Abstract
Background: Neutrophil PRV-1 over-expression has been strongly associated with polycythemia vera (PV) and its quantitative measurement might complement the diagnostic distinction between PV and secondary polycythemia (
Methods: The purpose of the current study was two-fold; i) to further evaluate the specificity of neutrophil PRV-1 over expression to either PV or clonal myeloproliferation by testing the assay in atypical myeloproliferative disorders (AMPD) and ii) to evaluate eosinophil PRV-1 expression in AMPD associated with eosinophilia. In a prospective study, 13 patients with AMPD and 2 with reactive eosinophilia were evaluated for neutrophil PRV-1 expression (table 1). PRV-1 transcript quantitation was performed according to published methods (
Table 1
Patient . | Diagnosis . | Neutrophil PRV-1/GAPDH ratio . | Neutrophil PRV-1 expression . |
---|---|---|---|
1 | Chronic myelomonocytic leukemia associated with myelofibrosis | 1.05 | Increased |
2 | FIP1L1/PDGFRA-positive eosinophilic disorder | 1.39 | Normal |
3 | FIP1L1/PDGFRA-positive eosinophilic disorder | 1.19 | Normal |
4 | FIP1L1/PDGFRA-positive eosinophilic disorder | 1.10 | Increased |
5 | Biphenotypic acute leukemia with prominent blood eosinophilia | 0.99 | Increased |
6 | Hypereosinophilic syndrome with cardiac involvement | 1.15 | Increased |
7 | Hypereosinophilic syndrome with cardiac involvement | 1.13 | Increased |
8 | Hypereosinophilic syndrome with sinus involvement | 1.29 | Normal |
9 | Reactive eosinophilia associated with atopic dermatitis | 1.09 | Increased |
10 | Reactive eosinophilia associated with T cell skin lymphoma | 1.22 | Normal |
11 | Aggressive systemic mastocytosis associated with chronic myelomonocytic leukemia | 1.08 | Increased |
12 | Aggressive systemic mastocytosis associated with myelofibrosis | 1.09 | Increased |
13 | Aggressive systemic mastocytosis with circulating mast cells | 1.29 | Normal |
14 | Indolent systemic mastocytosis | 1.20 | Normal |
15 | Indolent systemic mastocytosis | 1.18 | Normal |
Patient . | Diagnosis . | Neutrophil PRV-1/GAPDH ratio . | Neutrophil PRV-1 expression . |
---|---|---|---|
1 | Chronic myelomonocytic leukemia associated with myelofibrosis | 1.05 | Increased |
2 | FIP1L1/PDGFRA-positive eosinophilic disorder | 1.39 | Normal |
3 | FIP1L1/PDGFRA-positive eosinophilic disorder | 1.19 | Normal |
4 | FIP1L1/PDGFRA-positive eosinophilic disorder | 1.10 | Increased |
5 | Biphenotypic acute leukemia with prominent blood eosinophilia | 0.99 | Increased |
6 | Hypereosinophilic syndrome with cardiac involvement | 1.15 | Increased |
7 | Hypereosinophilic syndrome with cardiac involvement | 1.13 | Increased |
8 | Hypereosinophilic syndrome with sinus involvement | 1.29 | Normal |
9 | Reactive eosinophilia associated with atopic dermatitis | 1.09 | Increased |
10 | Reactive eosinophilia associated with T cell skin lymphoma | 1.22 | Normal |
11 | Aggressive systemic mastocytosis associated with chronic myelomonocytic leukemia | 1.08 | Increased |
12 | Aggressive systemic mastocytosis associated with myelofibrosis | 1.09 | Increased |
13 | Aggressive systemic mastocytosis with circulating mast cells | 1.29 | Normal |
14 | Indolent systemic mastocytosis | 1.20 | Normal |
15 | Indolent systemic mastocytosis | 1.18 | Normal |
In addition, eosinophil PRV-1 expression was measured in 2 patients from the above cohort (patients 3 and 8) and 3 additional patients with hypereosinophilic syndrome (HES).
Results: Table 1 outlines specific diagnoses as well as the corresponding neutrophil PRV-1 expression levels in all 15 patients tested (median age 54 years, range 20–74; 11 males). Eosinophil PRV-1 expression was normal in all 5 patients tested (range of PRV-1/GAPDH ratio between 1.20–1.39).
Conclusion: The current study suggests that neutrophil PRV-1 over-expression is a non-specific marker of clonal myeloproliferation that is seen in a broad spectrum of both typical and atypical myeloid disorders. As has been the case in ET, only a subset of AMPD patients display the specific abnormality, thus undermining its diagnostic utility. The preliminary information from the current study does not suggest increased eosinophil PRV-1 expression in either HES or clonal eosinophilia.
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