15 October 2018

British researchers have developed a new tool which they believe will improve prediction of prognosis for patients with myeloproliferative neoplasms.

The tool combines extensive genetic and clinical information, and identifies eight genetic sub-groups linked to patterns of clinical disease and patient prognosis, the researchers reported in the New England Journal of Medicine last week.

Myeloproliferative neoplasms are a group of blood cancers affecting around 30,000 patients in the UK. These cancers are chronic, long-term conditions and patients suffer from a risk of blood clots and bleeding. In addition, these cancers can progress to more advanced forms of disease, including acute leukaemia, that have a poor outlook.

Currently, myeloproliferative neoplasms are divided into three clinical types, in a system dating from the 1950s. However, it is known that this classification system can’t give an accurate prognosis for individual patients, making it difficult for doctors to decide on the most appropriate course of treatment.

The researchers from the Wellcome Sanger Institute, the Wellcome-MRC Cambridge Stem Cell Institute and Cambridge University sequenced 69 cancer genes in cancerous cells from more than 2,000 patients.

Combining this with clinical information, they developed a prognostic tool which outperformed existing classification systems. It had the added benefit of giving personalised predictions for individual patients, rather than assigning patients to broad risk groups.

Co-leader of the study Professor Tony Green, from the Wellcome-MRC Cambridge Stem Cell Institute, said: “This work represents a step change in our understanding of the myeloproliferative neoplasms. Not only does it reveal a new classification based on causal mechanisms but it also provides for the first time personally-tailored predictions to guide patient management.”

Co-first author Dr Jyoti Nangalia, from the Wellcome Sanger Institute, said: “Despite some knowledge of the risks of myeloproliferative neoplasms we have been unable to make accurate personal predictions for individual patients.

Our new online calculator takes genetic and clinical information available for a patient and makes a prediction of the future outcome of that particular person’s disease.”

Source: Grinfeld, J., Nangalia, J., Baxter, E.J., Wedge, D.C., Angelopoulos, N., Cantrill, R., Godfrey, A.L., Papaemmanuil, E., Gundem, G., MacLean, C., Cook, J., O'Neil, L., O'Meara, S., Teague, J.W., Butler, A.P., Massie, C.E., Williams, N., Nice, F.L., Andersen, C.L., Hasselbalch, H.C., Guglielmelli, P., McMullin, M.F., Vannucchi, A.M., Harrison, C.N., Gerstung, M., Green, A.R., Campbell, P.J (2018) “Classification and personalised prognosis in myeloproliferative neoplasms”, New England Journal of Medicine, available at doi: 10.1056/NEJMoa1716614


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