Essential thrombocythaemia
Haematolymphoid Tumours (WHO Classification, 5th ed.)
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editContent Update To WHO 5th Edition Classification Is In Process; Content Below is Based on WHO 4th Edition ClassificationThis page was converted to the new template on 2023-12-07. The original page can be found at HAEM4:Essential Thrombocythemia (ET).
(General Instructions – The focus of these pages is the clinically significant genetic alterations in each disease type. This is based on up-to-date knowledge from multiple resources such as PubMed and the WHO classification books. The CCGA is meant to be a supplemental resource to the WHO classification books; the CCGA captures in a continually updated wiki-stye manner the current genetics/genomics knowledge of each disease, which evolves more rapidly than books can be revised and published. If the same disease is described in multiple WHO classification books, the genetics-related information for that disease will be consolidated into a single main page that has this template (other pages would only contain a link to this main page). Use HUGO-approved gene names and symbols (italicized when appropriate), HGVS-based nomenclature for variants, as well as generic names of drugs and testing platforms or assays if applicable. Please complete tables whenever possible and do not delete them (add N/A if not applicable in the table and delete the examples); to add (or move) a row or column in a table, click nearby within the table and select the > symbol that appears. Please do not delete or alter the section headings. The use of bullet points alongside short blocks of text rather than only large paragraphs is encouraged. Additional instructions below in italicized blue text should not be included in the final page content. Please also see Author_Instructions and FAQs as well as contact your Associate Editor or Technical Support.)
Primary Author(s)*
Rebecca Smith, PhD, Director, Genetics Associates, Nashville, TN
WHO Classification of Disease
| Structure | Disease |
|---|---|
| Book | Haematolymphoid Tumours (5th ed.) |
| Category | Myeloid proliferations and neoplasms |
| Family | Myeloproliferative neoplasms |
| Type | Myeloproliferative neoplasms |
| Subtype(s) | Essential thrombocythaemia |
WHO Essential and Desirable Genetic Diagnostic Criteria
(Instructions: The table will have the diagnostic criteria from the WHO book autocompleted; remove any non-genetics related criteria. If applicable, add text about other classification systems that define this entity and specify how the genetics-related criteria differ.)
| WHO Essential Criteria (Genetics)* | |
| WHO Desirable Criteria (Genetics)* | |
| Other Classification |
*Note: These are only the genetic/genomic criteria. Additional diagnostic criteria can be found in the WHO Classification of Tumours.
Related Terminology
(Instructions: The table will have the related terminology from the WHO autocompleted.)
| Acceptable | |
| Not Recommended |
Gene Rearrangements
Put your text here and fill in the table (Instructions: Details on clinical significance such as prognosis and other important information can be provided in the notes section. Please include references throughout the table. Do not delete the table.)
| Driver Gene | Fusion(s) and Common Partner Genes | Molecular Pathogenesis | Typical Chromosomal Alteration(s) | Prevalence -Common >20%, Recurrent 5-20% or Rare <5% (Disease) | Diagnostic, Prognostic, and Therapeutic Significance - D, P, T | Established Clinical Significance Per Guidelines - Yes or No (Source) | Clinical Relevance Details/Other Notes |
|---|---|---|---|---|---|---|---|
| EXAMPLE: ABL1 | EXAMPLE: BCR::ABL1 | EXAMPLE: The pathogenic derivative is the der(22) resulting in fusion of 5’ BCR and 3’ABL1. | EXAMPLE: t(9;22)(q34;q11.2) | EXAMPLE: Common (CML) | EXAMPLE: D, P, T | EXAMPLE: Yes (WHO, NCCN) | EXAMPLE:
The t(9;22) is diagnostic of CML in the appropriate morphology and clinical context (add reference). This fusion is responsive to targeted therapy such as Imatinib (Gleevec) (add reference). BCR::ABL1 is generally favorable in CML (add reference). |
| EXAMPLE: CIC | EXAMPLE: CIC::DUX4 | EXAMPLE: Typically, the last exon of CIC is fused to DUX4. The fusion breakpoint in CIC is usually intra-exonic and removes an inhibitory sequence, upregulating PEA3 genes downstream of CIC including ETV1, ETV4, and ETV5. | EXAMPLE: t(4;19)(q25;q13) | EXAMPLE: Common (CIC-rearranged sarcoma) | EXAMPLE: D | EXAMPLE:
DUX4 has many homologous genes; an alternate translocation in a minority of cases is t(10;19), but this is usually indistinguishable from t(4;19) by short-read sequencing (add references). | |
| EXAMPLE: ALK | EXAMPLE: ELM4::ALK
|
EXAMPLE: Fusions result in constitutive activation of the ALK tyrosine kinase. The most common ALK fusion is EML4::ALK, with breakpoints in intron 19 of ALK. At the transcript level, a variable (5’) partner gene is fused to 3’ ALK at exon 20. Rarely, ALK fusions contain exon 19 due to breakpoints in intron 18. | EXAMPLE: N/A | EXAMPLE: Rare (Lung adenocarcinoma) | EXAMPLE: T | EXAMPLE:
Both balanced and unbalanced forms are observed by FISH (add references). | |
| EXAMPLE: ABL1 | EXAMPLE: N/A | EXAMPLE: Intragenic deletion of exons 2–7 in EGFR removes the ligand-binding domain, resulting in a constitutively active tyrosine kinase with downstream activation of multiple oncogenic pathways. | EXAMPLE: N/A | EXAMPLE: Recurrent (IDH-wildtype Glioblastoma) | EXAMPLE: D, P, T | ||
editv4:Chromosomal Rearrangements (Gene Fusions)The content below was from the old template. Please incorporate above.
Very rarely, cases of ET acquire a BCR-ABL1 rearrangement. Consequently, in this situation, a morphological and hematological shift capable of chronic myeloid leukemia evolution may occur[1]
End of V4 Section
editv4:Clinical Significance (Diagnosis, Prognosis and Therapeutic Implications).Please incorporate this section into the relevant tables found in:
- Chromosomal Rearrangements (Gene Fusions)
- Individual Region Genomic Gain/Loss/LOH
- Characteristic Chromosomal Patterns
- Gene Mutations (SNV/INDEL)
ET is characterized by overall favorable prognosis as compared to the other MPNs (PV and PMF) with an expected survival of 19.8 years; however, life-expectancy is still reduced compared to the control population. Incidence of blast transformation and fibrotic transformation is lower in ET as compared to PV[2]. Transformation of ET to a blast phase (AML or MDS) occurs in <5% of cases, and is likely related to previous cytotoxic therapy[3].
Treatment for ET is usually kept to a minimum and the patient is monitored for progression to leukemia and post-ET myelofibrosis. The main indication for treatment of ET is to prevent thrombosis. There are four major risk categories for thrombosis risk[4]:
- High-risk: presence of thrombosis history or presence of both JAK2/MPL mutations and advanced age
- Intermediate-risk: presence of advanced age
- Low risk: presence of JAK2/MPL mutations
- Very low risk: absence of all risk factors
Disease progression
The transformation of ET to AML and/or post-ET myelofibrosis (post-ET MF) are rare events. The risk of transformation to acute leukemia was reported to 2-3% at 10 years and 5% at 15 years after diagnosis. Risk factors included age and age over 60 years. Occurrence of post-ET myelofibrosis does occur rarely with a risk of 6% at 15 years. Anemia was identified as the only significant risk factor for development of post-ET myelofibrosis[5]
End of V4 Section
Individual Region Genomic Gain/Loss/LOH
Put your text here and fill in the table (Instructions: Includes aberrations not involving gene rearrangements. Details on clinical significance such as prognosis and other important information can be provided in the notes section. Can refer to CGC workgroup tables as linked on the homepage if applicable. Please include references throughout the table. Do not delete the table.)
| Chr # | Gain, Loss, Amp, LOH | Minimal Region Cytoband and/or Genomic Coordinates [Genome Build; Size] | Relevant Gene(s) | Diagnostic, Prognostic, and Therapeutic Significance - D, P, T | Established Clinical Significance Per Guidelines - Yes or No (Source) | Clinical Relevance Details/Other Notes |
|---|---|---|---|---|---|---|
| EXAMPLE:
7 |
EXAMPLE: Loss | EXAMPLE:
chr7 |
EXAMPLE:
Unknown |
EXAMPLE: D, P | EXAMPLE: No | EXAMPLE:
Presence of monosomy 7 (or 7q deletion) is sufficient for a diagnosis of AML with MDS-related changes when there is ≥20% blasts and no prior therapy (add reference). Monosomy 7/7q deletion is associated with a poor prognosis in AML (add references). |
| EXAMPLE:
8 |
EXAMPLE: Gain | EXAMPLE:
chr8 |
EXAMPLE:
Unknown |
EXAMPLE: D, P | EXAMPLE:
Common recurrent secondary finding for t(8;21) (add references). | |
| EXAMPLE:
17 |
EXAMPLE: Amp | EXAMPLE:
17q12; chr17:39,700,064-39,728,658 [hg38; 28.6 kb] |
EXAMPLE:
ERBB2 |
EXAMPLE: D, P, T | EXAMPLE:
Amplification of ERBB2 is associated with HER2 overexpression in HER2 positive breast cancer (add references). Add criteria for how amplification is defined. | |
editv4:Genomic Gain/Loss/LOHThe content below was from the old template. Please incorporate above.
Uniparental disomy (UPD) in Essential Thrombocythemia has not been reported. Conversely, UPD of chromosome 9p (typically causing homozygosity of JAK2 pathogenic variants) is a frequent clonal occurrence in polycythemia vera (PV) [6].
End of V4 Section
Characteristic Chromosomal or Other Global Mutational Patterns
Put your text here and fill in the table (Instructions: Included in this category are alterations such as hyperdiploid; gain of odd number chromosomes including typically chromosome 1, 3, 5, 7, 11, and 17; co-deletion of 1p and 19q; complex karyotypes without characteristic genetic findings; chromothripsis; microsatellite instability; homologous recombination deficiency; mutational signature pattern; etc. Details on clinical significance such as prognosis and other important information can be provided in the notes section. Please include references throughout the table. Do not delete the table.)
| Chromosomal Pattern | Molecular Pathogenesis | Prevalence -
Common >20%, Recurrent 5-20% or Rare <5% (Disease) |
Diagnostic, Prognostic, and Therapeutic Significance - D, P, T | Established Clinical Significance Per Guidelines - Yes or No (Source) | Clinical Relevance Details/Other Notes |
|---|---|---|---|---|---|
| EXAMPLE:
Co-deletion of 1p and 18q |
EXAMPLE: See chromosomal rearrangements table as this pattern is due to an unbalanced derivative translocation associated with oligodendroglioma (add reference). | EXAMPLE: Common (Oligodendroglioma) | EXAMPLE: D, P | ||
| EXAMPLE:
Microsatellite instability - hypermutated |
EXAMPLE: Common (Endometrial carcinoma) | EXAMPLE: P, T | |||
editv4:Characteristic Chromosomal Aberrations / PatternsThe content below was from the old template. Please incorporate above.
An abnormal karyotype is found in 5-10% of cases; however, there is no consistent abnormality. Reported, but non-specific, abnormalities in ET include gain of chromosome 8, abnormalities of 9q, and del(20q). Isolated instances of del(5q) have also been reported in ET[3].
End of V4 Section
Gene Mutations (SNV/INDEL)
Put your text here and fill in the table (Instructions: This table is not meant to be an exhaustive list; please include only genes/alterations that are recurrent or common as well either disease defining and/or clinically significant. If a gene has multiple mechanisms depending on the type or site of the alteration, add multiple entries in the table. For clinical significance, denote associations with FDA-approved therapy (not an extensive list of applicable drugs) and NCCN or other national guidelines if applicable; Can also refer to CGC workgroup tables as linked on the homepage if applicable as well as any high impact papers or reviews of gene mutations in this entity. Details on clinical significance such as prognosis and other important information such as concomitant and mutually exclusive mutations can be provided in the notes section. Please include references throughout the table. Do not delete the table.)
| Gene | Genetic Alteration | Tumor Suppressor Gene, Oncogene, Other | Prevalence -
Common >20%, Recurrent 5-20% or Rare <5% (Disease) |
Diagnostic, Prognostic, and Therapeutic Significance - D, P, T | Established Clinical Significance Per Guidelines - Yes or No (Source) | Clinical Relevance Details/Other Notes |
|---|---|---|---|---|---|---|
| EXAMPLE:EGFR
|
EXAMPLE: Exon 18-21 activating mutations | EXAMPLE: Oncogene | EXAMPLE: Common (lung cancer) | EXAMPLE: T | EXAMPLE: Yes (NCCN) | EXAMPLE: Exons 18, 19, and 21 mutations are targetable for therapy. Exon 20 T790M variants cause resistance to first generation TKI therapy and are targetable by second and third generation TKIs (add references). |
| EXAMPLE: TP53; Variable LOF mutations
|
EXAMPLE: Variable LOF mutations | EXAMPLE: Tumor Supressor Gene | EXAMPLE: Common (breast cancer) | EXAMPLE: P | EXAMPLE: >90% are somatic; rare germline alterations associated with Li-Fraumeni syndrome (add reference). Denotes a poor prognosis in breast cancer. | |
| EXAMPLE: BRAF; Activating mutations | EXAMPLE: Activating mutations | EXAMPLE: Oncogene | EXAMPLE: Common (melanoma) | EXAMPLE: T | ||
Note: A more extensive list of mutations can be found in cBioportal, COSMIC, and/or other databases. When applicable, gene-specific pages within the CCGA site directly link to pertinent external content.
editv4:Gene Mutations (SNV/INDEL)The content below was from the old template. Please incorporate above.
Most cases of ET harbor a phenotypic driver mutation in JAK2 (50-60% of ET cases), CALR (in 30%), or MPL (in 3%), and about 13% of ET are triple negative for these mutations. None of these mutations are specific for ET; however, the presence of these mutations would rule out reactive or secondary thrombocytosis[3].
| Gene | Mutation | Percent of ET cases | Oncogene/Tumor Suppressor/Other | Presumed Mechanism (LOF/GOF/Other; Driver/Passenger) |
|---|---|---|---|---|
| JAK2 | V617F, c.1849G>T | 50-60% | Non-receptor tyrosine kinase | Constitutively activated |
| CALR exon 9 | Insertion or deletion (52-bp insertion, or 5 bp deletion) are most prevalent | 30% | Typical function as a ER CA2+ binding chaperone. Pathogenic variants cause ectopic cellular function in hematopoietic pathway. | GOF |
| MPL exon 10 | Most common affect a tryptophan in position 515 (W515L, W515K, W515A, and W515R). | 3% | proto-oncogene receptor | Constitutively activated |
| Triple negative | No specific marker (negative for pathogenic variants in JAK2, CALR, and MPL) | 12% | Not available | Not available |
Other Mutations
These main driver mutations, JAK2, CALR, and MPL have been considered to be mutually exclusive; however, there is a recent report of additional mutations in CALR or MPL co-existing in approximately 10% of patients with low JAK2 burden. The clinical significance of the co-occurrence of these variants is still unclear[7].
Sub-clonal mutations have been seen in TET2, ASXL1, CBL, IDH and IKZF1 are observed however the diagnostic value of these mutations in ET are not clear. In PMF, however, these mutations have a negative prognostic value and their presence is associated with lower survival and a greater risk of acute leukemia evolution (Accurso et al. 2019, Kalmpfl et al. 2013)
| Type | Gene/Region/Other | Comments |
|---|---|---|
| Secondary Mutations | TET2, ASXL1, CBL, IDH and IKZF1, DNMT3A, SF3B1, CEBPA, TP53, SH2B3, EZH2, and CSF3R. | The impact and disease prognosis of these secondary mutations in ET is not clear. These variants are not specific and overlap in occurrence with other MPNs, MDS, and AML diseases. |
| Mutually Exclusive | These main driver mutations, JAK2, CALR, and MPL have been considered to be mutually exclusive; however, a recent reports of additional mutations in CALR or MPL co-existing in approximately 10% of patients with low JAK2 burden. | The clinical significance of co-occurring variants is unclear[7] |
End of V4 Section
Epigenomic Alterations
Put your text here
Genes and Main Pathways Involved
Put your text here and fill in the table (Instructions: Please include references throughout the table. Do not delete the table.)
| Gene; Genetic Alteration | Pathway | Pathophysiologic Outcome |
|---|---|---|
| EXAMPLE: BRAF and MAP2K1; Activating mutations | EXAMPLE: MAPK signaling | EXAMPLE: Increased cell growth and proliferation |
| EXAMPLE: CDKN2A; Inactivating mutations | EXAMPLE: Cell cycle regulation | EXAMPLE: Unregulated cell division |
| EXAMPLE: KMT2C and ARID1A; Inactivating mutations | EXAMPLE: Histone modification, chromatin remodeling | EXAMPLE: Abnormal gene expression program |
editv4:Genes and Main Pathways InvolvedThe content below was from the old template. Please incorporate above.
JAK2
Janus Kinase 2 (JAK2) is a non-receptor kinase that activates the JAK-STAT pathway upon ligand binding. JAK2 has a critical role in signaling for hematopoietic cytokinases and associates to the cytoplasmic region of multiple receptors involved in myelopoesis including erythropoietin (Epo), thrombopoietin, granulocyte colony stimulating factor, IL-3, and granulocyte macrophage colony stimulating factor receptors). After ligand binding to these receptors, JAK2 tyrosine kinase domain is activated and allows for progression of the signal through signal transducers and activators of transcriptions (STATs), Ras-mitogen-activated protein kinase (MAPK), and phosphoinositide-S3-kinasae pathways, which regulate proliferation, apoptosis, and differentiation in myeloid cells[8].
The most prominent pathogenic variant in ET, JAK2 V617F, makes up 50-60% of cases and occurs at nucleotide 1849 in exon 14, and is a G to T somatic transversion. This pathogenic variant occurs in the pseudokinase JH2 domain of the protein, inhibits the normal JH2 autoinhibitory mechanism, and consequently results in the constitutive activity of JAK2[9]. The allelic burden of JAK2 at diagnosis can provide prognostic information because it correlates with phenotypic severity of MPNs, the risk of thrombotic events, and progress to secondary myelofibrosis (MF)[8].
CALR
Calreticulin (CALR) pathogenic variants represent the second most common genetic abnormality in ET and is found in ~30% of cases. CALR is a Ca2+ binding protein with chaperone activity that resides predominantly in the endoplasmic reticulum. In its wildtype form, CALR has a variety of roles including protein quality control, calcium metabolism, immune response, phagocytosis, cell adhesion and others. The localization of the CALR protein is determined by a KDEL sequence on the C-terminal end of the protein[8].
Pathogenic CALR variants driving MPNs, including more than 50 different variants, typically consisting of an insertion or deletion in exon 9 causing a frameshift. This results in a novel C-terminal peptide sequence, loss of the KDEL signal, and partial dislocation from the endoplasmic reticulum. There are two predominate variants seen driving ET (and MPNs as a whole), a type 1 variant (L367fs*46) results from a 52-bp deletion and a type 2 variant (K385fs*47) that results from a 5-bp TTGTC insertion. Within ET patients, the distribution of is 57% of patients have a type 1 variant (or type 1-like) and 39% were found to have a type 2 variant (or type 2-like)[8].
MPL
The myeloproliferative leukemia virus oncogene (MPL) encodes for the receptor for the thrombopoietin (TPO) ligand. This receptor is a primary regulator of megakaryopoiesis, driving early stages of megakarytocyte differentiation, and hematopoietic stem cell survival and proliferation. TPO binding to MPL leads to the activation of JAK2, leading to the downstream activation of signaling pathways involving STAT 1, 3, and 5, Akt, and ERK 1/2[8][10].
Mutations in MPL have been reported in 1-4% of patients with ET. Constitutively activating mutations in MPL all cluster in exon 10 and the majority of the cases affect a tryptophan in position 515 (W515L, W515K, W515A, and W515R)[8]. In a recent study, MPL-mutated ET was reported to have a higher rate of fibrotic progression than patients with a MPL-wildtype ET disease[11].
Driver mutations: CALR vs JAK2
Essential Thrombocythemia (ET) with CALR pathogenic variants has been proposed to be a distinct entity with a less severe course of disease compared with JAK2 mutations. ET patients with CALR-pathogenic variants were more often found to exhibit lower leukocyte and hemoglobin values, higher platelet counts, and to be male compared with JAK2-mutated ET patients. Additionally, a lower incidence of thrombosis was seen in CALR-mutated ET vs. JAK2-mutated ET. This information has the potential to further stratify ET patients based on the prognosis and severity of the disease [12][13].
End of V4 Section
Genetic Diagnostic Testing Methods
Samples from patients diagnosed with ET are routinely tested for JAK2 V617F, CALR exon 9 insertions or deletions, and MPL exon 10 gain of function variants. Although not an exhaustive list of testing methods for each pathogenic variant, several detection strategies have been described (see below)[8]:
| Genetic change: | Methods for testing |
| JAK2 V617F | Allele specific assay, TaqMan assay, NGS, real-time allele specific PCR, |
| CALR exon 9 insertion or deletion | Sanger sequencing Fragment length analysis, NGS, Real-time qPCR, HRM, ddPCR, pyrosequencing |
| MPL exon 10 | Sanger sequencing, pyrosequencing, melt-curve analysis, NGS, allele specific qPCR, a multiplexes allele-specific PCR assay for the four most frequent MPL exon 10 mutations (W515L, W515K, W515A, and S505N) |
Familial Forms
Most cases of ET are sporadic however, familial clustering has also been observed. One study established a 6x relative risk of developing a MPN, when there is also an affected relative[14] The JAK2 GGCC 46/1 haplotype represents a low penetrance predisposition allele and is associated with JAK2 mutated MPN. This haplotype consists of analyzing four SNPs in linkage disequilibrium, and located in introns 10, 12, 15 and 15 of the JAK2 gene and is found in about 50% of healthy subjects [15].
Additional Information
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References
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- ↑ K, Hussein; et al. (2008). "Chronic myeloproliferative diseases with concurrent BCR-ABL junction and JAK2V617F mutation". PMID 17972958.
- ↑ Accurso, V; et al. (2019). "Essential thrombocythemia: Biology, clinical features, thrombotic risk, therapeutic options and outcome". Journal of Hematology and Clinical Research. 3 (1): 053–059. doi:10.29328/journal.jhcr.1001012.
- ↑ Jump up to: 3.0 3.1 3.2 Thiele, J. et al., (2017). Essential thrombocythaemia, in World Health Organization Classification of Tumours of Haematopoietic and Lymphoid Tissues, Revised 4th edition. Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H, Thiele J, Arber DA, Hasserjian RP, Le Beau MM, Orazi A, and Siebert R, Editors. IARC Press: Lyon, France, p50-53
- ↑ Tefferi, Ayalew; et al. (2018). "Essential thrombocythemia treatment algorithm 2018". Blood Cancer Journal. 8 (1). doi:10.1038/s41408-017-0041-8. ISSN 2044-5385. PMC 5802626. PMID 29321520.CS1 maint: PMC format (link)
- ↑ F, Passamonti; et al. (2008). "Prognostic factors for thrombosis, myelofibrosis, and leukemia in essential thrombocythemia: a study of 605 patients". PMID 18790799.
- ↑ Kralovics, R (2002). "Acquired uniparental disomy of chromosome 9p is a frequent stem cell defect in polycythemia vera". Experimental Hematology. 30 (3): 229–236. doi:10.1016/S0301-472X(01)00789-5.
- ↑ Jump up to: 7.0 7.1 Mansier, Olivier; et al. (2018). "Clinical and biological characterization of MPN patients harboring two driver mutations, a French intergroup of myeloproliferative neoplasms (FIM) study". American Journal of Hematology. 93 (4): E84–E86. doi:10.1002/ajh.25014.
- ↑ Jump up to: 8.0 8.1 8.2 8.3 8.4 8.5 8.6 Ga, Palumbo; et al. (2019). "The Role of New Technologies in Myeloproliferative Neoplasms". doi:10.3389/fonc.2019.00321. PMC 6498877. PMID 31106152.CS1 maint: PMC format (link)
- ↑ O, Silvennoinen; et al. (2015). "Molecular insights into regulation of JAK2 in myeloproliferative neoplasms". doi:10.1182/blood-2015-01-621110. PMC 4447858. PMID 25824690.CS1 maint: PMC format (link)
- ↑ Sangkhae, Veena; et al. (2014). "The thrombopoietin receptor, MPL, is critical for development of a JAK2V617F-induced myeloproliferative neoplasm". Blood. 124 (26): 3956–3963. doi:10.1182/blood-2014-07-587238. ISSN 0006-4971. PMC 4271181. PMID 25339357.CS1 maint: PMC format (link)
- ↑ Szuber, Natasha; et al. (2018). "MPL-mutated essential thrombocythemia: a morphologic reappraisal". Blood Cancer Journal. 8 (12). doi:10.1038/s41408-018-0159-3. ISSN 2044-5385. PMC 6246562. PMID 30459342.CS1 maint: PMC format (link)
- ↑ Rotunno, Giada; et al. (2014). "Impact of calreticulin mutations on clinical and hematological phenotype and outcome in essential thrombocythemia". Blood. 123 (10): 1552–1555. doi:10.1182/blood-2013-11-538983. ISSN 0006-4971.
- ↑ E, Rumi; et al. (2014). "JAK2 or CALR mutation status defines subtypes of essential thrombocythemia with substantially different clinical course and outcomes". doi:10.1182/blood-2013-11-539098. PMC 3945864. PMID 24366362.CS1 maint: PMC format (link)
- ↑ Landgren, Ola; et al. (2008-09-15). "Increased risks of polycythemia vera, essential thrombocythemia, and myelofibrosis among 24 577 first-degree relatives of 11 039 patients with myeloproliferative neoplasms in Sweden". Blood. 112 (6): 2199–2204. doi:10.1182/blood-2008-03-143602. ISSN 0006-4971. PMC 2532797. PMID 18451307.CS1 maint: PMC format (link)
- ↑ Av, Jones; et al. (2009). "JAK2 haplotype is a major risk factor for the development of myeloproliferative neoplasms". doi:10.1038/ng.334. PMC 4120192. PMID 19287382.CS1 maint: PMC format (link)
Notes
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Prior Author(s):
*Citation of this Page: “Essential thrombocythaemia”. Compendium of Cancer Genome Aberrations (CCGA), Cancer Genomics Consortium (CGC), updated 03/24/2025, https://ccga.io/index.php/HAEM5:Essential_thrombocythaemia.