Thrombosis in myeloproliferative neoplasms - a viewpoint on its impact on myelofibrosis, mortality, and solid tumors

Sep 21, 2026

Uploaded by Skyler

Review article synthesizing large patient-database analyses in myeloproliferative neoplasms (MPNs) to evaluate how thrombosis influences mortality, disease progression, and secondary cancers. Despite treatment advances, arterial and venous thrombosis rates remain challenging. Thrombotic events are linked to a more aggressive disease course, including myelofibrosis progression and higher mortality. Inflammatory biomarkers such as neutrophil-to-lymphocyte ratio associate thrombosis with risk and suggest a shared inflammatory pathway across cardiovascular and cancer incidence, often in younger patients.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Introduction

Rates of thrombosis in MPNs

Blood Cancer [Journal](Journal www.nature.com/bcj)[ www.nature.com/bcj](Journal www.nature.com/bcj) REVIEW ARTICLE OPEN Thrombosis in myeloproliferative neoplasms: a viewpoint on its impact on myeloﬁbrosis, mortality, and solid tumors Tiziano Barbui 1 ✉ , Arianna Ghirardi1, Alessandra Carobbio 2, Valerio De Stefano 3,4, Alessandro Rambaldi 5,6 , Ayalew Tefferi 7 and Alessandro M. Vannucchi 8 © The Author(s) 2024 | | This viewpoint summarizes ﬁndings from analyses of large personal patient databases of myeloproliferative neoplasms (MPNs) to assess the impact of thrombosis on mortality, disease progression, and second cancers (SC) . Despite advances, the current incidence of arterial and venous thrombosis remains a challenge. These events appear to signal a more aggressive disease course, as evidenced by their association with myeloﬁbrosis progression and mortality using multistate models and time-dependent multivariable analysis. Inﬂammatory biomarkers, such as the neutrophil-to-lymphocyte ratio (NLR), are associated with the aggressiveness of polycythemia vera (PV) and essential thrombocythemia (ET), linking thrombosis to SC risk. This suggests a common inﬂammatory pathway likely inﬂuencing cardiovascular disease and cancer incidence. Notably, this is observed more frequently in younger patients, likely due to prolonged exposure to MPN and environmental inﬂammatory triggers. These data underscore the need for new studies to validate these associations, delineate the sequence of events, and identify therapeutic | | | --- | --- | --- | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | targets to mitigate thrombotic events and potentially improve overall patient outcomes in MPN. | | | | | Blood Cancer Journal (2024)14:188; [https://doi.org/10.1038/s41408-024-01](https://doi.org/10.1038/s41408-024-01)169-6 | | | | | | INTRODUCTION The classic chronic myeloproliferative neoplasms (MPNs) include polycythemia vera (PV), essential thrombocythemia (ET), and primary myeloﬁbrosis (PMF) [1] . These disorders are characterized by a high incidence of arterial and venous thrombotic events [2, 3], potential progression to post-PV and post-ET myeloﬁbrosis [4], and acute leukemia [5] . Understanding of the pathophysiology of MPNs has improved signiﬁcantly with the identiﬁcation of common genetic mutations, most notably the JAK2 V617F mutation, which is found in over 95% of PV and approximately 60–70% of ET and PMF cases [1, 6, 7] . Therapy is aimed at reducing the incidence of thrombosis, which is a major cause of death and severe disability in some patients [8, 9] . Recent reports suggest that the occurrence of thrombosis, particularly arterial events during the course of PV and ET, may pose additional risks such as progression to myeloﬁbrosis [10, 11], increased mortality [10–13], and the development of secondary solid tumors [14, 15] . These risks arise from disease-related clonal hematopoiesis and subsequent chronic systemic inﬂammation, leading to thrombosis and genetic instability. In our large databases of patients with MPN, we investigated the incidence and risk factors of thrombosis that may explain this association, culminating in an increased risk of mortality. This Viewpoint presents our ﬁndings with the goal of clarifying the current clinical evidence regarding key events that inﬂuence disease severity and may serve as potential therapeutic targets. This work is not intended to be a systematic review of the literature, but rather a perspective to stimulate interest and further research into these critical issues. RATES OF THROMBOSIS IN MPNS Despite recommended treatments, thrombosis remains a signiﬁcant challenge for patients diagnosed with MPNs today. It often heralds the diagnosis of MPN in approximately 20% of cases, with a persistent risk observed at subsequent follow-up. A recent study of 9429 MPN patients and 35,820 matched controls diagnosed betwee

FAQs

What is the main purpose of this viewpoint on thrombosis in MPNs?

To clarify current clinical evidence on key events showing how thrombosis impacts disease severity and identifies potential therapeutic targets.

How do thrombosis events relate to disease progression and outcomes in MPN patients?

They are associated with a more aggressive disease course, including myelofibrosis progression and increased mortality.

Which biomarkers and pathways are linked to thrombosis and cancer risk in this review?

Inflammatory biomarkers such as neutrophil-to-lymphocyte ratio (NLR) are associated with aggressiveness and connect thrombosis to secondary cancer risk, suggesting a common inflammatory pathway.

Sep 21, 2026

Uploaded by Skyler