Sequential mutational evaluation of CALR ‐mutated myeloproliferative neoplasms with thrombocytosis reveals an association between CALR allele burden evolution and disease progression

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Cottin, Laurane | Riou, Jeremie | Orvain, Corentin | Ianotto, Jean Christophe | Boyer, Françoise | Renard, Maxime | Truchan‐graczyk, Matgorzata | Murati, Anne | Jouanneau‐courville, Rebecca | Allangba, Olivier | Mansier, Olivier | Burroni, Barbara | Rousselet, Marie-Christine | Quintin‐roué, Isabelle | Martin, Antoine | Sadot‐lebouvier, Sophie | Delneste, Yves | Chrétien, Jean‐marie | Hunault‐berger, Mathilde | Blanchet, Odile | Lippert, Eric | Ugo, Valérie | Luque Paz, Damien

Edité par CCSD ; Wiley -

International audience. In myeloproliferative neoplasms (MPN), JAK2V617F allele burden measurement has an impact on prognosis that helps in patient monitoring. Less is known about its usefulness in CALR-mutated cases. Additional mutations found by next-generation sequencing have also shown an impact on prognosis that may drive therapeutic choices, especially in myelofibrosis, but few studies focused on CALR-mutated patients. We performed a molecular evaluation combining next-generation sequencing with a myeloid panel and CALR allele burden measurement at diagnosis and during follow-up in a cohort of 45 patients with CALR-mutated essential thrombocythaemia. The bone marrow histology was also blindly reviewed in order to apply the WHO2016 classification. The most frequently mutated gene was TET2 (11/21 mutations). CALR type 1-like patients appear to have a more complex molecular landscape. We found an association between disease progression and CALR allele burden increase during follow-up, independently of additional mutations and WHO2016-reviewed diagnosis. Patients with disease progression at the time of follow-up showed a significant increase in CALR allele burden (+16·7%, P = 0·005) whereas patients without disease progression had a stable allele burden (+3·7%, P = 0·194). This result argues for clinical interest in CALR allele burden monitoring.

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