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The Pathologist / Issues / 2026 / March / Targeted NGS Streamlines Myeloproliferative Neoplasm Diagnostics
Oncology Precision medicine Omics Laboratory management Technology and innovation Insights Molecular Pathology Voices in the Community

Targeted NGS Streamlines Myeloproliferative Neoplasm Diagnostics

Kritika Krishnamurthy shares real-world experience on advanced MPN genomic profiling

03/18/2026 Future 7 min read

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Clinical Report: Targeted NGS Streamlines Myeloproliferative Neoplasm Diagnostics

Overview

Next-generation sequencing (NGS) enhances the diagnostic accuracy of myeloproliferative neoplasms (MPNs) by identifying driver mutations and co-mutations that influence prognosis and treatment. This approach is particularly beneficial in cases with low variant allele frequencies, where traditional PCR methods may fall short.

Background

The evolving landscape of MPN diagnostics emphasizes the need for comprehensive molecular characterization to guide treatment decisions. Traditional testing methods, while efficient, may overlook critical co-mutations that affect patient outcomes. NGS offers a broader genomic assessment, aligning with current guidelines that advocate for its integration into routine diagnostics.

Data Highlights

Remove placeholder text and summarize key qualitative insights from the source material.

Key Findings

  • NGS can detect low-level variants in oncogenic driver genes, enhancing diagnostic precision.
  • Approximately 90% of MPNs carry mutations in JAK2, CALR, or MPL, which are critical for diagnosis.
  • Sequential PCR testing may miss important co-mutations that could influence prognosis and therapy.
  • The NCCN guidelines recommend NGS for diagnostic and prognostic evaluation, especially in triple-negative cases.
  • Case studies demonstrated that NGS can alter the interpretation of disease biology compared to traditional PCR testing.

Clinical Implications

Incorporating NGS into MPN diagnostics allows for a more nuanced understanding of disease complexity, which can inform treatment strategies. Clinicians should consider NGS, particularly in cases with low variant allele frequencies, to avoid misdiagnosis and ensure appropriate management.

Conclusion

The integration of targeted NGS into the diagnostic workflow for MPNs represents a significant advancement in precision medicine, enabling better patient stratification and tailored therapeutic approaches.

References

  1. Blood Cancer Journal, 2020 -- Baseline VDJ clonotype detection using a targeted sequencing NGS assay: allowing for subsequent MRD assessment
  2. Blood Cancer Journal, 2017 -- The Mutational Profile Illustrates the Biological Spectrum of Plasma Cell Dyscrasias
  3. Blood Cancer Journal, 2020 -- Comparison of next-generation sequencing (NGS) and next-generation flow (NGF) for minimal residual disease (MRD) assessment in multiple myeloma
  4. Blood Cancer Journal, 2023 -- Prognostic Significance of NGS-Identified Measurable Residual Disease Following Initial Chemotherapy in Acute Myeloid Leukemia
  5. Hematology.org, 2025 -- Myelofibrosis draft recommendations for public comment
  6. Nature Medicine, 2025 -- Pelabresib plus ruxolitinib for JAK inhibitor-naive myelofibrosis: a randomized phase 3 trial
  7. Haematologica -- Pathogenesis and management of high molecular risk myeloproliferative neoplasms
  8. https://www.hematology.org/-/media/hematology/files/clinicians/guidelines/myelofibrosis-draft-recommendations-for-public-comment-20251017.pdf
  9. Pelabresib plus ruxolitinib for JAK inhibitor-naive myelofibrosis: a randomized phase 3 trial | Nature Medicine
  10. Pathogenesis and management of high molecular risk myeloproliferative neoplasms | Haematologica

This content is an AI-generated, fully rewritten summary based on a published scholarly article. It does not reproduce the original text and is not a substitute for the original publication. Readers are encouraged to consult the source for full context, data, and methodology.

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References

  1. Khoury, J.D., Solary, E., Abla, O. et al. The 5th edition of the World Health Organization Classification of Haematolymphoid Tumours: Myeloid and Histiocytic/Dendritic Neoplasms. Leukemia 36, 1703–1719 (2022). https://doi.org/10.1038/s41375-022-01613-1
  2. RH Zulkeflee et al., “Clinical and laboratory features of JAK2 V617F, CALR, and MPL mutations in Malaysian patients with classical myeloproliferative neoplasm (MPN),” Int J Environ Res Public Health, 18, 14 (2021). PMID: 34300032.
  3. National Comprehensive Cancer Network, “NCCN guidelines: myeloproliferative neoplasms” (2026). Available at: https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1477.
  4. X Liu et al., “A comparison of sequential polymerase chain reaction–based cascade testing vs next-generation sequencing in molecular profiling of myeloproliferative neoplasms: improving testing strategies in light of evolving molecular landscapes,” Lab Med, 56, 5 (2025). PMID: 40238187.

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