Following the 2016 reclassification of myeloproliferative disorders by the world health organization (WHO), a significant percentage of patients with myelofibrosis (MF) does not receive early prognostic risk assessment, furthermore over a third of patients diagnosed with essential thrombocytopenia (ET) do not undergo bone marrow examination despite meeting at least 1 WHO criteria for MF, according to a recently published study in the Journal of Cancer and Clinical Oncology.

The 2016 reclassification of myeloproliferative disorders by WHO introduced a prefibrotic phase of primary myelofibrosis. This change has created a debate on whether patient diagnoses must be reclassified and whether the results of recent clinical trials must be reinterpreted.

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“In this study, we sought to evaluate the treatment reality of patients diagnosed with ET or MF in real life after the 2016 update of the WHO classification in terms of clinical characteristics, diagnostic measures, use of risk assessment and therapy decisions,” the study authors noted.

The retrospective chart study included over 900 patients diagnosed with either ET or MF being managed in primary care centers. All of the included patients received their diagnosis after the 2016 reclassification.

Approximately 42% of the patients diagnosed with ET had yet to undergo bone marrow examination in comparison to only 9% of patients diagnosed with MF. However, over 80% of patients diagnosed with ET fulfilled at least one criterion for myelofibrosis. Only 2% of patients that underwent bone marrow histology had findings of a degree of fibrosis incompatible with an ET diagnosis.

Over half of the patients diagnosed with MF had histologic findings compatible with prefibrotic myelofibrosis. At the moment of diagnosis, only a third of patients with MF received risk stratification, an important finding when considering that close to half of the included patients were candidates for a curative allogeneic bone marrow transplant.

“In conclusion, improved histopathology assessment and dynamic risk stratification including genetic risk factors for cases of suspected ET and MF are recommended for precise risk assessment and therapeutic stratification according to WHO criteria,” the authors concluded.


Schmidt A, Bernhardt C, Bürkle D, et al. Diagnosis and treatment of MPN in real life: exploratory and retrospective chart review including 960 MPN patients diagnosed with ET or MF in Germany. J Cancer Res Clin Oncol. Published online March 3, 2023. doi:10.1007/s00432-023-04669-3