Next-Generation Sequencing in Myeloproliferative Neoplasms: Is This Indicated in All Patients?

PURPOSE OF REVIEW: To discuss the impact that next-generation sequencing has had on myeloproliferative neoplasm prognosis and treatment response. RECENT FINDINGS: Extended genetic testing has led to a more comprehensive understanding of the mutational landscape in the myeloproliferative neoplasms. More refined prognostic models that predict disease course have therefore been developed. In myelofibrosis, this has led to a more nuanced prognostic assessment which is a necessary tool for the identification of potential transplant patients. The extended molecular profile may also help set expectations for ruxolitinib response duration. In essential thrombocythemia and polycythemia vera, elucidation of the molecular landscape beyond driving mutations may identify patients at risk for more rapid progression. However, results from testing are less likely to lead to action, at least in the current era. Use of next-generation sequencing has become routine in myelofibrosis, as a means of identifying patients at highest risk for progression, who may be eligible for transplantation. Extended genetic sequencing is still investigational in essential thrombocytosis and polycythemia vera, and not recommended by guidelines.

Novel Therapies and Approaches to Relapsed/Refractory HL Beyond Chemotherapy.

Although Hodgkin lymphoma (HL) is highly curable with first-line therapy, relapses occur in approximately 10⁻20% of patients with early stage disease and 30⁻40% of patients with advanced stage disease. The standard approach for relapsed or refractory disease is salvage therapy, followed by consolidation with high dose therapy and autologous stem cell transplant (ASCT). Patients who achieve a complete response to salvage therapy prior to ASCT have better outcomes, thus recent studies have focused on incorporating newer agents in this setting. Major challenges in the management of relapsed patients remain how to choose and sequence the many salvage therapies that are currently available and how to best incorporate novel agents in the current treatment paradigms. In this article, we will summarize the most recent advances in the management of patients with recurrent HL and will mainly focus on the role of new agents approved and under investigation. Aside from brentuximab vedotin and checkpoint inhibitors, other novel agents and therapies are showing promising early results. However, at least with some of the newest targeted strategies, it is important to recognize that we are facing new challenges in terms of toxicities, which require very close monitoring and education of both the patient and treating physician.