Myeloproliferative neoplasms: Morphology and clinical practice

Area of Science:

• Hematology
• Oncology
• Pathology

Background:

• Bone marrow (BM) features are critical in diagnosing myeloproliferative neoplasms (MPNs).
• Reproducibility and standardization of BM morphology for MPN classification remain controversial.
• Accurate differentiation between essential thrombocythemia (ET), prefibrotic primary myelofibrosis (prePMF), and polycythemia vera (PV) is clinically significant due to differing prognoses.

Purpose of the Study:

• To address the controversy surrounding the utility and reproducibility of bone marrow findings in MPN diagnosis.
• To highlight the challenges in distinguishing between ET, prePMF, and prodromal PV based on current morphological criteria.
• To emphasize the need for standardized diagnostic features for improved MPN classification.

Main Methods:

• Review of existing literature and classification guidelines (e.g., WHO).
• Analysis of diagnostic discrepancies related to bone marrow morphology.
• Discussion of the impact of non-standardized features on diagnostic accuracy.

Main Results:

• Significant disagreements exist regarding the World Health Organization (WHO) classification of MPNs, particularly for ET, prePMF, and PV.
• Lack of standardized bone marrow features impedes reliable morphological pattern recognition.
• Morphology is often considered non-specific for polycythemia vera (PV), leading to potential under-diagnosis.

Conclusions:

• Standardization of bone marrow features is essential for reproducible MPN diagnosis.
• Improved diagnostic criteria are needed to accurately differentiate between ET, prePMF, and PV.
• Addressing these diagnostic challenges is crucial for appropriate patient management and prognostication.