Top

Published in:

01-12-2013 | Myeloproliferative Disorders (JJ Kiladjian, Section Editor)

WHO Classification of Myeloproliferative Neoplasms (MPN): A Critical Update

Author: Hans Michael Kvasnicka

Published in: Current Hematologic Malignancy Reports | Issue 4/2013

Abstract

Although the revised World Health Organization (WHO) criteria for the diagnosis and classification of myeloproliferative neoplasms (MPN) were defined by a panel of expert hematopathologists and clinicians, controversy has been repeatedly expressed questioning the clinical usefulness and reproducibility of these diagnostic guidelines. In particular, the distinction between essential thrombocythemia (ET), early/prefibrotic primary myelofibrosis (PMF) and initial stages of polycythemia vera (PV) is still a matter of debate. In this context, it has been argued that clinical correlations with histological features were not firmly substantiated. On the other hand, recently published data from independently performed studies have repeatedly validated the reproducibility of the WHO criteria and provided persuasive evidence that discrimination of early/prefibrotic PMF has a significant impact on the risk of myelofibrotic and leukemic transformation. However, as has been explicitly required, the WHO concept is based on the recognition of characteristic bone marrow patterns and a consensus of clinical and molecular data.

Swerdlow S, Campo E, Harris N, et al. WHO classification of tumours of haematopoietic and lympoid tissues Lyon. France: IARC Press; 2008.

Tefferi A, Thiele J, Orazi A, et al. 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. 2007;110:1092–7.PubMedCrossRef

Spivak JL, Silver RT. The revised World Health Organization diagnostic criteria for polycythemia vera, essential thrombocytosis, and primary myelofibrosis: an alternative proposal. Blood. 2008;112:231–9.PubMedCrossRef

Campbell PJ, Bareford D, Erber WN, et al. Reticulin accumulation in essential thrombocythemia: prognostic significance and relationship to therapy. J Clin Oncol. 2009;27:2991–9.PubMedCrossRef

Wilkins BS, Erber WN, Bareford D, et al. Bone marrow pathology in essential thrombocythemia: interobserver reliability and utility for identifying disease subtypes. Blood. 2008;111:60–70.PubMedCrossRef

Rüdiger T, Weisenburger DD, Anderson JR, et al. Peripheral T-cell lymphoma (excluding anaplastic large-cell lymphoma): results from the Non-Hodgkin's Lymphoma Classification Project. Ann Oncol. 2002;13:140–9.PubMedCrossRef

Lones MA, Auperin A, Raphael M, et al. Mature B-cell lymphoma/leukemia in children and adolescents: intergroup pathologist consensus with the revised European-American Lymphoma Classification. Ann Oncol. 2000;11:47–51.PubMedCrossRef

Glaser SL, Dorfman RF, Clarke CA. Expert review of the diagnosis and histologic classification of Hodgkin disease in a population-based cancer registry: interobserver reliability and impact on incidence and survival rates. Cancer. 2001;92:218–24.PubMedCrossRef

• Barbui T, Thiele J, Passamonti F, et al. Survival and disease progression in essential thrombocythemia are significantly influenced by accurate morphologic diagnosis: an international study of 1,104 patients. J Clin Oncol. 2011;29:3179–84. An important multicenter study that highlighted the clinical impact of WHO diagnostic criteria.PubMedCrossRef

10.

• Thiele J, Kvasnicka HM, Mullauer L, et al. Essential thrombocythemia versus early primary myelofibrosis: a multicenter study to validate the WHO classification. Blood. 2011;117:5710–8. A multicenter trial that underscored the prognostic impact of the WHO guidelines with regard to early/prefibrotic PMF.PubMedCrossRef

11.

Vardiman JW, Thiele J, Arber DA, et al. The 2008 revision of the World Health Organization (WHO) classification of myeloid neoplasms and acute leukemia: rationale and important changes. Blood. 2009;114:937–51.PubMedCrossRef

12.

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.PubMedCrossRef

13.

Kvasnicka HM, Thiele J. Classification of Ph-negative chronic myeloproliferative disorders–morphology as the yardstick of classification. Pathobiology. 2007;74:63–71.PubMedCrossRef

14.

• Kvasnicka HM, Thiele J. Prodromal myeloproliferative neoplasms: the 2008 WHO classification. Am J Hematol. 2010;85:62–9. A very comprehensive review that summarized the problems of prodromal MPN.PubMed

15.

Thiele J, Kvasnicka HM, Diehl V. Standardization of bone marrow features - does it work in hematopathology for histological discrimination of different disease patterns? Histol Histopathol. 2005;20:633–44.PubMed

16.

Thiele J, Kvasnicka HM. Diagnostic differentiation of essential thrombocythaemia from thrombocythaemias associated with chronic idiopathic myelofibrosis by discriminate analysis of bone marrow features-a clinicopathological study on 272 patients. Histol Histopathol. 2003;18:93–102.PubMed

17.

• Barbui T, Thiele J, Vannucchi AM, et al. Problems and pitfalls regarding WHO-defined diagnosis of early/prefibrotic primary myelofibrosis versus essential thrombocythemia. Leukemia. 2013. doi:10.1038/leu.2013.74. A comprehensive survey about the current problems of the WHO criteria for the diagnosis of early stage PMF.

18.

Thiele J, Kvasnicka HM, Orazi A. Bone marrow histopathology in myeloproliferative disorders - current diagnostic approach. Semin Hematol. 2005;42:184–95.PubMedCrossRef

19.

Thiele J, Kvasnicka HM. A critical reappraisal of the WHO classification of the chronic myeloproliferative disorders. Leuk Lymphoma. 2006;47:381–96.PubMedCrossRef

20.

Thiele J, Kvasnicka HM, Vardiman J. Bone marrow histopathology in the diagnosis of chronic myeloproliferative disorders: a forgotten pearl. Best Pract Res Clin Haematol. 2006;19:413–37.PubMedCrossRef

21.

Thiele J, Kvasnicka HM, Facchetti F, et al. European consensus for grading of bone marrow fibrosis and assessment of cellularity. Haematologica. 2005;90:1128–32.PubMed

22.

Kuter DJ, Bain B, Mufti G, et al. Bone marrow fibrosis: pathophysiology and clinical significance of increased bone marrow stromal fibres. Br J Haematol. 2007;139:351–62.PubMedCrossRef

23.

Thiele J, Kvasnicka HM. Myelofibrosis–what's in a name? Consensus on definition and EUMNET grading. Pathobiology. 2007;74:89–96.PubMedCrossRef

24.

Thiele J, Kvasnicka HM. Hematopathologic findings in chronic idiopathic myelofibrosis. Semin Oncol. 2005;32:380–94.PubMedCrossRef

25.

Thiele J, Kvasnicka HM. Grade of bone marrow fibrosis is associated with relevant hematological findings-a clinicopathological study on 865 patients with chronic idiopathic myelofibrosis. Ann Hematol. 2006;85:226–32.PubMedCrossRef

26.

Thiele J, Kvasnicka HM. Myelofibrosis in chronic myeloproliferative disorders-dynamics and clinical impact. Histol Histopathol. 2006;21:1367–78.PubMed

27.

• Gianelli U, Vener C, Bossi A, et al. The European Consensus on grading of bone marrow fibrosis allows a better prognostication of patients with primary myelofibrosis. Mod Pathol. 2012;25:1193–202. An important paper that underscores the impact of bone marrow fibrosis as prognostic marker in PMF.PubMedCrossRef

28.

Vener C, Fracchiolla NS, Gianelli U, et al. Prognostic implications of the European consensus for grading of bone marrow fibrosis in chronic idiopathic myelofibrosis. Blood. 2008;111:1862–5.PubMedCrossRef

29.

Thiele J, Kvasnicka HM. Chronic myeloproliferative disorders with thrombocythemia: a comparative study of two classification systems (PVSG, WHO) on 839 patients. Ann Hematol. 2003;82:148–52.PubMed

30.

Brousseau M, Parot-Schinkel E, Moles MP, et al. Practical application and clinical impact of the WHO histopathological criteria on bone marrow biopsy for the diagnosis of essential thrombocythemia versus prefibrotic primary myelofibrosis. Histopathology. 2010;56:758–67.PubMedCrossRef

31.

Buhr T, Hebeda K, Kaloutsi V, et al. European Bone Marrow Working Group trial on reproducibility of World Health Organization criteria to discriminate essential thrombocythemia from prefibrotic primary myelofibrosis. Haematologica. 2012;97:360–5.PubMedCrossRef

32.

Florena AM, Tripodo C, Iannitto E, et al. Value of bone marrow biopsy in the diagnosis of essential thrombocythemia. Haematologica. 2004;89:911–9.PubMed

33.

Kreft A, Buesche G, Ghalibafian M, et al. The incidence of myelofibrosis in essential thrombocythaemia, polycythaemia vera and chronic idiopathic myelofibrosis: a retrospective evaluation of sequential bone marrow biopsies. Acta Haematol. 2005;113:137–43.PubMedCrossRef

34.

Gianelli U, Iurlo A, Vener C, et al. The significance of bone marrow biopsy and JAK2V617F mutation in the differential diagnosis between the "early" prepolycythemic phase of polycythemia vera and essential thrombocythemia. Am J Clin Pathol. 2008;130:336–42.PubMedCrossRef

35.

Gianelli U, Vener C, Raviele PR, et al. Essential thrombocythemia or chronic idiopathic myelofibrosis? A single-center study based on hematopoietic bone marrow histology. Leuk Lymphoma. 2006;47:1774–81.PubMedCrossRef

36.

Boiocchi L, Mathew S, Gianelli U, et al. Morphologic and cytogenetic differences between post-polycythemic myelofibrosis and primary myelofibrosis in fibrotic stage. Mod Pathol. 2013.

37.

Diebold J, Anderson JR, Armitage JO, et al. Diffuse large B-cell lymphoma: a clinicopathologic analysis of 444 cases classified according to the updated Kiel classification. Leuk Lymphoma. 2002;43:97–104.PubMedCrossRef

38.

Mufti GJ, Bennett JM, Goasguen J, et al. Diagnosis and classification of myelodysplastic syndrome: International Working Group on Morphology of myelodysplastic syndrome (IWGM-MDS) consensus proposals for the definition and enumeration of myeloblasts and ring sideroblasts. Haematologica. 2008;93:1712–7.PubMedCrossRef

39.

Murphy S, Peterson P, Iland H, et al. Experience of the Polycythemia Vera Study Group with essential thrombocythemia: a final report on diagnostic criteria, survival, and leukemic transition by treatment. Semin Hematol. 1997;34:29–39.PubMed

40.

Pearson TC. Diagnosis and classification of erythrocytoses and thrombocytoses. Baillieres Clin Haematol. 1998;11:695–720.PubMedCrossRef

41.

Murphy S. Diagnostic criteria and prognosis in polycythemia vera and essential thrombocythemia. Semin Hematol. 1999;36:9–13.PubMed

42.

Harrison CN, Bareford D, Butt N, et al. Guideline for investigation and management of adults and children presenting with a thrombocytosis. Br J Haematol. 2010;149:352–75.PubMedCrossRef

43.

Thiele J, Kvasnicka HM, Schmitt-Graeff A, et al. Follow-up examinations including sequential bone marrow biopsies in essential thrombocythemia (ET): a retrospective clinicopathological study of 120 patients. Am J Hematol. 2002;70:283–91.PubMedCrossRef

44.

Thiele J, Kvasnicka HM, Schmitt-Gräff A, et al. Dynamics of fibrosis in chronic idiopathic (primary) myelofibrosis during therapy: a follow-up study on 309 patients. Leuk Lymphoma. 2003;44:549–53.CrossRef

45.

Harrison CN, Campbell PJ, Buck G, et al. Hydroxyurea compared with anagrelide in high-risk essential thrombocythemia. N Engl J Med. 2005;353:33–45.PubMedCrossRef

46.

Thiele J, Kvasnicka HM, Vardiman JW, et al. Bone marrow fibrosis and diagnosis of essential thrombocythemia. J Clin Oncol. 2009;27:e220–1. author reply e222-223.PubMedCrossRef

47.

Thiele J, Orazi A, Kvasnicka HM, et al. European Bone Marrow Working Group trial on reproducibility of World Health Organization criteria to discriminate essential thrombocythemia from prefibrotic primary myelofibrosis. Haematologica. 2012;97(3):360–5. --comment. Haematologica 2012, 97:e5-6; discussion e7-8.CrossRef

48.

• Madelung AB, Bondo H, Stamp I, et al. WHO-defined classification of myeloproliferative neoplasms: morphological reproducibility and clinical correlations—the Danish experience. Am J Hematol. 2013. doi:10.1002/ajh.23554. In this study interobserver and intraobserver reproducibility and concordance between histological diagnosis and independently collected clinical findings in a large series of patients with the major subtypes of MPN and controls were examined.PubMed

49.

Tefferi A, Skoda R, Vardiman JW. Myeloproliferative neoplasms: contemporary diagnosis using histology and genetics. Nat Rev Clin Oncol. 2009;6:627–37.PubMedCrossRef

50.

Tefferi A, Thiele J, Vardiman JW. The 2008 World Health Organization classification system for myeloproliferative neoplasms: order out of chaos. Cancer. 2009.

51.

Tefferi A, Vardiman JW. The diagnostic interface between histology and molecular tests in myeloproliferative disorders. Curr Opin Hematol. 2007;14:115–22.PubMedCrossRef

52.

Tefferi A. Primary myelofibrosis: 2012 update on diagnosis, risk stratification, and management. Am J Hematol. 2011;86:1017–26.PubMedCrossRef

53.

• Barosi G, Rosti V, Bonetti E, et al. Evidence that prefibrotic myelofibrosis is aligned along a clinical and biological continuum featuring primary myelofibrosis. PLoS One. 2012;7:e35631. A landmark paper that supports the concept of early/prefibrotic PMF.PubMedCrossRef

54.

Kvasnicka HM, Thiele J. Bone marrow angiogenesis: methods of quantification and changes evolving in chronic myeloproliferative disorders. Histol Histopathol. 2004;19:1245–60.PubMed

55.

Thiele J, Kvasnicka HM. Prefibrotic chronic idiopathic myelofibrosis-a diagnostic enigma? Acta Haematol. 2004;111:155–9.PubMedCrossRef

56.

Campbell PJ, Green AR. The myeloproliferative disorders. N Engl J Med. 2006;355:2452–66.PubMedCrossRef

57.

Lengfelder E, Hochhaus A, Kronawitter U, et al. Should a platelet limit of 600 × 10(9)/l be used as a diagnostic criterion in essential thrombocythaemia? An analysis of the natural course including early stages. Br J Haematol. 1998;100:15–23.PubMedCrossRef

58.

Regev A, Stark P, Blickstein D, et al. Thrombotic complications in essential thrombocythemia with relatively low platelet counts. Am J Hematol. 1997;56:168–72.PubMedCrossRef

59.

Sacchi S, Vinci G, Gugliotta L, et al. Diagnosis of essential thrombocythemia at platelet counts between 400 and 600x10(9)/L. Gruppo Italiano Malattie Mieloproliferative Croniche(GIMMC). Haematologica. 2000;85:492–5.PubMed

60.

De Stefano V, Fiorini A, Rossi E, et al. Incidence of the JAK2 V617F mutation among patients with splanchnic or cerebral venous thrombosis and without overt chronic myeloproliferative disorders. J Thromb Haemost. 2007;5:708–14.PubMedCrossRef

61.

Patel RK, Lea NC, Heneghan MA, et al. Prevalence of the activating JAK2 tyrosine kinase mutation V617F in the Budd-Chiari syndrome. Gastroenterology. 2006;130:2031–8.PubMedCrossRef

62.

Primignani M, Barosi G, Bergamaschi G, et al. Role of the JAK2 mutation in the diagnosis of chronic myeloproliferative disorders in splanchnic vein thrombosis. Hepatology. 2006;44:1528–34.PubMedCrossRef

63.

Smalberg JH, Murad SD, Braakman E, et al. Myeloproliferative disease in the pathogenesis and survival of Budd-Chiari syndrome. Haematologica. 2006;91:1712–3.PubMed

64.

Colaizzo D, Amitrano L, Guardascione MA, et al. Outcome of patients with splanchnic venous thrombosis presenting without overt MPN: a role for the JAK2 V617F mutation re-evaluation. Thromb Res. 2013.

65.

Donadini MP, Dentali F, Ageno W. Splanchnic vein thrombosis: new risk factors and management. Thromb Res. 2012;129 Suppl 1:S93–6.PubMedCrossRef

66.

Kiladjian JJ, Cervantes F, Leebeek FW, et al. The impact of JAK2 and MPL mutations on diagnosis and prognosis of splanchnic vein thrombosis: a report on 241 cases. Blood. 2008;111:4922–9.PubMedCrossRef

67.

Kouroupi E, Kiladjian JJ, Chomienne C, et al. The JAK2 46/1 haplotype in splanchnic vein thrombosis. Blood. 2011;117:5777–8.PubMedCrossRef

68.

Villani L, Bergamaschi G, Primignani M, et al. JAK2 46/1 haplotype predisposes to splanchnic vein thrombosis-associated BCR-ABL negative classic myeloproliferative neoplasms. Leuk Res. 2012;36:e7–9.PubMedCrossRef

69.

Orazi A, Germing U. The myelodysplastic/myeloproliferative neoplasms: myeloproliferative diseases with dysplastic features. Leukemia. 2008;22:1308–19.PubMedCrossRef

70.

Shaw GR. Ringed sideroblasts with thrombocytosis: an uncommon mixed myelodysplastic/myeloproliferative disease of older adults. Br J Haematol. 2005;131:180–4.PubMed

71.

Ceesay MM, Lea NC, Ingram W, et al. The JAK2 V617F mutation is rare in RARS but common in RARS-T. Leukemia. 2006;20:2060–1.PubMedCrossRef

72.

Hyjek E, Vardiman JW. Myelodysplastic/myeloproliferative neoplasms. Semin Diagn Pathol. 2011;28:283–97.PubMedCrossRef

73.

Malcovati L, Della Porta MG, Pietra D, et al. Molecular and clinical features of refractory anemia with ringed sideroblasts associated with marked thrombocytosis. Blood. 2009;114:3538–45.PubMedCrossRef

74.

Schmitt-Graeff AH, Teo SS, Olschewski M, et al. JAK2V617F mutation status identifies subtypes of refractory anemia with ringed sideroblasts associated with marked thrombocytosis. Haematologica. 2008;93:34–40.PubMedCrossRef

75.

Atallah E, Nussenzveig R, Yin CC, et al. Prognostic interaction between thrombocytosis and JAK2 V617F mutation in the WHO subcategories of myelodysplastic/myeloproliferative disease-unclassifiable and refractory anemia with ringed sideroblasts and marked thrombocytosis. Leukemia. 2008;22:1295–8.PubMedCrossRef

76.

Kvasnicka HM, Thiele J. The impact of clinicopathological studies on staging and survival in essential thrombocythemia, chronic idiopathic myelofibrosis, and polycythemia rubra vera. Semin Thromb Hemost. 2006;32:362–71.PubMedCrossRef

77.

Kvasnicka HM, Thiele J, Werden C, et al. Prognostic factors in idiopathic (primary) osteomyelofibrosis. Cancer. 1997;80:708–19.PubMedCrossRef

78.

Finazzi G, Carobbio A, Thiele J, et al. Incidence and risk factors for bleeding in 1104 patients with essential thrombocythemia or prefibrotic myelofibrosis diagnosed according to the 2008 WHO criteria. Leukemia. 2012;26:716–9.PubMedCrossRef

79.

Buxhofer-Ausch V, Gisslinger B, Stangl G, et al. Successful treatment sequence incorporating bevacizumab for therapy of polyneuropathy in two patients with POEMS syndrome. Leuk Res. 2012;36:e98–100.PubMedCrossRef

80.

• Ejerblad E, Kvasnicka HM, Thiele J, et al. Diagnosis according to World Health Organization determines the long-term prognosis in patients with myeloproliferative neoplasms treated with anagrelide: results of a prospective long-term follow-up. Hematology. 2013;18:8–13. The first prospective study that provided evidence about significant differences in follow-up outcome between WHO-defined ET and early/prefibrotic PMF.PubMedCrossRef

81.

• Gisslinger H, Gotic M, Holowiecki J, et al. Anagrelide compared with hydroxyurea in WHO-classified essential thrombocythemia: the ANAHYDRET Study, a randomized controlled trial. Blood. 2013;121:1720–8. An international prospective multicenter trial regarding WHO-defined ET and Anagrelide therapy.PubMedCrossRef

82.

• Thiele J, Kvasnicka HM. Clinicopathological criteria for differential diagnosis of thrombocythemias in various myeloproliferative disorders. Semin Thromb Hemost. 2006;32:219–30. This paper highlights the problem associated with the classification of thrombocythemic MPDs.PubMedCrossRef

83.

Barosi G. Myelofibrosis with myeloid metaplasia: diagnostic definition and prognostic classification for clinical studies and treatment guidelines. J Clin Oncol. 1999;17:2954–70.PubMed

84.

Johansson PL, Safai-Kutti S, Kutti J. An elevated venous haemoglobin concentration cannot be used as a surrogate marker for absolute erythrocytosis: a study of patients with polycythaemia vera and apparent polycythaemia. Br J Haematol. 2005;129:701–5.PubMedCrossRef

85.

Alvarez-Larran A, Ancochea A, Angona A, et al. Red cell mass measurement in patients with clinically suspected diagnosis of polycythemia vera or essential thrombocythemia. Haematologica. 2012;97:1704–7.PubMedCrossRef

86.

Cassinat B, Laguillier C, Gardin C, et al. Classification of myeloproliferative disorders in the JAK2 era: is there a role for red cell mass? Leukemia. 2008;22:452–3.PubMedCrossRef

87.

• Silver RT, Chow W, Orazi A, et al. Evaluation of WHO criteria for diagnosis of polycythemia vera: a prospective analysis. Blood. 2013. doi:10.1182/blood-2013-06-508416. A comprehensive study regarding the current diagnostic criteria of PV and the value of bone marrow histology.

88.

Barbui T, Thiele J, Gisslinger H, et al. Masked polycythemia vera (mPV): results of an international study. Am J Hematol. 2013. doi:10.1002/ajh.23585.

89.

Silver RT, Vandris K, Goldman JJ. Recombinant interferon-alpha may retard progression of early primary myelofibrosis: a preliminary report. Blood. 2011;117:6669–72.PubMedCrossRef

90.

Tefferi A. Polycythemia vera and essential thrombocythemia: 2013 update on diagnosis, risk-stratification, and management. Am J Hematol. 2013;88:507–16.PubMedCrossRef

91.

Mossuz P, Girodon F, Donnard M, et al. Diagnostic value of serum erythropoietin level in patients with absolute erythrocytosis. Haematologica. 2004;89:1194–8.PubMed

92.

Thiele J, Kvasnicka HM. Diagnostic impact of bone marrow histopathology in polycythemia vera (PV). Histol Histopathol. 2005;20:317–28.PubMed

93.

Thiele J, Kvasnicka HM, Diehl V. Initial (latent) polycythemia vera with thrombocytosis mimicking essential thrombocythemia. Acta Haematol. 2005;113:213–9.PubMedCrossRef

94.

Barbui T, Thiele J, Passamonti F, et al. Initial bone marrow reticulin fibrosis in polycythemia vera exerts an impact on clinical outcome. Blood. 2012;119:2239–41.PubMedCrossRef

95.

Jantunen R, Juvonen E, Ikkala E, et al. Development of erythrocytosis in the course of essential thrombocythemia. Ann Hematol. 1999;78:219–22.PubMedCrossRef

96.

Gruppo Italiano Studio Policitemia. Polycythemia vera: the natural history of 1213 patients followed for 20 years. Ann Intern Med. 1995;123:656–64.CrossRef

97.

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.PubMedCrossRef

98.

Barbui T, Barosi G, Birgegard G, et al. Philadelphia-negative classical myeloproliferative neoplasms: critical concepts and management recommendations from European LeukemiaNet. J Clin Oncol. 2011;29:761–70.PubMedCrossRef

99.

Barosi G, Mesa RA, Thiele J, et al. Proposed criteria for the diagnosis of post-polycythemia vera and post-essential thrombocythemia myelofibrosis: a consensus statement from the International Working Group for Myelofibrosis Research and Treatment. Leukemia. 2008;22:437–8.PubMedCrossRef

Title: WHO Classification of Myeloproliferative Neoplasms (MPN): A Critical Update
Author: Hans Michael Kvasnicka
Publication date: 01-12-2013
Publisher: Springer US
Published in: Current Hematologic Malignancy Reports / Issue 4/2013
Print ISSN: 1558-8211
Electronic ISSN: 1558-822X
DOI: https://doi.org/10.1007/s11899-013-0186-x

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits

Illustration of figure on mountain summit/© Orapun / Stock.adobe.com, STEP AAG HeroTeaserCollection image/© Tarek / Generated with AI / Stock.adobe.com, ACC 2024 Pediatric and Congenital Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Pulmonary Vascular Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Valvular Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 HF and Cardiomyopathies: Year in Review/© 2024 American College of Cardiology, Woman out walking/© Seventyfour / stock.adobe.com (symbolic image with model), Woman checking smartwatch /© saltdium / stock.adobe.com (symbolic image with model), Cardiac catheterization/© Damian / stock.adobe.com

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 4/2013

Are MPNs Vascular Diseases?

Febrile Neutropenia in Hematologic Malignancies

New Insights and Modern Treatment of AL Amyloidosis

Multiple Myeloma: Defining the High-Risk Patient and Determining the Optimal Treatment Strategy

Genetic Basis of MPN: Beyond JAK2-V617F

Standardizing the Initial Evaluation for Myelodysplastic Syndromes

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

Highlights from the ACC 2024 Congress

ACC 2024 Congress Coverage