Polycythemia vera emerging eighteen years after acute myeloid leukemia diagnosis

Can Polycythemia Vera evolve from Acute Myeloid Leukemia? A Case Report Showing a Simultaneous Minor JAK2 V617F Mutated Clone,

“…One additional hypothesis is that the initial low-level JAK2 mutation was part of clonal hematopoiesis of indeterminate potential (CHIP), where JAK2 is one of the most frequently mutated genes. 21,22,12 In conclusion, we interpret the two diseases as simultaneous and not sequential, further supporting the idea of competing clones in myeloid malignancies. 23 The lack of sequential samples after AML diagnosis did not allow for the correlation of the kinetics of emergence of the JAK2 mutant clone.…”

“…Previous studies reported in the literature speculated the possibility that intensive induction chemotherapy for AML, which results in the ablation of the BM microenvironment, may provide a suitable niche for pre-existing JAK2 V617F-positive stem cells with clonal potential to expand, resulting in the appearance of PV. [8][9][10][11][12] In summary, our report indicates that the coexistence of AML and MPNs could be possible beyond the natural history of myeloid malignancies, leading physicians to proceed to the diagnostic algorithm of MPN also in the presence of subtle clues that could suggest a "color change" towards myeloproliferative phenotype. The availability of sensitive diagnostic techniques such as ddPCR may provide the necessary diagnostic support to unravel these situations.…”

“…One additional hypothesis is that the initial low-level JAK2 mutation was part of clonal hematopoiesis of indeterminate potential (CHIP), where JAK2 is one of the most frequently mutated genes. 21 , 22 , 12 …”

“…Despite progression to AML is a possible evolution of MPN, only a few cases of JAK2 V617F-positive PV developing while in long-term remission from AML have been previously described. [8][9][10][11][12] Here, we reported on a patient diagnosed with AML, who was treated with conventional 7+3 basedchemotherapy, achieved complete remission, and developed a JAK2-mutated PV two years after the end of consolidation treatment. We were interested in the biological features of the two diseases to define better the onset of the MPN clone and its kinetics.…”

“…Despite progression to AML is a possible evolution of MPN, only a few cases of JAK2 V617F-positive PV developing while in long-term remission from AML have been previously described. 8 – 12 …”