{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T14:07:35Z","timestamp":1791295655348,"version":"4.1.0"},"reference-count":125,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2015,1,21]],"date-time":"2015-01-21T00:00:00Z","timestamp":1421798400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["American J Hematol"],"published-print":{"date-parts":[[2015,2]]},"abstract":"<jats:p><jats:bold><jats:italic>Disease overview:<\/jats:italic><\/jats:bold>Polycythemia vera (PV) and essential thrombocythemia (ET) are myeloproliferative neoplasms, respectively characterized by erythrocytosis and thrombocytosis. Other disease features include leukocytosis, splenomegaly, thrombosis, bleeding, microcirculatory symptoms, pruritus, and risk of leukemic or fibrotic transformation.<jats:bold><jats:italic>Diagnosis:<\/jats:italic><\/jats:bold>PV is defined by a<jats:italic>JAK2<\/jats:italic>mutation, whose absence, combined with normal or increased serum erythropoietin level, makes the diagnosis unlikely. Differential diagnosis in ET includes reactive thrombocytosis, chronic myeloid leukemia, and prefibrotic myelofibrosis. Janus kinase 2 (<jats:italic>JAK2<\/jats:italic>), calreticulin (<jats:italic>CALR<\/jats:italic>), or myeloproliferative leukemia virus oncogene (<jats:italic>MPL<\/jats:italic>) mutations occur in approximately 55%, 25%, and 3% of ET patients, respectively. The same molecular markers are also present in prefibrotic myelofibrosis, which needs to be morphologically distinguished from ET.<jats:bold><jats:italic>Survival and leukemic\/fibrotic transformation:<\/jats:italic><\/jats:bold>Median survivals are \u223c14 years for PV and 20 years for ET; the corresponding values for younger patients are 24 and 33 years. Life\u2010expectancy in ET is inferior to the control population.<jats:italic>JAK2<\/jats:italic>\/<jats:italic>CALR<\/jats:italic>mutational status does not affect survival in ET. Risk factors for survival in ET and PV include advanced age, leukocytosis, and thrombosis. Leukemic transformation rates at 20 years are estimated at &lt;10% for PV and 5% for ET; fibrotic transformation rates are slightly higher.<jats:bold><jats:italic>Thrombosis risk stratification:<\/jats:italic><\/jats:bold>Current risk stratification in PV and ET is designed to estimate the likelihood of recurrent thrombosis: high\u2010risk is defined by the presence of age &gt;60 years or presence of thrombosis history; low\u2010risk is defined by the absence of both of these two risk factors. Recent data consider<jats:italic>JAK2<\/jats:italic>V617F and cardiovascular risk factors as additional risk factors. Presence of extreme thrombocytosis might be associated with acquired von Willebrand syndrome (AvWS) and, therefore, risk of bleeding.<jats:bold><jats:italic>Risk\u2010adapted therapy:<\/jats:italic><\/jats:bold>The main goal of therapy in PV and ET is to prevent thrombohemorrhagic complications. In low risk patients, this is accomplished by the use of low\u2010dose aspirin and phlebotomy (hematocrit target &lt;45%) in PV. In high risk (for thrombosis) patients, treatment with hydroxyurea is additionally recommended. Treatment with busulfan or interferon\u2010\u03b1 is usually effective in hydroxyurea failures and the additional value of JAK inhibitor therapy in such cases is limited. Screening for AvWS is recommended before administrating aspirin, in the presence of extreme thrombocytosis. Am. J. 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