{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T04:50:44Z","timestamp":1791348644609,"version":"4.3.1"},"reference-count":93,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"vor","delay-in-days":5,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    The diagnostic landscape for the Philadelphia\u2010negative myeloproliferative neoplasms (MPNs), particularly in distinguishing Essential Thrombocythemia (ET) from Polycythemia Vera (PV), is compromised. The gold standard for diagnosing PV\u2014measurement of red cell mass (RCM) by radioisotope dilution\u2014has been largely abandoned, leading to widespread misclassification. Thus, an estimated 30%\u201350% (varying by diagnostic center and testing practice) of\n                    <jats:italic>JAK2V617F<\/jats:italic>\n                    \u2010positive ET patients may, in fact, have \u201chidden\u201d PV, depriving them of the cornerstone PV therapy: phlebotomy. This diagnostic inaccuracy exposes a sizable patient population to an unfortunate high risk of life\u2010threatening thrombotic events. Concurrently, the management of established PV is suboptimal, often relying solely on hematocrit, a flawed parameter especially in iron\u2010deficient or hydroxyurea\u2010treated patients. This perspective calls for the revival and clinical implementation of the Carbon Monoxide (CO)\u2010rebreathing technique as a promising, rapid, and nonradioactive alternative for RCM assessment. Herein, we review the history of this methodology and discuss its potential to improve MPN care by ensuring precise diagnosis, guiding rational phlebotomy, and ultimately reducing thrombotic morbidity and mortality, while also candidly addressing the current evidentiary and practical limitations that must be resolved before clinical adoption, while also offering potential health\u2010economic benefits.\n                  <\/jats:p>","DOI":"10.1002\/cam4.72317","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T04:17:27Z","timestamp":1791346647000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["<scp>CO<\/scp>\n                    \u2010Rebreathing in Essential Thrombocythemia and Polycythemia Vera. A Revival of an Old Methodology to Improve Diagnosis and Phlebotomy Decisions"],"prefix":"10.1002","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3936-8032","authenticated-orcid":false,"given":"Hans C.","family":"Hasselbalch","sequence":"first","affiliation":[{"name":"Department of Hematology Zealand University Hospital  Roskilde Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2873-5928","authenticated-orcid":false,"given":"Morten Kranker","family":"Larsen","sequence":"additional","affiliation":[{"name":"Department of Hematology Zealand University Hospital  Roskilde Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5903-4092","authenticated-orcid":false,"given":"Lea","family":"L\u00f8ffler","sequence":"additional","affiliation":[{"name":"Department of Hematology Zealand University Hospital  Roskilde Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camilla","family":"Andersen","sequence":"additional","affiliation":[{"name":"Department of Hematology Zealand University Hospital  Roskilde Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0515-8432","authenticated-orcid":false,"given":"Isabella","family":"Davidsen","sequence":"additional","affiliation":[{"name":"Department of Hematology Zealand University Hospital  Roskilde Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2295-0422","authenticated-orcid":false,"given":"Mette Grymer","family":"Jensen","sequence":"additional","affiliation":[{"name":"Department of Hematology Zealand University Hospital  Roskilde Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6768-8695","authenticated-orcid":false,"given":"Jonas","family":"Bechlund","sequence":"additional","affiliation":[{"name":"Detalo Health Aps  H\u00f8rsholm Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6767-0226","authenticated-orcid":false,"given":"Lasse","family":"Kj\u00e6r","sequence":"additional","affiliation":[{"name":"Department of Hematology Zealand University Hospital  Roskilde Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0097-7826","authenticated-orcid":false,"given":"Vibe","family":"Skov","sequence":"additional","affiliation":[{"name":"Department of Hematology Zealand University Hospital  Roskilde Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3533-8098","authenticated-orcid":false,"given":"Henning Bay","family":"Nielsen","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care Zealand University Hospital  Roskilde Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carsten","family":"Lundby","sequence":"additional","affiliation":[{"name":"Center for Physical Activity Research, Rigshospitalet  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,6]]},"reference":[{"issue":"22","key":"e_1_2_10_2_1","doi-asserted-by":"crossref","first-page":"2168","DOI":"10.1056\/NEJMra1406186","article-title":"Myeloproliferative Neoplasms","volume":"376","author":"Spivak J. 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