Myelofibrosis natural history, complications and prognosis: Difference between revisions

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*[[Bleeding]]
*[[Bleeding]]
*[[Blood clots|Thrombohemorrhagic events]]
*[[Blood clots|Thrombohemorrhagic events]]
*[[Hepatic failure]]
*[[Hepatic failure]]<ref name="pmid7996922">{{cite journal |vauthors=Escorsell A, Montero A |title=[Severe acute liver insufficiency in a 72 year old male with idiopathic myelofibrosis] |language=Spanish; Castilian |journal=Med Clin (Barc) |volume=103 |issue=16 |pages=628–35 |date=November 1994 |pmid=7996922 |doi= |url=}}</ref><ref name="pmid7446477">{{cite journal |vauthors=McBrine PA, Miller A, Zimelman AP, Koff RS |title=Polycythemia vera with myelofibrosis and myeloid metaplasia. Acute hepatic failure following splenectomy |journal=Am. J. Clin. Pathol. |volume=74 |issue=5 |pages=693–6 |date=November 1980 |pmid=7446477 |doi= |url=}}</ref>
*[[Heart failure]]
*[[Heart failure]]<ref name="pmid18160817">{{cite journal |vauthors=Guilpain P, Montani D, Damaj G, Achouh L, Lefrère F, Le Pavec J, Marfaing-Koka A, Dartevelle P, Simonneau G, Humbert M, Hermine O |title=Pulmonary hypertension associated with myeloproliferative disorders: a retrospective study of ten cases |journal=Respiration |volume=76 |issue=3 |pages=295–302 |date=2008 |pmid=18160817 |doi=10.1159/000112822 |url=}}</ref><ref name="pmid9929105">{{cite journal |vauthors=García-Manero G, Schuster SJ, Patrick H, Martinez J |title=Pulmonary hypertension in patients with myelofibrosis secondary to myeloproliferative diseases |journal=Am. J. Hematol. |volume=60 |issue=2 |pages=130–5 |date=February 1999 |pmid=9929105 |doi= |url=}}</ref>
*[[Gout]]<ref name="pmid702809">{{cite journal |vauthors=Nagai Y, Ikebe K, Ito K, Nishizawa T, Akaoka I, Muranaka M, Horiuchi Y |title=[A case of secondary gout associated with myelofibrosis following polycythemia vera (author's transl)] |language=Japanese |journal=Rinsho Ketsueki |volume=19 |issue=3 |pages=226–33 |date=March 1978 |pmid=702809 |doi= |url=}}</ref><ref name="pmid1062009">{{cite journal |vauthors=Yu T, Weinreb N, Wittman R, Wasserman LR |title=Secondary gout associated with chronic myeloproliferative disorders |journal=Semin. Arthritis Rheum. |volume=5 |issue=3 |pages=247–56 |date=February 1976 |pmid=1062009 |doi= |url=}}</ref>
*[[Gout]]<ref name="pmid5216775">{{cite journal |vauthors=Yü TF |title=Secondary gout associated with myeloproliferative diseases |journal=Arthritis Rheum. |volume=8 |issue=5 |pages=765–71 |date=October 1965 |pmid=5216775 |doi= |url=}}</ref><ref name="pmid702809">{{cite journal |vauthors=Nagai Y, Ikebe K, Ito K, Nishizawa T, Akaoka I, Muranaka M, Horiuchi Y |title=[A case of secondary gout associated with myelofibrosis following polycythemia vera (author's transl)] |language=Japanese |journal=Rinsho Ketsueki |volume=19 |issue=3 |pages=226–33 |date=March 1978 |pmid=702809 |doi= |url=}}</ref><ref name="pmid1062009">{{cite journal |vauthors=Yu T, Weinreb N, Wittman R, Wasserman LR |title=Secondary gout associated with chronic myeloproliferative disorders |journal=Semin. Arthritis Rheum. |volume=5 |issue=3 |pages=247–56 |date=February 1976 |pmid=1062009 |doi= |url=}}</ref>
*[[Bone marrow failure|Progressive marrow failure]]<ref name="pmid10550553">{{cite journal |vauthors=Le Bousse-Kerdilès MC, Martyré MC |title=Dual implication of fibrogenic cytokines in the pathogenesis of fibrosis and myeloproliferation in myeloid metaplasia with myelofibrosis |journal=Ann. Hematol. |volume=78 |issue=10 |pages=437–44 |date=October 1999 |pmid=10550553 |doi= |url=}}</ref><ref name="pmid17910625">{{cite journal |vauthors=Kuter DJ, Bain B, Mufti G, Bagg A, Hasserjian RP |title=Bone marrow fibrosis: pathophysiology and clinical significance of increased bone marrow stromal fibres |journal=Br. J. Haematol. |volume=139 |issue=3 |pages=351–62 |date=November 2007 |pmid=17910625 |doi=10.1111/j.1365-2141.2007.06807.x |url=}}</ref><ref name="pmid8435338">{{cite journal |vauthors=Reilly JT, Barnett D, Dolan G, Forrest P, Eastham J, Smith A |title=Characterization of an acute micromegakaryocytic leukaemia: evidence for the pathogenesis of myelofibrosis |journal=Br. J. Haematol. |volume=83 |issue=1 |pages=58–62 |date=January 1993 |pmid=8435338 |doi= |url=}}</ref><ref name="pmid12153156">{{cite journal |vauthors=Schmitt A, Drouin A, Massé JM, Guichard J, Shagraoui H, Cramer EM |title=Polymorphonuclear neutrophil and megakaryocyte mutual involvement in myelofibrosis pathogenesis |journal=Leuk. Lymphoma |volume=43 |issue=4 |pages=719–24 |date=April 2002 |pmid=12153156 |doi=10.1080/10428190290016809 |url=}}</ref><ref name="pmid10942376">{{cite journal |vauthors=Schmitt A, Jouault H, Guichard J, Wendling F, Drouin A, Cramer EM |title=Pathologic interaction between megakaryocytes and polymorphonuclear leukocytes in myelofibrosis |journal=Blood |volume=96 |issue=4 |pages=1342–7 |date=August 2000 |pmid=10942376 |doi= |url=}}</ref><ref name="pmid27252511">{{cite journal |vauthors=Zahr AA, Salama ME, Carreau N, Tremblay D, Verstovsek S, Mesa R, Hoffman R, Mascarenhas J |title=Bone marrow fibrosis in myelofibrosis: pathogenesis, prognosis and targeted strategies |journal=Haematologica |volume=101 |issue=6 |pages=660–71 |date=June 2016 |pmid=27252511 |pmc=5013940 |doi=10.3324/haematol.2015.141283 |url=}}</ref>
*[[Bone marrow failure|Progressive marrow failure]]<ref name="pmid10550553">{{cite journal |vauthors=Le Bousse-Kerdilès MC, Martyré MC |title=Dual implication of fibrogenic cytokines in the pathogenesis of fibrosis and myeloproliferation in myeloid metaplasia with myelofibrosis |journal=Ann. Hematol. |volume=78 |issue=10 |pages=437–44 |date=October 1999 |pmid=10550553 |doi= |url=}}</ref><ref name="pmid17910625">{{cite journal |vauthors=Kuter DJ, Bain B, Mufti G, Bagg A, Hasserjian RP |title=Bone marrow fibrosis: pathophysiology and clinical significance of increased bone marrow stromal fibres |journal=Br. J. Haematol. |volume=139 |issue=3 |pages=351–62 |date=November 2007 |pmid=17910625 |doi=10.1111/j.1365-2141.2007.06807.x |url=}}</ref><ref name="pmid8435338">{{cite journal |vauthors=Reilly JT, Barnett D, Dolan G, Forrest P, Eastham J, Smith A |title=Characterization of an acute micromegakaryocytic leukaemia: evidence for the pathogenesis of myelofibrosis |journal=Br. J. Haematol. |volume=83 |issue=1 |pages=58–62 |date=January 1993 |pmid=8435338 |doi= |url=}}</ref><ref name="pmid12153156">{{cite journal |vauthors=Schmitt A, Drouin A, Massé JM, Guichard J, Shagraoui H, Cramer EM |title=Polymorphonuclear neutrophil and megakaryocyte mutual involvement in myelofibrosis pathogenesis |journal=Leuk. Lymphoma |volume=43 |issue=4 |pages=719–24 |date=April 2002 |pmid=12153156 |doi=10.1080/10428190290016809 |url=}}</ref><ref name="pmid10942376">{{cite journal |vauthors=Schmitt A, Jouault H, Guichard J, Wendling F, Drouin A, Cramer EM |title=Pathologic interaction between megakaryocytes and polymorphonuclear leukocytes in myelofibrosis |journal=Blood |volume=96 |issue=4 |pages=1342–7 |date=August 2000 |pmid=10942376 |doi= |url=}}</ref><ref name="pmid27252511">{{cite journal |vauthors=Zahr AA, Salama ME, Carreau N, Tremblay D, Verstovsek S, Mesa R, Hoffman R, Mascarenhas J |title=Bone marrow fibrosis in myelofibrosis: pathogenesis, prognosis and targeted strategies |journal=Haematologica |volume=101 |issue=6 |pages=660–71 |date=June 2016 |pmid=27252511 |pmc=5013940 |doi=10.3324/haematol.2015.141283 |url=}}</ref>
*[[Hypertrophic osteoarthropathy]]<ref name="pmid29037318">{{cite journal |vauthors=Kelle B, Yıldız F, Paydas S, Bagır EK, Ergin M, Kozanoglu E |title=Coexistence of hypertrophic osteoarthropathy and myelofibrosis |journal=Rev Bras Reumatol Engl Ed |volume=57 |issue=5 |pages=472–474 |date=2017 |pmid=29037318 |doi=10.1016/j.rbre.2014.11.004 |url=}}</ref><ref name="pmid25785156">{{cite journal |vauthors=Li S, Li Q, Wang Q, Chen D, Li J |title=Primary hypertrophic osteoarthropathy with myelofibrosis and anemia: a case report and review of literature |journal=Int J Clin Exp Med |volume=8 |issue=1 |pages=1467–71 |date=2015 |pmid=25785156 |pmc=4358611 |doi= |url=}}</ref><ref name="pmid18038138">{{cite journal |vauthors=Saghafi M, Azarian A, Nohesara N |title=Primary hypertrophic osteoarthropathy with myelofibrosis |journal=Rheumatol. Int. |volume=28 |issue=6 |pages=597–600 |date=April 2008 |pmid=18038138 |doi=10.1007/s00296-007-0477-4 |url=}}</ref><ref name="pmid15107873">{{cite journal |vauthors=John B, Subhash H, Thomas K |title=Case of myelofibrosis with hypertrophic osteoarthropathy: the role of platelet-derived growth factor in pathogenesis |journal=N. Z. Med. J. |volume=117 |issue=1192 |pages=U853 |date=April 2004 |pmid=15107873 |doi= |url=}}</ref>
*[[Hypertrophic osteoarthropathy]]<ref name="pmid29037318">{{cite journal |vauthors=Kelle B, Yıldız F, Paydas S, Bagır EK, Ergin M, Kozanoglu E |title=Coexistence of hypertrophic osteoarthropathy and myelofibrosis |journal=Rev Bras Reumatol Engl Ed |volume=57 |issue=5 |pages=472–474 |date=2017 |pmid=29037318 |doi=10.1016/j.rbre.2014.11.004 |url=}}</ref><ref name="pmid25785156">{{cite journal |vauthors=Li S, Li Q, Wang Q, Chen D, Li J |title=Primary hypertrophic osteoarthropathy with myelofibrosis and anemia: a case report and review of literature |journal=Int J Clin Exp Med |volume=8 |issue=1 |pages=1467–71 |date=2015 |pmid=25785156 |pmc=4358611 |doi= |url=}}</ref><ref name="pmid18038138">{{cite journal |vauthors=Saghafi M, Azarian A, Nohesara N |title=Primary hypertrophic osteoarthropathy with myelofibrosis |journal=Rheumatol. Int. |volume=28 |issue=6 |pages=597–600 |date=April 2008 |pmid=18038138 |doi=10.1007/s00296-007-0477-4 |url=}}</ref><ref name="pmid15107873">{{cite journal |vauthors=John B, Subhash H, Thomas K |title=Case of myelofibrosis with hypertrophic osteoarthropathy: the role of platelet-derived growth factor in pathogenesis |journal=N. Z. Med. J. |volume=117 |issue=1192 |pages=U853 |date=April 2004 |pmid=15107873 |doi= |url=}}</ref>
*[[Splenic rupture]]<ref name="pmid2395215">{{cite journal |vauthors=Baba M, Tanahashi N, Seno K, Nara M, Shinbo T |title=[Myelofibrosis with marked subcapsular bleeding of the spleen--a case report] |language=Japanese |journal=Rinsho Ketsueki |volume=31 |issue=5 |pages=669–73 |date=May 1990 |pmid=2395215 |doi= |url=}}</ref>
*[[Splenic rupture]]<ref name="pmid2395215">{{cite journal |vauthors=Baba M, Tanahashi N, Seno K, Nara M, Shinbo T |title=[Myelofibrosis with marked subcapsular bleeding of the spleen--a case report] |language=Japanese |journal=Rinsho Ketsueki |volume=31 |issue=5 |pages=669–73 |date=May 1990 |pmid=2395215 |doi= |url=}}</ref>
*Pulmonary hypertension<ref name="pmid28680586">{{cite journal |vauthors=Singh I, Mikita G, Green D, Risquez C, Sanders A |title=Pulmonary extra-medullary hematopoiesis and pulmonary hypertension from underlying polycythemia vera: a case series |journal=Pulm Circ |volume=7 |issue=1 |pages=261–267 |date=March 2017 |pmid=28680586 |pmc=5448544 |doi=10.1177/2045893217702064 |url=}}</ref><ref name="pmid28090305">{{cite journal |vauthors=Faiz SA, Iliescu C, Lopez-Mattei J, Patel B, Bashoura L, Popat U |title=Resolution of myelofibrosis-associated pulmonary arterial hypertension following allogeneic hematopoietic stem cell transplantation |journal=Pulm Circ |volume=6 |issue=4 |pages=611–613 |date=December 2016 |pmid=28090305 |pmc=5210054 |doi=10.1086/687291 |url=}}</ref><ref name="pmid28070238">{{cite journal |vauthors=Mathew R, Huang J, Wu JM, Fallon JT, Gewitz MH |title=Hematological disorders and pulmonary hypertension |journal=World J Cardiol |volume=8 |issue=12 |pages=703–718 |date=December 2016 |pmid=28070238 |pmc=5183970 |doi=10.4330/wjc.v8.i12.703 |url=}}</ref>
*Pulmonary hypertension<ref name="pmid28680586">{{cite journal |vauthors=Singh I, Mikita G, Green D, Risquez C, Sanders A |title=Pulmonary extra-medullary hematopoiesis and pulmonary hypertension from underlying polycythemia vera: a case series |journal=Pulm Circ |volume=7 |issue=1 |pages=261–267 |date=March 2017 |pmid=28680586 |pmc=5448544 |doi=10.1177/2045893217702064 |url=}}</ref><ref name="pmid28090305">{{cite journal |vauthors=Faiz SA, Iliescu C, Lopez-Mattei J, Patel B, Bashoura L, Popat U |title=Resolution of myelofibrosis-associated pulmonary arterial hypertension following allogeneic hematopoietic stem cell transplantation |journal=Pulm Circ |volume=6 |issue=4 |pages=611–613 |date=December 2016 |pmid=28090305 |pmc=5210054 |doi=10.1086/687291 |url=}}</ref><ref name="pmid28070238">{{cite journal |vauthors=Mathew R, Huang J, Wu JM, Fallon JT, Gewitz MH |title=Hematological disorders and pulmonary hypertension |journal=World J Cardiol |volume=8 |issue=12 |pages=703–718 |date=December 2016 |pmid=28070238 |pmc=5183970 |doi=10.4330/wjc.v8.i12.703 |url=}}</ref>
*Portal hypertension<ref name="pmid11293952">{{cite journal |vauthors=Bĕlohlávek J, Schwarz J, Jirásek A, Krajina A, Polák F, Hrubý M |title=Idiopathic myelofibrosis complicated by portal hypertension treated with a transjugular intrahepatic portosystemic shunt (TIPS) |journal=Wien. Klin. Wochenschr. |volume=113 |issue=5-6 |pages=208–11 |date=March 2001 |pmid=11293952 |doi= |url=}}</ref><ref name="pmid24501543">{{cite journal |vauthors=Mughal TI, Vaddi K, Sarlis NJ, Verstovsek S |title=Myelofibrosis-associated complications: pathogenesis, clinical manifestations, and effects on outcomes |journal=Int J Gen Med |volume=7 |issue= |pages=89–101 |date=2014 |pmid=24501543 |pmc=3912063 |doi=10.2147/IJGM.S51800 |url=}}</ref><ref name="pmid17301514">{{cite journal |vauthors=Doki N, Irisawa H, Takada S, Sakura T, Miyawaki S |title=Transjugular intrahepatic portosystemic shunt for the treatment of portal hypertension due to idiopathic myelofibrosis |journal=Intern. Med. |volume=46 |issue=4 |pages=187–90 |date=2007 |pmid=17301514 |doi= |url=}}</ref>
*Peritonitis<ref name="pmid21134837">{{cite journal |vauthors=Srinivasaiah N, Zia MK, Muralikrishnan V |title=Peritonitis in myelofibrosis: a cautionary tale |journal=HBPD INT |volume=9 |issue=6 |pages=651–3 |date=December 2010 |pmid=21134837 |doi= |url=}}</ref>


==Prognosis==
==Prognosis==

Revision as of 17:33, 27 November 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2]

Overview

The development of myelofibrosis is a a slow process and it does not cause early symptoms. A significant proportion of the patients can be asymptomatic and the diagnosis is usually made in the setting of an unrelated condition. The most overlapping and common findings encountered are anemia and splenomegaly presenting as weakness, easy fatigability, palpitations, and dyspnea in the case of anemia and early satiety with possible accompanying left upper quadrant discomfort if splenomegaly is present.

The disease has a progressive course and can result in pancytopenia as the bone marrow failure ensues. This can result in bleeding complications, easy bruising, increase in the susceptibility to infections, and worsening anemia. The bone marrow failure paves the way for extramedullary hematopoiesis which mainly occurs in the reticuloendothelial tissues.

If left untreated, myelofibrosis can lead to severe complications, the most feared of which are acute leukemia, heart failure, and portal hypertension.

Natural History

  • Myelofibrosis is a chronic, malignant hematologic disorder which can have a slow progressive course.[1]
  • Along the course of the disease, myelofibrosis most commonly presents with symptoms related to hypermetabolic state, anemia, and splenomegaly.[2]
  • Progression of the disease can vary from patient to patient and a significant proportion of patients can be asymptomatic.[3][4][2]
  • The disease is characterized by irregularity in the blood cells as a result of marrow fibrosis and the clinical course correlates with this accordingly.[5][6][7][8][9][10][11]
  • Myelofibrosis can manifest as anemia if the pathology involves the red blood cells (RBCs) as the initiating event and it can present as shortness of breath, tiredness, lightheadedness, weakness, headaches, irritability, and pale skin color.[12][13][14]
  • Patients can present with increased susceptibility to infections which can be the presenting or an additional symptom. These infections can be viral, bacterial, or fungal in origin.[15]
  • The distorted platelet production results in bleeding complications such as easy bruising following minimal injury and bleeding from the mucous membranes.[16][17]
  • As a compensation for the lack of efficient blood cell production in the bone marrow, extramedullary hematopoiesis can ensue which will present as splenomegaly, hepatomegaly, lymph node enlargement, and skin, kidney, or lung pathology.[18][19][20][21][22][23][24][22][21][23][25][26][22]
  • Bone or joint pain can be a late presentation of myelofibrosis.[27]
  • The progression of myelofibrosis and its respective presentation can further be aligned with the complications encountered as a result of the disease itself.

Complications

Common complications of myelofibrosis include:[28][29][30][31]

Prognosis

  • Prognosis is generally poor and the median survival for myelofibrosis is 3.5 years to 5.5 years, but patients younger than 55 years have a median survival of 11 years.[30]
  • Poor prognostic factors for myelofibrosis include:[30]
  • Patients without any of the adverse features, excluding age, have a median survival of more than 10 to 15 years, but the presence of any two of the adverse features lowers the median survival to less than 4 years.
  • Karyotype abnormalities can also affect prognosis of myelofibrosis. In a retrospective series, the 13q and 20q deletions and trisomy 9 correlated with improved survival and no leukemia transformation in comparison with the worse prognosis with trisomy 8, complex karyotype, -7/7q-, i(17q), inv(3), -5/5q-, 12p-, or 11q23 rearrangement.[30]

References

  1. Hoffman, Ronald (2018). Hematology : basic principles and practice. Philadelphia, PA: Elsevier. ISBN 9780323357623.
  2. 2.0 2.1 Cervantes F, Pereira A, Esteve J, Cobo F, Rozman C, Montserrat E (November 1997). "[Idiopathic myelofibrosis: initial features, evolutive patterns and survival in a series of 106 patients]". Med Clin (Barc) (in Spanish; Castilian). 109 (17): 651–5. PMID 9488952.
  3. O'Sullivan JM, Harrison CN (February 2018). "Myelofibrosis: clinicopathologic features, prognosis, and management". Clin Adv Hematol Oncol. 16 (2): 121–131. PMID 29741513.
  4. Tefferi A (December 2016). "Primary myelofibrosis: 2017 update on diagnosis, risk-stratification, and management". Am. J. Hematol. 91 (12): 1262–1271. doi:10.1002/ajh.24592. PMID 27870387.
  5. Bedekovics J, Méhes G (March 2014). "[Pathomechanism and clinical impact of myelofibrosis in neoplastic diseases of the bone marrow]". Orv Hetil (in Hungarian). 155 (10): 367–75. doi:10.1556/OH.2014.29823. PMID 24583557.
  6. 6.0 6.1 Le Bousse-Kerdilès MC, Martyré MC (October 1999). "Dual implication of fibrogenic cytokines in the pathogenesis of fibrosis and myeloproliferation in myeloid metaplasia with myelofibrosis". Ann. Hematol. 78 (10): 437–44. PMID 10550553.
  7. 7.0 7.1 Kuter DJ, Bain B, Mufti G, Bagg A, Hasserjian RP (November 2007). "Bone marrow fibrosis: pathophysiology and clinical significance of increased bone marrow stromal fibres". Br. J. Haematol. 139 (3): 351–62. doi:10.1111/j.1365-2141.2007.06807.x. PMID 17910625.
  8. 8.0 8.1 Reilly JT, Barnett D, Dolan G, Forrest P, Eastham J, Smith A (January 1993). "Characterization of an acute micromegakaryocytic leukaemia: evidence for the pathogenesis of myelofibrosis". Br. J. Haematol. 83 (1): 58–62. PMID 8435338.
  9. 9.0 9.1 Schmitt A, Drouin A, Massé JM, Guichard J, Shagraoui H, Cramer EM (April 2002). "Polymorphonuclear neutrophil and megakaryocyte mutual involvement in myelofibrosis pathogenesis". Leuk. Lymphoma. 43 (4): 719–24. doi:10.1080/10428190290016809. PMID 12153156.
  10. 10.0 10.1 Schmitt A, Jouault H, Guichard J, Wendling F, Drouin A, Cramer EM (August 2000). "Pathologic interaction between megakaryocytes and polymorphonuclear leukocytes in myelofibrosis". Blood. 96 (4): 1342–7. PMID 10942376.
  11. 11.0 11.1 Zahr AA, Salama ME, Carreau N, Tremblay D, Verstovsek S, Mesa R, Hoffman R, Mascarenhas J (June 2016). "Bone marrow fibrosis in myelofibrosis: pathogenesis, prognosis and targeted strategies". Haematologica. 101 (6): 660–71. doi:10.3324/haematol.2015.141283. PMC 5013940. PMID 27252511.
  12. Birgegard G, Samuelsson J, Ahlstrand E, Ejerblad E, Enevold C, Ghanima W, Hasselbalch H, Nielsen CH, Knutsen H, Pedersen OB, Sørensen A, Andreasson B (November 2018). "Inflammatory functional iron deficiency common in myelofibrosis, contributes to anaemia and impairs quality of life. From the Nordic MPN study Group". Eur. J. Haematol. doi:10.1111/ejh.13198. PMID 30472746.
  13. Chahdi H, Oukabli M (2018). "[A special form of pancytopenia]". Pan Afr Med J (in French). 29: 209. doi:10.11604/pamj.2018.29.209.14055. PMC 6080970. PMID 30100963.
  14. Tefferi A (December 2018). "Primary myelofibrosis: 2019 update on diagnosis, risk-stratification and management". Am. J. Hematol. 93 (12): 1551–1560. doi:10.1002/ajh.25230. PMID 30039550.
  15. Karigane D, Kikuchi T, Sakurai M, Kato J, Yamane Y, Hashida R, Abe R, Hatano M, Hasegawa N, Wakayama M, Shibuya K, Okamoto S, Mori T (July 2018). "Invasive hepatic mucormycosis: A case report and review of the literature". J. Infect. Chemother. doi:10.1016/j.jiac.2018.06.013. PMID 30057341.
  16. Finazzi G, Vannucchi AM, Barbui T (November 2018). "Prefibrotic myelofibrosis: treatment algorithm 2018". Blood Cancer J. 8 (11): 104. doi:10.1038/s41408-018-0142-z. PMC 6221891. PMID 30405096.
  17. Hofmann I, Geer MJ, Vögtle T, Crispin A, Campagna DR, Barr A, Calicchio ML, Heising S, van Geffen JP, Kuijpers M, Heemskerk J, Eble JA, Schmitz-Abe K, Obeng EA, Douglas M, Freson K, Pondarré C, Favier R, Jarvis GE, Markianos K, Turro E, Ouwehand WH, Mazharian A, Fleming MD, Senis YA (September 2018). "Congenital macrothrombocytopenia with focal myelofibrosis due to mutations in human G6b-B is rescued in humanized mice". Blood. 132 (13): 1399–1412. doi:10.1182/blood-2017-08-802769. PMID 29898956. Vancouver style error: initials (help)
  18. Pizzi M, Gergis U, Chaviano F, Orazi A (September 2016). "The effects of hematopoietic stem cell transplant on splenic extramedullary hematopoiesis in patients with myeloproliferative neoplasm-associated myelofibrosis". Hematol Oncol Stem Cell Ther. 9 (3): 96–104. doi:10.1016/j.hemonc.2016.07.002. PMID 27521149.
  19. Mohyuddin GR, Yacoub A (2016). "Primary Myelofibrosis Presenting as Extramedullary Hematopoiesis in a Transplanted Liver Graft: Case Report and Review of the Literature". Case Rep Hematol. 2016: 9515404. doi:10.1155/2016/9515404. PMC 4739215. PMID 26885416.
  20. Henry M, Chitlur M, Rajpurkar M, Mastropietro CW, Poulik J, Ravindranath Y (May 2014). "Myelofibrosis, hepatic extramedullary hematopoiesis and ascites associated with vitamin D deficiency in early infancy". J. Pediatr. Hematol. Oncol. 36 (4): 319–21. doi:10.1097/MPH.0b013e31828e548a. PMID 23619118.
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