ASH Clinical News ACN_5.4_Full Issue_web | Page 7

You Make the Call: Readers’ Response
ON
and EDUCATI
was positive.
counts are
The patient’s
be done?
A JAK2 mutation confers a higher
tendency for thrombosis if the patient
is young. I would consider observation
in an older patient, with the presumed
development of a myeloproliferative
neoplasm or atypical MDS in the future. I
would also consider aspirin.
normal,
ma:
anything
for unclear
of this? Should
test on a patient
Clinical Dilem
significance
What is the
ordered a JAK2
reasons. It
mbolic events.
Another clinician
no thromboe
and there are
inion
Expert Op
Endowed
MD
Margaret Nugent
Josef Prchal, Nugent, M.D., and
Center
A.
The Charles Utah & Huntsman Cancer
of
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Professor
• Anemias
of indeter-
hematopoiesis However,
e of clonal
Our knowledg (CHIP) is still evolving.
increasing
minate potential
due to the
more data
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evaluation
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also revealed
, such as JAK2,
These
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who have no
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on presentati
have an increased that
family prevalenc JAK2, CALR, and
plasm (MPN)
do. These patients evidence suggests
with an increased characterized by
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risk of
Current
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with increased
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are associated While these are acquired
of cardiovas
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predisposition established if that is
studies also
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tion of
but follow-up
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Email us at
Crohn
managem
required therapy.
small bowel
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ashclinicalnews@he
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DISCLAIMER
March 2019
News
We asked, and you answered! Here are
a few responses from this month’s “You
Make the Call.”
To see how the expert responded, turn to
page 28.
Clinical Dilemma:
Another clinician ordered a JAK2 test
on a patient for unclear reasons. It was
positive. The patient’s counts are nor-
mal, and there are no thromboembolic
events. What is the significance of this?
Should anything be done?
I think you are obligated to perform a
bone marrow biopsy. And a CT scan to
look for splenomegaly.
Susan E. Wheaton, MD
Golden Valley, MN
1. Get a good clinical and family history.
2. Warn the patient regarding risk of
thrombosis.
3. See the patient once yearly for
monitoring.
Kelty R. Baker, MD
Houston, TX
Check complete blood count (CBC) every
six months. No other action is needed
unless there are significant changes in
CBC or a thrombotic event.
Majid Shojania, MD
Winnipeg, Canada
JAK2 mutation should not be present
in the normal population; it is a sign
of a hematologic condition but not
specific. It is more common in patients
with polycythemia vera or myelofibro-
sis but also can be seen in those with
myelodysplastic syndromes (MDS) and
leukemias. If counts are normal and
the patient is asymptomatic, I would
perform a general physical exam and
basic laboratories, including CBC, every
six to 12 months.
William Caceres, MD
San Juan VA Medical Center
Río Piedras, Puerto Rico
No treatment necessary. Prognostic
significance is unclear. I’d follow the
patient, including annual CBC, to see if
anything develops.
It is possible to see clonality without
disease. I would not do serial genetic
testing but would follow symptoms and
obtain routine bloodwork. I would also
consult with the physician who ordered
the JAK2 test.
Antoine Sayegh, MD
Roseville, CA
Alan Feiner, MD
Denver, CO
Russel Kaufman, MD
Durham, NC
See more reader responses at ashclinicalnews.org/
you-make-the-call.
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e program
Consult a Colleagu clinical
month’s
in
in the
patient.
, but we also
Each month
in a healthy
up to the expert’s
expert’s response
itive test results
answer matches
and post the
nce of JAK2-pos
see how your
s the significa
dilemma and
MD, discusse
Josef Prchal,
This month,
TRAINING
through the
ed
to next
question submitt in your response
e the Call we pick a challenging clinical
do. Send
You Mak
what you would print issue.
the Call,”
want to know
next
“You Make
Copyright © Loxo Oncology, Inc, 2018, All Rights Reserved. LMA-US-BTK-122018-00001
Imbruvica ® is a registered trademark of Pharmacyclics LLC and Janssen Biotech, Inc.
Calquence ® is a registered trademark of AstraZeneca.