WHO criteria for prePMF
| WHO prePMF criteria . |
|---|
| Major criteria |
| 1. Megakaryocytic proliferation and atypia, without reticulin fibrosis >grade 1*, accompanied by increased age-adjusted BM cellularity, granulocytic proliferation, and often decreased erythropoiesis |
| 2. Not meeting the WHO criteria for BCR-ABL1+ CML, PV, ET, myelodysplastic syndromes, or other myeloid neoplasms |
| 3. Presence of JAK2, CALR, or MPL mutation or in the absence of these mutations, presence of another clonal marker,† or absence of minor reactive BM reticulin fibrosis‡ |
| Minor criteria |
| Presence of at least 1 of the following, confirmed in 2 consecutive determinations: |
| a. Anemia not attributed to a comorbid condition |
| b. Leukocytosis ≥11 × 109/L |
| c. Palpable splenomegaly |
| d. LDH increased to above upper normal limit of institutional reference range |
| Diagnosis of prePMF requires meeting all 3 major criteria, and at least 1 minor criterion |
| WHO prePMF criteria . |
|---|
| Major criteria |
| 1. Megakaryocytic proliferation and atypia, without reticulin fibrosis >grade 1*, accompanied by increased age-adjusted BM cellularity, granulocytic proliferation, and often decreased erythropoiesis |
| 2. Not meeting the WHO criteria for BCR-ABL1+ CML, PV, ET, myelodysplastic syndromes, or other myeloid neoplasms |
| 3. Presence of JAK2, CALR, or MPL mutation or in the absence of these mutations, presence of another clonal marker,† or absence of minor reactive BM reticulin fibrosis‡ |
| Minor criteria |
| Presence of at least 1 of the following, confirmed in 2 consecutive determinations: |
| a. Anemia not attributed to a comorbid condition |
| b. Leukocytosis ≥11 × 109/L |
| c. Palpable splenomegaly |
| d. LDH increased to above upper normal limit of institutional reference range |
| Diagnosis of prePMF requires meeting all 3 major criteria, and at least 1 minor criterion |
See Table 8.
In the absence of any of the 3 major clonal mutations, the search for the most frequent accompanying mutations (eg, ASXL1, EZH2, TET2, IDH1/IDH2, SRSF2, SF3B1) are of help in determining the clonal nature of the disease.
Minor (grade 1) reticulin fibrosis secondary to infection, autoimmune disorder or other chronic inflammatory conditions, hairy cell leukemia or other lymphoid neoplasm, metastatic malignancy, or toxic (chronic) myelopathies.