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Alex Ambinder, MD MPH
- Assistant Professor of Oncology
Primary Location: Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
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Amy DeZern, MD MHS
- Vice Chair for Hematologic Malignancies
- Professor of Oncology
Primary Location: Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
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Ivana Gojo, MD
- Co-Director, Leukemia Drug Development Program
- Professor of Oncology
Primary Location: Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
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Tania Jain, MBBS
- Director, Immune Effector Cell Therapy Program, Johns Hopkins University
- Associate Professor of Oncology
Primary Location: Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
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Douglas Smith, MD
- Co-director, Clinical Research Operations for the Division of Hematologic Malignancies
- Professor of Oncology
Primary Location: Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
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Jonathan Webster, MD
- Associate Professor of Oncology
Primary Location: Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
Myeloproliferative Neoplasm
Myeloproliferative neoplasms (MPNs) are a rare group of blood disorders in which the bone marrow, the spongy tissue inside of our bones, produces too many blood cells. The risks for patients with MPNs include blood clots or excessive bleeding, bone marrow damage due to fibrous scar tissue, and enlargement of the body’s organs.
Most patients with MPNs are in their 60s or older, and while some MPNs may develop into a more aggressive disease, most are considered chronic, meaning that patients can live with few symptoms with proper treatment.
John Hopkins has extensive experience and expertise in caring for patients with MPNs and offers personalized treatments based on your particular case.
Meet Our Team
Johns Hopkins’ physician scientists conduct the cutting-edge research that determines the best, most effective treatments for MPNs. Their world-class patient care is complemented by highly trained and experienced healthcare professionals offering patient support. Patients are seen in a multidisciplinary clinic, where the entire team of experts will work together with you to develop your treatment plan.
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Types of Myeloproliferative Neoplasms
MPNs are in general divided into different types depending on whether red blood cells, white blood cells, or platelets are produced in a greater amount. Treatments (listed below) vary according to the MPN types. Here are the four most common types:
- Essential thrombocytosis – the body produces too many platelets, which can cause blood clots or excessive bleeding. A small number of patients may develop acute leukemia or a bone marrow disorder called myelofibrosis.
- Polycythemia vera – the body produces too many blood cells of all types, particularly red blood cells, which makes the blood thicker and can lead to strokes or tissue and organ damage. A small number of patients may develop acute leukemia or myelofibrosis.
- Myelofibrosis – the body produces bone marrow cells called fibroblasts that make too much fibrous (scar) tissue in the bone marrow, harming the bone marrow’s ability to make healthy blood cells.
- MDS/MPN overlap – in this distinct group of blood cancers, the body produces high numbers of blood cells, and the mature blood cells are abnormal.
Treatment
Some patients with MPNs do not need active treatment but should be watched by a doctor with specialized knowledge of the specific disorders.
Treating Essential Thrombocytosis (ET)
Common treatments to include low-dose aspirin to reduce the risk of blood clots, platelet-lowering medications, and a procedure in which blood is drawn from a patient and returned after being stripped of its platelets. Because ET can progress to acute leukemia, patients are often treated with chemotherapy to reduce the number of abnormal stem cells (immature cells found in the fatty tissue inside of bones that grow into blood and other cells) and allow healthy stem cells to grow back.
Treating Polycythemia Vera (PV)
Among the treatments used are low-dose aspirin to prevent blood clots, removing some blood from the body in order to thin remaining blood and allow it to flow more easily, medications that reduce the risk of abnormal bleeding or clotting and an enlarged spleen. As with ET, PV can progress to acute leukemia, so chemotherapy is often prescribed to reduce the number of abnormal stem cells (immature cells found in the fatty tissue inside of bones) and allow healthy stem cells to grow back.
Treating Myelofibrosis (MF)
Patients with MF receive treatments such as low-dose aspirin to prevent blood clots, drugs that reduce the risk of bleeding or clotting complications and the risk of developing an enlarged spleen. Researchers are testing new treatments, including medications such as JAK 2 inhibitors that turn on and off genes that are involved in the overproduction of blood cells or medications that treat anemia. Blood transfusions are sometimes used to increase the number of normal blood cells in the body. Because MF can progress to acute leukemia, chemotherapy is sometimes prescribed to reduce the number of abnormal cells. Radiation therapy can be used for enlargement of the spleen.
The only possible “cure” for myelofibrosis is a bone marrow transplant, and Johns Hopkins is considered a leader in bone marrow transplant procedures. Also called a stem cell transplant, the procedure involves removing stem cells from the bone marrow, then using chemotherapy, radiation, or both to kill any remaining cancer cells. Stem cells are then injected into the patient’s bloodstream so they can enter the bone marrow and reproduce to make healthy new blood cells.
Treating MDS/MPN Overlap
Because MDS/MPN overlap has features of both MDS (myelodysplastic syndromes, in which mature blood cells are abnormal, and the body produces high numbers of blood cells) and MPN, the treatment depends on which condition is dominant. If MDS features are dominant, treatment may include hypomethylating agents, which cause cell death of abnormal cells. If more MPN features are present, JAK2 inhibitors may be used to turn off genes that can be involved in overproduction of blood cells.