New Insights into Myeloproliferative Neoplasms

Dear Colleagues,

In recent years, new insights into the Philadelphia-negative chronic myeloproliferative neoplasms (MPNs) have emerged, including the important role of chronic inflammation as the driving force for clonal evolution and disease progression and the impact of chronic inflammation upon symptom burden as well. The role of interferon-alfa2 (IFN) in the initial treatment of MPNs has been increasingly recognized, being fueled by the EU marketing authorization for RopegInterferon Alfa2b (Besremi^R) as first line monotherapy in adults for the treatment of PV without symptomatic splenomegaly. The “wait and watch strategy” in low-risk patients is currently being challenged, since treatment with IFN may induce minimal residual disease (MRD) with low-burden JAK2V617F and normal bone marrow after about five years of IFN-treatment. Next generation sequencing is being used increasingly at the time of diagnosis for early prognostication and guidance for treatment. Most recent studies have unraveled MPNs to be far more prevalent than previously recognized, underscoring the unmet need of much earlier diagnosis of MPNs by molecular screening of patients at risk of having undiagnosed MPNs. This might also imply an earlier diagnosis of second cancers which MPN-patients are prone to develop, likely as a consequence of chronic inflammation, immunoderegulation and associated defective tumor immune surveillance.

This Special Issue will highlight several of the above issues, including mathematical modelling studies, substantiating the proof of concept for chronic inflammation as a trigger and driver of MPN development, and underscoring the importance of initiating IFN-treatment as early as possible. A new bright future for patients with MPNs is foreseen, in whom early intervention with stem cell targeted therapy (IFN) or IFN in combination with agents targeting the chronic inflammatory state (e.g., ruxolitinib and statins) may open the avenue for many more patients to follow the path towards MRD, and even cure being obtained by vaccination strategies.

Prof. Dr. Hans Hasselbalch
Guest Editor

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