Proceedings of the 13th International Conference on Thrombosis and Hemostasis Issues in Cancer, 2026

Genomic profiling for thrombosis risk prediction in myeloproliferative neoplasms

Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Published: 16 April 2026
0
Views
0
Downloads

Authors

The main BCR-ABL-negative myeloproliferative neoplasms consist of polycythemia vera, essential thrombocythemia and primary myelofibrosis. They have been associated with an overall elevated risk of thromboembolism, including both venous and arterial events. Different risk factors for thrombosis have been identified in this patient population, including clinical but also molecular predictors. Accurate estimation of thrombotic risk could potentially allow for identification of patients who are the best candidates for pharmacological prophylaxis with an antiplatelet or anticoagulant agent. The genes for which most data on associated risk of thromboembolism are available are JAK2, CALR and MPL. The JAK2 V617 mutation is the most common driver alteration for polycythemia vera and has been clearly associated with approximately a doubling in the risk of venous thromboembolism compared with JAK2-negative myeloproliferative neoplasms. It is also found in about half of cases of essential thrombocythemia. CALR-mutated essential thrombocythemia has been associated with a lower risk of thromboembolic event, while there is less data about MPL given it low frequency of alterations. In later years more knowledge has emerged about mutations found in other genes altered in the blood and marrow of individuals with a myeloproliferative neoplasm. Risk stratification schemes have been derived using basic patient characteristics but so far no well validated model or clinical prediction rule includes any molecular predictor besides the JAK2 V617F mutation. Additional work is needed to validate associations for markers other than JAK2 and integrate this knowledge into clinically useful prediction models.

Downloads

Download data is not yet available.

Citations

1. Tefferi A, Vardiman JW. Classification and diagnosis of myeloproliferative neoplasms: the 2008 World Health Organization criteria and point-of-care diagnostic algorithms. Leukemia 2008;22:14-22. DOI: https://doi.org/10.1038/sj.leu.2404955
2. Bjorkholm M, Derolf AR, Hultcrantz M, et al. Treatment-related risk factors for transformation to acute myeloid leukemia and myelodysplastic syndromes in myeloproliferative neoplasms. J Clin Oncol 2011;29:2410-5. DOI: https://doi.org/10.1200/JCO.2011.34.7542
3. Grinfeld J, Nangalia J, Baxter EJ, et al. Classification and personalized prognosis in myeloproliferative neoplasms. N Engl J Med 2018;379:1416-30. DOI: https://doi.org/10.1056/NEJMoa1716614
4. Elliott MA, Tefferi A. Thrombosis and haemorrhage in polycythaemia vera and essential thrombocythaemia. Br J Haematol 2005;128:275-90. DOI: https://doi.org/10.1111/j.1365-2141.2004.05277.x
5. Hultcrantz M, Bjorkholm M, Dickman PW, et al. Risk for arterial and venous thrombosis in patients with myeloproliferative neoplasms: a population-based cohort study. Ann Intern Med 2018;168:317-25.. DOI: https://doi.org/10.7326/M17-0028
6. Barbui T, Falanga A. Molecular biomarkers of thrombosis in myeloproliferative neoplasms. Thromb Res 2016;140:S71-5. DOI: https://doi.org/10.1016/S0049-3848(16)30102-5
7. Landolfi R, Marchioli R, Kutti J, et al. Efficacy and safety of low-dose aspirin in polycythemia vera. N Engl J Med 2004;350:114-24. DOI: https://doi.org/10.1056/NEJMoa035572
8. Cazzola M, Kralovics R. From Janus kinase 2 to calreticulin: the clinically relevant genomic landscape of myeloproliferative neoplasms. Blood 2014;123:3714-9. DOI: https://doi.org/10.1182/blood-2014-03-530865
9. Rampal R, Al-Shahrour F, Abdel-Wahab O, et al. Integrated genomic analysis illustrates the central role of JAK-STAT pathway activation in myeloproliferative neoplasm pathogenesis. Blood 2014;123:e123-33. DOI: https://doi.org/10.1182/blood-2014-02-554634
10. Rumi E, Pietra D, Ferretti V, et al. JAK2 or CALR mutation status defines subtypes of essential thrombocythemia with substantially different clinical course and outcomes. Blood 2014;123:1544-51. DOI: https://doi.org/10.1182/blood-2013-11-539098
11. Pietra D, Rumi E, Ferretti VV, et al. Differential clinical effects of different mutation subtypes in CALR-mutant myeloproliferative neoplasms. Leukemia 2016;30:431-8. DOI: https://doi.org/10.1038/leu.2015.277
12. Carobbio A, Finazzi G, Antonioli E, et al. JAK2V617F allele burden and thrombosis: a direct comparison in essential thrombocythemia and polycythemia vera. Exp Hematol 2009;37:1016-21. DOI: https://doi.org/10.1016/j.exphem.2009.06.006
13. Zhang Y, Zhou Y, Wang Y, et al. Thrombosis among 1537 patients with JAK2(V617F) -mutated myeloproliferative neoplasms: Risk factors and development of a predictive model. Cancer Med 2020;9:2096-105. DOI: https://doi.org/10.1002/cam4.2886
14. Guglielmelli P, Loscocco GG, Mannarelli C, et al. JAK2V617F variant allele frequency >50% identifies patients with polycythemia vera at high risk for venous thrombosis. Blood Cancer J 2021;11:199. DOI: https://doi.org/10.1038/s41408-021-00581-6
15. Soudet S, Le Roy G, Cadet E, et al. JAK2 allele burden is correlated with a risk of venous but not arterial thrombosis. Thromb Res 2022;211:1-5. DOI: https://doi.org/10.1016/j.thromres.2022.01.011
16. Passamonti F, Rumi E, Pietra D, et al. A prospective study of 338 patients with polycythemia vera: the impact of JAK2 (V617F) allele burden and leukocytosis on fibrotic or leukemic disease transformation and vascular complications. Leukemia 2010;24:1574-9. DOI: https://doi.org/10.1038/leu.2010.148
17. Moliterno AR, Kaizer H, Reeves BN. JAK2 V617F allele burden in polycythemia vera: burden of proof. Blood 2023;141:1934-42. DOI: https://doi.org/10.1182/blood.2022017697
18. Barbui T, Ghirardi A, Carobbio A, et al. Increased risk of thrombosis in JAK2 V617F-positive patients with primary myelofibrosis and interaction of the mutation with the IPSS score. Blood Cancer J 2022;12:156. DOI: https://doi.org/10.1038/s41408-022-00743-0
19. Cattaneo D, Croci GA, Bucelli C, et al. Triple-negative essential thrombocythemia: clinical-pathological and molecular features. A single-center cohort study. Front Oncol 2021;11:637116. DOI: https://doi.org/10.3389/fonc.2021.637116
20. Jaiswal S, Natarajan P, Silver AJ, et al. Clonal hematopoiesis and risk of atherosclerotic cardiovascular disease. N Engl J Med 2017;377:111-21. DOI: https://doi.org/10.1056/NEJMoa1701719
21. Gu W, Zhang Y, Sun T, et al. Prediction of thrombosis in polycythemia vera: Development and validation of a multiple factor-based prognostic score system. Res Pract Thromb Haemost 2023;7:100132. DOI: https://doi.org/10.1016/j.rpth.2023.100132
22. Furuya C, Morishita S, Hashimoto Y, et al. Impact of non-driver gene mutations on thrombo-haemorrhagic events in ET patients. Br J Haematol 2024;204:221-8. DOI: https://doi.org/10.1111/bjh.19177
23. Pasquer H, Daltro de Oliveira R, Vasseur L, et al. Distinct clinico-molecular arterial and venous thrombosis scores for myeloproliferative neoplasms risk stratification. Leukemia 2024;38:326-39. DOI: https://doi.org/10.1038/s41375-023-02114-5
24. Sekhar M, McVinnie K, Burroughs AK. Splanchnic vein thrombosis in myeloproliferative neoplasms. Br J Haematol 2013;162:730-47 DOI: https://doi.org/10.1111/bjh.12461
25. Dentali F, Squizzato A, Brivio L, et al. JAK2V617F mutation for the early diagnosis of Ph- myeloproliferative neoplasms in patients with venous thromboembolism: a meta-analysis. Blood 2009;113:5617-23. DOI: https://doi.org/10.1182/blood-2008-12-196014
26. Barbui T, Vannucchi AM, Buxhofer-Ausch V, et al. Practice-relevant revision of IPSET-thrombosis based on 1019 patients with WHO-defined essential thrombocythemia. Blood Cancer J 2015;5:e369. DOI: https://doi.org/10.1038/bcj.2015.94
27. Alvarez-Larran A, Cuevas B, Velez P, et al. Application of IPSET-thrombosis in 1366 Patients Prospectively Followed From the Spanish Registry of Essential Thrombocythemia. Hemasphere 2023;7:e936. DOI: https://doi.org/10.1097/HS9.0000000000000936
28. Tefferi A, Barbui T. Polycythemia vera: 2024 update on diagnosis, risk-stratification, and management. Am J Hematol 2023;98:1465-87. DOI: https://doi.org/10.1002/ajh.27002
29. Tefferi A, Vannucchi AM, Barbui T. Essential thrombocythemia: 2024 update on diagnosis, risk stratification, and management. Am J Hematol 2024;99:697-718. DOI: https://doi.org/10.1002/ajh.27216
30. Tefferi A, Wassie EA, Lasho TL, et al. Calreticulin mutations and long-term survival in essential thrombocythemia. Leukemia 2014;28:2300-3. DOI: https://doi.org/10.1038/leu.2014.148
31. Alvarez-Larran A, Pereira A, Guglielmelli P, et al. Antiplatelet therapy versus observation in low-risk essential thrombocythemia with a CALR mutation. Haematologica 2016;101:926-31. DOI: https://doi.org/10.3324/haematol.2016.146654
32. De Stefano V, Vannucchi AM, Ruggeri M, et al. Splanchnic vein thrombosis in myeloproliferative neoplasms: risk factors for recurrences in a cohort of 181 patients. Blood Cancer J 2016;6:e493. DOI: https://doi.org/10.1038/bcj.2016.103
33. Perez Encinas MM, Sobas M, Gomez-Casares MT, et al. The risk of thrombosis in essential thrombocythemia is associated with the type of CALR mutation: A multicentre collaborative study. Eur J Haematol 2021;106:371-9. DOI: https://doi.org/10.1111/ejh.13561
34. Wang Z, Liu W, Wang D, et al. TET2 mutation may be more valuable in predicting thrombosis in ET patients compared to pv patients: a preliminary report. J Clin Med 2022;11:6615. DOI: https://doi.org/10.3390/jcm11226615
35. Ozdemir ZN, Ipek Y, Patir P, et al. Impact of CALR and JAK2V617F mutations on clinical course and disease outcomes in essential thrombocythemia: a multicenter retrospective study in Turkish patients. Turk J Haematol 2024;41:26-36. DOI: https://doi.org/10.4274/tjh.galenos.2024.2023.0430

How to Cite



1.
Mantha S. Genomic profiling for thrombosis risk prediction in myeloproliferative neoplasms. Bleeding Thromb Vasc Biol [Internet]. 2026 Apr. 16 [cited 2026 Apr. 17];5(s1). Available from: https://www.btvb.org/btvb/article/view/451

Most read articles by the same author(s)