean Medical Science·Bo Hyun KimChan-Jeoung Park
Aug 24, 2016·Journal of Korean Medical Science·Yoojoo LimSoo Mee Bang
Dec 29, 2016·Blood·William Vainchenker, Robert Kralovics
Nov 30, 2019·The Korean Journal of Internal Medicine·Mi-Ae Jang, Chul Won Choi

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Methods Mentioned

BETA
biopsy
PCR
bone marrow aspiration

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