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Experience and Expertise in Myeloproliferative Disorders
While most oncologists see only a few patients with myeloproliferative disorder in their careers, we see hundreds every month. This translates into a remarkable depth of experience and expertise, which we draw upon to give you personalized treatment.
Myeloproliferative disorder, or myeloproliferative neoplams, can be challenging to diagnose and treat, often requiring years of follow-up care and treatment. At MD Anderson, a team of experts, which may include hematologists, pathologists, advanced practice nurses and physician's assistants, as well as a specially trained support staff, plans your treatment for myeloproliferative disease by drawing upon the very latest advancements and therapies. It all begins with precise diagnosis by our specialized pathologists, who use advanced technology and skill to pinpoint the exact disorder.
Innovation and Research
At MD Anderson's Leukemia Center, you benefit from the most active research program in the United States. We have helped pioneer many advancements in MPD treatment, and we offer a wide range of clinical trials (research studies) of innovative treatments. The Department of Leukemia has established a Clinical Research Center for Myeloproliferative Neoplasia. This new research center will develop a comprehensive approach to understanding the biology of MPN through translational research on patient tissue samples, and work to find new, effective therapies for MPN.
Myeloproliferative disorders can strike at any age, and they have no known cause. They have a wide range of symptoms and outlooks. Sometimes the disease progresses slowly and requires little treatment; other times it develops into acute myeloid leukemia (AML).
To understand what happens to your blood when you have MPD disease, it helps to know what makes up normal blood and bone marrow. There are three major types of blood cells: red blood cells (RBCs), white blood cells (WBCs) and platelets. These cells are made in the bone marrow and flow through the bloodstream in a liquid called plasma.
Red Blood Cells (RBCs), the major part of your blood, carry oxygen and carbon dioxide throughout your body. The percentage of RBCs in the blood is called hematocrit. The part of the RBC that carries oxygen is a protein called hemoglobin. All body tissues need oxygen to work properly. When the bone marrow is working normally, the RBC count remains stable. Anemia occurs when there are too few RBCs in the body. Symptoms of anemia include shortness of breath, weakness and fatigue.
White Blood Cells (WBCs) include several different types. Each has its own role in protecting the body from germs. The three major types are neutrophils, monocytes, and lymphocytes.
- Neutrophils (also known as granulocytes or polys) destroy most bacteria.
- Monocytes destroy germs such as tuberculosis.
- Lymphocytes are responsible for destroying viruses and for overall management of the immune system. When lymphocytes see foreign material, they increase the body’s resistance to infection.
WBCs play a major role in fighting infection. Infections are more likely to occur when there are too few normal WBCs in the body.
Absolute Neutrophil Count (ANC) is a measure of the number of WBCs you have to fight infections. You can figure out your ANC by multiplying the total number of WBCs by the percentage of neutrophils (“neuts”). The K in the report means thousands. For example:
- WBC = 1000 = 1.0K
- Neuts = 50% (0.5)
- 1000 X 0.5 = 500 neutrophils
Also, when you receive your blood counts, this equation may be written as polys plus bands = neutrophils. Further, while anyone can catch a cold or other infections, this is more likely to occur when your ANC falls below 500. Your WBC count generally will fall within the first week you start chemotherapy, but it should be back to normal between 21 and 28 days after starting chemotherapy.
Platelets are the cells that help control bleeding. When you cut yourself, the platelets collect at the site of the injury and form a plug to stop the bleeding.
Bone marrow is the soft tissue within the bones where blood cells are made. All blood cells begin in the bone marrow as stem cells.
The bone marrow is made up of blood cells at different stages of maturity. As each cell fully matures, it is released from the bone marrow to circulate in the bloodstream. The blood circulating outside of the bone marrow in the heart, veins and arteries is called peripheral blood.
Stem cells are very immature cells. When there is a need, the stem cells are signaled to develop into mature RBCs, WBCs or platelets. This signaling is done with “growth factors.”
Myeloproliferative Disorder Types
There are several types of myeloproliferative disease. The main types are:
Primary Myelofibrosis affects the red blood cells and granulocytes, a type of white blood cell. The cells don't mature normally and are irregularly shaped. Primary myelofibrosis also causes thickening or scarring of the fibers inside bone marrow, which can decrease the production of red blood cells and cause anemia.
Polycythemia Vera (PV) is caused by the overproduction of red blood cells in the bone marrow, which then build up in the blood. Often, the spleen swells as extra blood cells collect there, causing pain or a full feeling on the left side. Itching all over the body is a symptom of PV.
Essential Thrombocythemia (ET) means that the number of platelets in the blood is much higher than normal, while other blood cell types are normal. The extra platelets make the blood "sticky," which slows down blood flow.
Chronic Eosinophilic Leukemia/Hypereosinophilic Syndrome (HES) is characterized by a higher than normal number of the white blood cells responsible for fighting allergic reactions and some parasitic infections (eosonophils). You may experience itching, swelling around the eyes and lips or swollen hands and/or feet. In some patients, HES may quickly progress to acute myelogenous leukemia.
Systemic Mastocytosis (SM) affects mast cells, which are found in skin, connective tissue and in the lining of the stomach and intestines. Mast cells serve as a sort of alarm system by signaling disease-fighting blood cells to target areas of the body where they're needed. They may also play a role in wound healing. SM is caused by too many mast cells accumulating in the body's tissues, which can eventually affect the spleen, bone marrow, liver or small intestine.
Myeloproliferative Disorder Risk Factors
Anything that increases your chance of getting myeloproliferative disease is a risk factor. These include exposure to:
- Intense radiation, such as a nuclear bomb
- Petrochemicals, such as benzene or toluene
- Electrical wiring
Many people with myeloproliferative disease have a mutation in the JAK2 gene. This gene mutation is acquired, which means you are not born with it.
Some cases of myeloproliferative disorder can be passed down from one generation to the next. Genetic counseling may be right for you. Learn more about the risk to you and your family on our genetic testing page.
Did You Know?
Many times, especially in the early stages, myeloproliferative disorder does not have symptoms. When it does have signs, they vary from person to person. If you have symptoms, they may include:
- Shortness of breath
- Easy bruising or bleeding
- Petechiae (tiny red spots under the skin)
- Unexplained weight loss
- Night sweats
These symptoms do not always mean you have myeloproliferative disorder or neoplasms. However, it is important to discuss any symptoms with your doctor, since they may signal other health problems.
At MD Anderson, we have extensive expertise in diagnosing myeloproliferative disorder, as well as the latest technology. Our hematopathologists are among a few in the nation who specialize in myeloproliferative disorders, giving them the knowledge to pinpoint your exact diagnosis.
Diagnosis of myeloproliferative disorder can be challenging. It often does not have symptoms in the early stages, and when it does they are often mistaken for signs of other diseases. A doctor must have a high degree of experience in MPD to make an accurate diagnosis.
If MPD is suspected, blood tests will be ordered. The blood test results can validate the suspicion, but a bone marrow biopsy may be required to definitively confirm the diagnosis.
Getting a Second Opinion at MD Anderson
The experts at MD Anderson are highly specialized in diagnosing every type of myeloproliferative disorder. We welcome the opportunity to provide second opinions for myeloproliferative disorders.
As one of the world’s most active centers for the care of myeloproliferative disorder, MD Anderson has a level of experience and expertise that can make a profound difference in your treatment. Our experts design your personal care plan specifically for you, drawing upon the most advanced options with the least impact on your body.
We are at the forefront of developing new treatments for MPD, including innovative drugs to improve blood counts. As one of the nation’s leading MPD research programs, we are able to offer clinical trials of investigational agents, while most other cancer centers do not.
Myeloproliferative Disorder Treatments
Myeloproliferative disorder is often challenging to treat, and it may require years of therapy and follow-up care. Treatments for MPD generally are aimed at controlling disease symptoms, and your symptoms will help the doctor decide which treatment is best. Therapies may include one or more of the following.
- Medications: Aspirin, hydroxyurea, anagrelide and interferon-alpha are the main medications for essential thrombocytemia and polycythemia vera. Thalidomide, steroids and other hormones, and cladribine and busulfan also may be used.
- Blood or platelet transfusion
- Growth factors, which stimulate growth of bone marrow cells, are given as injections under the skin and may benefit patients with low blood cell counts.
- Radiation therapy
- Surgical removal of the spleen