Impact of somatic gene mutations on the risk of thrombosis in myelofibrosis

Abstract

Myelofibrosis (MF) is a chronic myeloproliferative neoplasm (MPN) characterized by clonal proliferation of hematopoietic progenitors, bone marrow fibrosis, and extramedullary hematopoiesis. Constitutive activation of JAK-STAT pathway signaling through mutations in the MPN driver genes (i.e., JAK2, CALR, and MPL) plays a fundamental role in its pathogenesis and progression, which can be influenced by mutations in other genes (non-MPN driver genes) [1].

Thrombotic complications increase morbidity and mortality in MF [2,3,4,5]. Around 20% of patients experience thrombosis before or at diagnosis, with 6–12% developing thrombotic events during follow-up. The main risk factors for thrombosis include older age, a prior history of thrombosis, and a JAK2 mutated genotype [2, 3]. While several studies have evaluated non-MPN driver gene mutations as risk factors for thrombosis in essential thrombocythemia (ET) [6, 7] and polycythemia vera (PV) [8, 9], their role in MF is less defined.