Dr Chris Hillis is an assistant professor in the Division of Oncology at McMaster University and hematologist at the Juravinski Hospital and Cancer Centre.
Do you perform cytogenetic tests in every patient with a myeloproliferative neoplasm (MPN)?
Chris Hillis, MD, MSc: Actually we very rarely perform cytogenetic testing in these patients. The new guidelines from the World Health Organization (WHO) for the diagnostic criteria do require a bone marrow biopsy and aspirate for the diagnosis of all of the MPNs and it is tempting to send cytogenetics while you are doing the bone marrow aspirate. However, we are not certain how to action the results, particularly in essential thrombocythemia (ET) or polycythemia vera (PV), so I tend not to send it. Of course, if I am worried about progression in a patient, I do send cytogenetics at that time.
What about prefibrotic myelofibrosis?
That is a tough one because oftentimes when you are doing the test you do not know that the person has prefibrotic MPNs. It may be of research interest but I would not say it is of clinical interest at this time.