Precision Medicine in BCR-ABL1 Negative Myeloproliferative Neoplasms

Polycythemia vera, essential thrombocythemia, and primary myelofibrosis constitute BCR-ABL1-negative myeloproliferative neoplasms (MPNs) and are characterized by activation of the physiologic signal-transduction pathways resulting in cell proliferation of one or more of the hematopoietic lineages. The evolution of molecular studies has enlightened us in the understanding of this complex disease and has contributed to revisions of the World Health Organization (WHO) diagnostic criteria and risk stratification. A challenging aspect of these disorders is the diverse clinical features that occur in each disease type, with variability in risks of disease complications such as thrombosis and progression to fibrosis and/or leukemia. The selection of the precise management for each patient is mandatory, and therefore, an accurate definition of diagnosis and prognostication is necessary. The clinical presentation, peripheral blood and chemical blood changes, the bone marrow histological features as well as the molecular/genomic profile are all aspects that contribute to a more precise way to diagnose and treat these patients. This review attempts to summarize all those aspects that can contribute to the most detailed diagnosis and therapy approach in patients with classic BCR-ABL1 negative MPNs, emphasizing the relevance of interpretation of each step in the concept of personalized medicine.