Top

Published in:

01-12-2013 | Myelodysplastic Syndromes (M Sekeres, Section Editor)

Standardizing the Initial Evaluation for Myelodysplastic Syndromes

Authors: Danielle Marshall, Gail J. Roboz

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

Abstract

The myelodysplastic syndromes (MDS) pose a unique diagnostic challenge for clinicians and pathologists due to the clinicopathologic heterogeneity of the disease and overlapping features with other benign and malignant disorders. Currently, the initial evaluation of a patient with suspected MDS centers around a detailed medical history, review of the peripheral blood and bone marrow by an expert hematopathologist and risk stratification using laboratory results, morphology and cytogenetics. More sophisticated technologies, including multi-color flow cytometry, fluorescence in-situ hybridization (FISH), next-generation sequencing, and others are emerging and promise to offer significant refinements in diagnostic, prognostic and, hopefully, therapeutic information. With the incidence and prevalence of MDS increasing worldwide, it is critical for clinicians to optimize the initial evaluation of a patient with suspected disease, using a standard schema, to facilitate accurate diagnosis, risk stratification and treatment.

Issa JP. The myelodysplastic syndrome as a prototypical epigenetic disease. Blood. 2013;121(19):3811–7. doi:10.1182/blood-2013-02-451757.PubMedCrossRef

Pang WW, Pluvinage JV, Price EA, Sridhar K, Arber DA, Greenberg PL, et al. Hematopoietic stem cell and progenitor cell mechanisms in myelodysplastic syndromes. Proc Natl Acad Sci U S A. 2013;110(8):3011–6. doi:10.1073/pnas.1222861110.PubMedCrossRef

Greenberg PL. The multifaceted nature of myelodysplastic syndromes: clinical, molecular, and biological prognostic features. J Natl Compr Canc Netw. 2013;11(7):877–85.PubMed

Howlader NNA, Krapcho M, Garshell J, Neyman N, Altekruse SF, Kosary CL, et al., editors. SEER cancer statistics review, 1975–2010: section 30 Myelodysplastic Syndromes (MDS), Chronic Myeloproliferative Disorders (CMD), and Chronic Myelomonocytic Leukemia (CMML). Bethesda: National Cancer Institute; 2013. http://seer.cancer.gov/csr/1975_2010/. Accessed August 15, 2013 2013.

Sekeres MA. Epidemiology, natural history, and practice patterns of patients with myelodysplastic syndromes in 2010. J Natl Compr Canc Netw. 2011;9(1):57–63.PubMed

• Greenberg PL, Attar E, Bennett JM, Bloomfield CD, Borate U, De Castro CM, et al. Myelodysplastic syndromes. J Natl Compr Canc Netw. 2013;11(7):838–74. Current NCCN guidelines for the diagnosis and treatment of MDS provide detailed recommendations and the standards of care based on updated data, with am extensive list of references.PubMed

Pellagatti A, Cazzola M, Giagounidis A, Perry J, Malcovati L, Della Porta MG, et al. Deregulated gene expression pathways in myelodysplastic syndrome hematopoietic stem cells. Leukemia. 2010;24(4):756–64. doi:10.1038/leu.2010.31.PubMedCrossRef

Naqvi K, Garcia-Manero G, Sardesai S, Oh J, Vigil CE, Pierce S, et al. Association of comorbidities with overall survival in myelodysplastic syndrome: development of a prognostic model. J Clin Oncol. 2011;29(16):2240–6. doi:10.1200/JCO.2010.31.3353.PubMedCrossRef

Bennett JM, Catovsky D, Daniel MT, Flandrin G, Galton DA, Gralnick HR, et al. Proposals for the classification of the myelodysplastic syndromes. Br J Haematol. 1982;51(2):189–99.PubMed

10.

Swerdlow S, Campo E, Harris NL, Jaff ES, Pileri SA, Stein H, et al. WHO classification of tumours of haematopoietic and lymphoid tissues. 4th ed. Lyon: IARC Press; 2008.

11.

• Vardiman JW, Thiele J, Arber DA, Brunning RD, Borowitz MJ, Porwit A, 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(5):937–51. doi:10.1182/blood-2009-03-209262. The updated 2008 pathologic classification of hematopoietic malignancies is an essential reference and integrates clinical and pathology data.PubMedCrossRef

12.

Valent P, Horny HP, Bennett JM, Fonatsch C, Germing U, Greenberg P, et al. Definitions and standards in the diagnosis and treatment of the myelodysplastic syndromes: Consensus statements and report from a working conference. Leuk Res. 2007;31(6):727–36. doi:10.1016/j.leukres.2006.11.009.PubMedCrossRef

13.

Valent P, Bain BJ, Bennett JM, Wimazal F, Sperr WR, Mufti G, et al. Idiopathic cytopenia of undetermined significance (ICUS) and idiopathic dysplasia of uncertain significance (IDUS), and their distinction from low risk MDS. Leuk Res. 2012;36(1):1–5. doi:10.1016/j.leukres.2011.08.016.PubMedCrossRef

14.

Schanz J, Tuchler H, Sole F, Mallo M, Luno E, Cervera J, et al. New comprehensive cytogenetic scoring system for primary myelodysplastic syndromes (MDS) and oligoblastic acute myeloid leukemia after MDS derived from an international database merge. J Clin Oncol. 2012;30(8):820–9. doi:10.1200/JCO.2011.35.6394.PubMedCrossRef

15.

• Afable 2nd MG, Wlodarski M, Makishima H, Shaik M, Sekeres MA, Tiu RV, et al. SNP array-based karyotyping: differences and similarities between aplastic anemia and hypocellular myelodysplastic syndromes. Blood. 2011;117(25):6876–84. doi:10.1182/blood-2010-11-314393. The most recent and comprehensive analysis of cytogenetics in MDS serves as the basis for the IPSS-R.PubMedCrossRef

16.

Mohamedali AM, Alkhatabi H, Kulasekararaj A, Shinde S, Mian S, Malik F, et al. Utility of peripheral blood for cytogenetic and mutation analysis in myelodysplastic syndrome. Blood. 2013;122(4):567–70. doi:10.1182/blood-2012-12-471847.PubMedCrossRef

17.

Tiu RV, Gondek LP, O’Keefe CL, Elson P, Huh J, Mohamedali A, et al. Prognostic impact of SNP array karyotyping in myelodysplastic syndromes and related myeloid malignancies. Blood. 2011;117(17):4552–60. doi:10.1182/blood-2010-07-295857.PubMedCrossRef

18.

Thiel A, Beier M, Ingenhag D, Servan K, Hein M, Moeller V, et al. Comprehensive array CGH of normal karyotype myelodysplastic syndromes reveals hidden recurrent and individual genomic copy number alterations with prognostic relevance. Leukemia. 2011;25(3):387–99. doi:10.1038/leu.2010.293.PubMedCrossRef

19.

Jadersten M, Saft L, Smith A, Kulasekararaj A, Pomplun S, Gohring G, et al. TP53 mutations in low-risk myelodysplastic syndromes with del(5q) predict disease progression. J Clin Oncol. 2011;29(15):1971–9. doi:10.1200/JCO.2010.31.8576.PubMedCrossRef

20.

Padron E, Komrokji R, List AF. The 5q- syndrome: biology and treatment. Curr Treat Options Oncol. 2011;12(4):354–68. doi:10.1007/s11864-011-0165-1.PubMedCrossRef

21.

Graubert TA, Payton MA, Shao J, Walgren RA, Monahan RS, Frater JL, et al. Integrated genomic analysis implicates haploinsufficiency of multiple chromosome 5q31.2 genes in de novo myelodysplastic syndromes pathogenesis. PloS one. 2009;4(2):e4583.PubMedCrossRef

22.

Heinrichs S, Kulkarni RV, Bueso-Ramos CE, Levine RL, Loh ML, Li C, et al. Accurate detection of uniparental disomy and microdeletions by SNP array analysis in myelodysplastic syndromes with normal cytogenetics. Leukemia. 2009;23(9):1605–13. doi:10.1038/leu.2009.82.PubMedCrossRef

23.

Hussain FT, Nguyen EP, Raza S, Knudson R, Pardanani A, Hanson CA, et al. Sole abnormalities of chromosome 7 in myeloid malignancies: spectrum, histopathologic correlates, and prognostic implications. Am J Hematol. 2012;87(7):684–6. doi:10.1002/ajh.23230.PubMedCrossRef

24.

Saumell S, Florensa L, Luno E, Sanzo C, Canizo C, Hernandez JM, et al. Prognostic value of trisomy 8 as a single anomaly and the influence of additional cytogenetic aberrations in primary myelodysplastic syndromes. Br J Haematol. 2012;159(3):311–21. doi:10.1111/bjh.12035.PubMedCrossRef

25.

Bernasconi P, Klersy C, Boni M, Cavigliano PM, Dambruoso I, Zappatore R. Validation of the new comprehensive cytogenetic scoring system (NCCSS) on 630 consecutive de novo MDS patients from a single institution. Am J Hematol. 2013;88(2):120–9. doi:10.1002/ajh.23369.PubMedCrossRef

26.

Greenberg PL, Tuechler H, Schanz J, Sanz G, Garcia-Manero G, Sole F, et al. Revised international prognostic scoring system for myelodysplastic syndromes. Blood. 2012;120(12):2454–65. doi:10.1182/blood-2012-03-420489.PubMedCrossRef

27.

• Jabbour E, Takahashi K, Wang X, Cornelison AM, Abruzzo L, Kadia T, et al. Acquisition of cytogenetic abnormalities in patients with IPSS defined lower-risk myelodysplastic syndrome is associated with poor prognosis and transformation to acute myelogenous leukemia. Am J Hematol. 2013. doi:10.1002/ajh.23513. This reference is the manuscript introducing the revised IPSS, which is expected to become the new gold standard of risk stratification in MDS.

28.

Haferlach C, Alpermann T, Schnittger S, Kern W, Chromik J, Schmid C, et al. Prognostic value of monosomal karyotype in comparison to complex aberrant karyotype in acute myeloid leukemia: a study on 824 cases with aberrant karyotype. Blood. 2012;119(9):2122–5. doi:10.1182/blood-2011-10-385781.PubMedCrossRef

29.

Voutiadou G, Papaioannou G, Gaitatzi M, Lalayanni C, Syrigou A, Vadikoliou C, et al. Monosomal karyotype in acute myeloid leukemia defines a distinct subgroup within the adverse cytogenetic risk category. Cancer Genet. 2013;206(1–2):32–6. doi:10.1016/j.cancergen.2012.10.003.PubMedCrossRef

30.

Gangat N, Patnaik MM, Begna K, Kourelis T, Knudson RA, Ketterling RP, et al. Evaluation of revised IPSS cytogenetic risk stratification and prognostic impact of monosomal karyotype in 783 patients with primary myelodysplastic syndromes. Am J Hematol. 2013;88(8):690–3. doi:10.1002/ajh.23477.PubMedCrossRef

31.

Cluzeau T, Mounier N, Karsenti JM, Richez V, Legros L, Gastaud L, et al. Monosomal karyotype improves IPSS-R stratification in MDS and AML patients treated with Azacitidine. Am J Hematol. 2013. doi:10.1002/ajh.23509.PubMed

32.

Patnaik MM, Hanson CA, Hodnefield JM, Knudson R, Van Dyke DL, Tefferi A. Monosomal karyotype in myelodysplastic syndromes, with or without monosomy 7 or 5, is prognostically worse than an otherwise complex karyotype. Leukemia. 2011;25(2):266–70. doi:10.1038/leu.2010.258.PubMedCrossRef

33.

Schanz J, Tuchler H, Sole F, Mallo M, Luno E, Cervera J, et al. Monosomal karyotype in MDS: explaining the poor prognosis? Leukemia. 2013. doi:10.1038/leu.2013.187.PubMed

34.

Valcarcel D, Adema V, Sole F, Ortega M, Nomdedeu B, Sanz G, et al. Complex, not monosomal, karyotype is the cytogenetic marker of poorest prognosis in patients with primary myelodysplastic syndrome. J Clin Oncol. 2013;31(7):916–22. doi:10.1200/JCO.2012.41.6073.PubMedCrossRef

35.

Braulke F, Jung K, Schanz J, Gotze K, Muller-Thomas C, Platzbecker U, et al. Molecular cytogenetic monitoring from CD34+ peripheral blood cells in myelodysplastic syndromes: First results from a prospective multicenter German diagnostic study. Leuk Res. 2013;37(8):900–6. doi:10.1016/j.leukres.2013.03.019.PubMedCrossRef

36.

37.

Greenberg P, Cox C, LeBeau MM, Fenaux P, Morel P, Sanz G, et al. International scoring system for evaluating prognosis in myelodysplastic syndromes. Blood. 1997;89(6):2079–88.PubMed

38.

Malcovati L, Germing U, Kuendgen A, Della Porta MG, Pascutto C, Invernizzi R, et al. Time-dependent prognostic scoring system for predicting survival and leukemic evolution in myelodysplastic syndromes. J Clin Oncol. 2007;25(23):3503–10. doi:10.1200/JCO.2006.08.5696.PubMedCrossRef

39.

Malcovati L, Della Porta MG, Strupp C, Ambaglio I, Kuendgen A, Nachtkamp K, et al. Impact of the degree of anemia on the outcome of patients with myelodysplastic syndrome and its integration into the WHO classification-based Prognostic Scoring System (WPSS). Haematologica. 2011;96(10):1433–40. doi:10.3324/haematol.2011.044602.PubMedCrossRef

40.

Garcia-Manero G, Shan J, Faderl S, Cortes J, Ravandi F, Borthakur G, et al. A prognostic score for patients with lower risk myelodysplastic syndrome. Leukemia. 2008;22(3):538–43. doi:10.1038/sj.leu.2405070.PubMedCrossRef

41.

Bejar R, Stevenson KE, Caughey BA, Abdel-Wahab O, Steensma DP, Galili N, et al. Validation of a prognostic model and the impact of mutations in patients with lower-risk myelodysplastic syndromes. J Clin Oncol. 2012;30(27):3376–82. doi:10.1200/JCO.2011.40.7379.PubMedCrossRef

42.

Voso MT, Fenu S, Latagliata R, Buccisano F, Piciocchi A, Aloe-Spiriti MA, et al. Revised International Prognostic Scoring System (IPSS) Predicts Survival and Leukemic Evolution of Myelodysplastic Syndromes Significantly Better Than IPSS and WHO Prognostic Scoring System: Validation by the Gruppo Romano Mielodisplasie Italian Regional Database. J Clin Oncol. 2013;31(21):2671–7. doi:10.1200/JCO.2012.48.0764.PubMedCrossRef

43.

Platzbecker U, Santini V, Mufti GJ, Haferlach C, Maciejewski JP, Park S, et al. Update on developments in the diagnosis and prognostic evaluation of patients with myelodysplastic syndromes (MDS): consensus statements and report from an expert workshop. Leuk Res. 2012;36(3):264–70. doi:10.1016/j.leukres.2011.11.005.PubMedCrossRef

44.

Adema V, Hernandez JM, Abaigar M, Lumbreras E, Such E, Calull A, et al. Application of FISH 7q in MDS patients without monosomy 7 or 7q deletion by conventional G-banding cytogenetics: does −7/7q- detection by FISH have prognostic value? Leuk Res. 2013;37(4):416–21. doi:10.1016/j.leukres.2012.12.010.PubMedCrossRef

45.

Mallo M, Arenillas L, Espinet B, Salido M, Hernandez JM, Lumbreras E, et al. Fluorescence in situ hybridization improves the detection of 5q31 deletion in myelodysplastic syndromes without cytogenetic evidence of 5q. Haematologica. 2008;93(7):1001–8. doi:10.3324/haematol.13012.PubMedCrossRef

46.

Seegmiller AC, Wasserman A, Kim AS, Kressin MK, Marx ER, Zutter MM, et al. Limited utility of fluorescence in situ hybridization for common abnormalities of myelodysplastic syndrome at first presentation and follow-up of myeloid neoplasms. Leuk Lymphoma. 2013. doi:10.3109/10428194.2013.801470.PubMed

47.

van de Loosdrecht AA, Westers TM. Cutting edge: flow cytometry in myelodysplastic syndromes. J Natl Compr Canc Netw. 2013;11(7):892–902.PubMed

48.

Wells DA, Benesch M, Loken MR, Vallejo C, Myerson D, Leisenring WM, et al. Myeloid and monocytic dyspoiesis as determined by flow cytometric scoring in myelodysplastic syndrome correlates with the IPSS and with outcome after hematopoietic stem cell transplantation. Blood. 2003;102(1):394–403. doi:10.1182/blood-2002-09-2768.PubMedCrossRef

49.

van de Loosdrecht AA, Ireland R, Kern W, Della Porta MG, Alhan C, Balleisen JS, et al. Rationale for the clinical application of flow cytometry in patients with myelodysplastic syndromes: position paper of an International Consortium and the European LeukemiaNet Working Group. Leuk Lymphoma. 2013;54(3):472–5. doi:10.3109/10428194.2012.718341.PubMedCrossRef

50.

Westers TM, Ireland R, Kern W, Alhan C, Balleisen JS, Bettelheim P, et al. Standardization of flow cytometry in myelodysplastic syndromes: a report from an international consortium and the European LeukemiaNet Working Group. Leukemia. 2012;26(7):1730–41. doi:10.1038/leu.2012.30.PubMedCrossRef

51.

Westers TM, van der Velden VH, Alhan C, Bekkema R, Bijkerk A, Brooimans RA, et al. Implementation of flow cytometry in the diagnostic work-up of myelodysplastic syndromes in a multicenter approach: report from the Dutch Working Party on Flow Cytometry in MDS. Leuk Res. 2012;36(4):422–30. doi:10.1016/j.leukres.2011.09.015.PubMedCrossRef

52.

Kern W, Haferlach C, Schnittger S, Haferlach T. Clinical utility of multiparameter flow cytometry in the diagnosis of 1013 patients with suspected myelodysplastic syndrome: correlation to cytomorphology, cytogenetics, and clinical data. Cancer. 2010;116(19):4549–63. doi:10.1002/cncr.25353.PubMedCrossRef

53.

Bacher U, Haferlach T, Kern W, Weiss T, Schnittger S, Haferlach C. The impact of cytomorphology, cytogenetics, molecular genetics, and immunophenotyping in a comprehensive diagnostic workup of myelodysplastic syndromes. Cancer. 2009;115(19):4524–32. doi:10.1002/cncr.24501.PubMedCrossRef

54.

Della Porta MG, Picone C, Pascutto C, Malcovati L, Tamura H, Handa H, et al. Multicenter validation of a reproducible flow cytometric score for the diagnosis of low-grade myelodysplastic syndromes: results of a European LeukemiaNET study. Haematologica. 2012;97(8):1209–17. doi:10.3324/haematol.2011.048421.PubMedCrossRef

55.

Bejar R, Levine R, Ebert BL. Unraveling the molecular pathophysiology of myelodysplastic syndromes. J Clin Oncol. 2011;29(5):504–15. doi:10.1200/JCO.2010.31.1175.PubMedCrossRef

56.

Lindsley RC, Ebert BL. Molecular pathophysiology of myelodysplastic syndromes. Annu Rev Pathol. 2013;8:21–47. doi:10.1146/annurev-pathol-011811-132436.PubMedCrossRef

57.

• Bejar R, Stevenson K, Abdel-Wahab O, Galili N, Nilsson B, Garcia-Manero G, et al. Clinical effect of point mutations in myelodysplastic syndromes. New Engl J Med. 2011;364(26):2496–506. doi:10.1056/NEJMoa1013343. This reference is an excellent review of what is currently known about the molecular pathophysiology of MDS.PubMedCrossRef

58.

Graubert TA, Shen D, Ding L, Okeyo-Owuor T, Lunn CL, Shao J, et al. Recurrent mutations in the U2AF1 splicing factor in myelodysplastic syndromes. Nat Genet. 2012;44(1):53–7. doi:10.1038/ng.1031.CrossRef

59.

Papaemmanuil E, Cazzola M, Boultwood J, Malcovati L, Vyas P, Bowen D, et al. Somatic SF3B1 mutation in myelodysplasia with ring sideroblasts. New Engl J Med. 2011;365(15):1384–95. doi:10.1056/NEJMoa1103283.PubMedCrossRef

60.

Abdel-Wahab O, Levine R. The spliceosome as an indicted conspirator in myeloid malignancies. Cancer Cell. 2011;20(4):420–3. doi:10.1016/j.ccr.2011.10.004.PubMedCrossRef

61.

Yoshida K, Sanada M, Shiraishi Y, Nowak D, Nagata Y, Yamamoto R, et al. Frequent pathway mutations of splicing machinery in myelodysplasia. Nature. 2011;478(7367):64–9. doi:10.1038/nature10496.PubMedCrossRef

Title: Standardizing the Initial Evaluation for Myelodysplastic Syndromes
Authors: Danielle Marshall
Gail J. Roboz
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/s11899-013-0180-3

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

Management of Double-Refractory Multiple Myeloma

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

Allogeneic Hematopoietic Stem Cell Transplantation for Multiple Myeloma: What Place, If Any?

Preclinical Models for Drug Selection in Myeloproliferative Neoplasms

Febrile Neutropenia in Hematologic Malignancies

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

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

Highlights from the ACC 2024 Congress

ACC 2024 Congress Coverage