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Reply To: Assessment of Liver and Spleen Stiffness in Patients With Myelofibrosis Using FibroScan and Shear Wave Elastography

Reply To: Assessment of Liver and Spleen Stiffness in Patients With Myelofibrosis Using FibroScan... LETTER TO THE EDITOR was more pronounced in PMF patients than in Mariangela Giunta, MD Reply To: Assessment of Gastroenterology and Endoscopy Unit those with other hematological malignancies. IRCCS Ca' Granda Foundation - Policlinico Liver and Spleen Stiffness in In a second investigation, we specifi- Maggiore Hospital cally considered the role of LS and SS in Patients With Myelofibrosis 3 University of Milan 108 PMF patients. In this study, we had previ- Milan, Italy ously excluded any case of postpolycythemic Using FibroScan and Shear or postessential thrombocythemia MF, and Umberto Gianelli, MD Wave Elastography Hematopathology Service the histological confirmation of the clinical di- Division of Pathology agnosis of PMF for every patient included was Department of Pathophysiology performed by an experienced pathologist ac- and Transplantation cordingly to the World Health Organization University of Milan and IRCCS Ca' classification. In particular, liver and spleen Granda Foundation - Policlinico TE was successfully performed in 88 (81.5%) To the Editor: Maggiore Hospital of the 108 PMF patients, whereas the S-TE Milan, Italy t was with great interest that we recently results were indeterminate in the remaining Mirella Fraquelli, MD, PhD read the article by Webb et al concern- 20 (18.5%). The median liver-transient elasto- Gastroenterology and Endoscopy Unit ing the evaluation of liver stiffness (LS) graphy and S-TE values were, respectively, IRCCS Ca' Granda Foundation - Policlinico and spleen stiffness (SS) in 9 patients with 7.1 (range, 3.5–19.6) and 40.1 (range, 11.8–75.0) Maggiore Hospital myelofibrosis (MF) through FibroScan and shear kPa. By that study, for the first time, we dem- University of Milan wave elastography (SWE). In that study, the onstrated that SS can be used as a reliable, Milan, Italy authors considered 4 cases of postpolycythemic noninvasive, and repeatable surrogate marker Agostino Cortelezzi, MD MF, 4 of postessential thrombocythemia MF and for monitoring the bone marrow fibrotic pro- Oncohematology Division 1 additional case of primary MF (PMF), and gression of the disease during follow-up. In IRCCS Ca' Granda Foundation - Policlinico compared them with 11 cirrhotic patients addition, we were also able to measure SS Maggiore Hospital and 8 healthy volunteers (HVs). Accordingly, before and after treatment with ruxolitinib in University of Milan they concluded that FibroScan and spleen 3 patients, and the results showed that the im- Milan, Italy SWE have little ability to distinguish between provements in constitutional symptoms and patients with MF and cirrhosis, but they can spleen size were paralleled by a reduction in The authors declare no conflict of differentiate HVs from both patient groups. Fur- SS. Therefore, we suggested that this tech- interest. thermore, they also reported that FibroScan nique can also be used with the primary aim and SWE may serve as tools to evaluate the of facilitating the assessment of the responses response to specific MF therapy, such as anti- of PMF patients to innovative treatments with JAK2 treatment. JAK1/2 inhibitors (such as ruxolitinib), al- REFERENCES We would like to highlight the fact that though this needs to be confirmed by further 1. Webb M, Shibolet O, Halpern Z, et al. our center had already conducted 2 published studies involving larger numbers of patients. Assessment of Liver and Spleen Stiffness investigations on this topic. The first one fo- in Patients With Myelofibrosis Using Alessandra Iurlo, MD, PhD cused on the diagnostic accuracy of LS and FibroScan and Shear Wave Elastography. Oncohematology Division and SS in the prediction of liver fibrosis and por- Ultrasound Q. 2015;31(3):166–9. Oncohematology Unit of the Elderly tal hypertension in patients with chronic viral 2. Fraquelli M, Giunta M, Pozzi R, et al. IRCCS Ca' Granda Foundation - Policlinico disease. In this study, 132 chronic viral dis- Feasibility and reproducibility of Maggiore Hospital spleen transient elastography and its ease patients were compared with a control pop- University of Milan role in combination with liver transient ulation of 64 HVs and 48 patients with BCR- Milan, Italy elastography for predicting the severity of aiurlo@policlinico.mi.it ABL1 myeloproliferative neoplasms but no 2 chronic viral hepatitis. J Viral Hepat. 2014; significant hepatic comorbidity. In that study, Daniele Cattaneo, MD 21(2):90–8. we had not only gained insight into the use Oncohematology Division 3. Iurlo A, Cattaneo D, Giunta M, et al. Transient of spleen-transient elastography (S-TE) in he- IRCCS Ca' Granda Foundation - Policlinico elastography spleen stiffness measurements matological patients, but our attention was also Maggiore Hospital in primary myelofibrosis patients: a pilot drawn to the finding of a correlation between University of Milan study in a single centre. Br J Haematol. 2015; SS and bone marrow fibrosis (P < 0.01), which Milan, Italy 170(6):890–2. Ultrasound Quarterly � Volume 32, Number 3, September 2016 www.ultrasound-quarterly.com 317 Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Ultrasound Quarterly Wolters Kluwer Health

Reply To: Assessment of Liver and Spleen Stiffness in Patients With Myelofibrosis Using FibroScan and Shear Wave Elastography

Iurlo, Alessandra
Ultrasound Quarterly , Volume Publish Ahead of Print – Jun 22, 2016
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References (3)

Publisher
Wolters Kluwer Health
Copyright
Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
Subject
Letter to the Editor
ISSN
0894-8771
eISSN
1536-0253
DOI
10.1097/RUQ.0000000000000224
pmid
27331581
Publisher site
See Article on Publisher Site

Abstract

LETTER TO THE EDITOR was more pronounced in PMF patients than in Mariangela Giunta, MD Reply To: Assessment of Gastroenterology and Endoscopy Unit those with other hematological malignancies. IRCCS Ca' Granda Foundation - Policlinico Liver and Spleen Stiffness in In a second investigation, we specifi- Maggiore Hospital cally considered the role of LS and SS in Patients With Myelofibrosis 3 University of Milan 108 PMF patients. In this study, we had previ- Milan, Italy ously excluded any case of postpolycythemic Using FibroScan and Shear or postessential thrombocythemia MF, and Umberto Gianelli, MD Wave Elastography Hematopathology Service the histological confirmation of the clinical di- Division of Pathology agnosis of PMF for every patient included was Department of Pathophysiology performed by an experienced pathologist ac- and Transplantation cordingly to the World Health Organization University of Milan and IRCCS Ca' classification. In particular, liver and spleen Granda Foundation - Policlinico TE was successfully performed in 88 (81.5%) To the Editor: Maggiore Hospital of the 108 PMF patients, whereas the S-TE Milan, Italy t was with great interest that we recently results were indeterminate in the remaining Mirella Fraquelli, MD, PhD read the article by Webb et al concern- 20 (18.5%). The median liver-transient elasto- Gastroenterology and Endoscopy Unit ing the evaluation of liver stiffness (LS) graphy and S-TE values were, respectively, IRCCS Ca' Granda Foundation - Policlinico and spleen stiffness (SS) in 9 patients with 7.1 (range, 3.5–19.6) and 40.1 (range, 11.8–75.0) Maggiore Hospital myelofibrosis (MF) through FibroScan and shear kPa. By that study, for the first time, we dem- University of Milan wave elastography (SWE). In that study, the onstrated that SS can be used as a reliable, Milan, Italy authors considered 4 cases of postpolycythemic noninvasive, and repeatable surrogate marker Agostino Cortelezzi, MD MF, 4 of postessential thrombocythemia MF and for monitoring the bone marrow fibrotic pro- Oncohematology Division 1 additional case of primary MF (PMF), and gression of the disease during follow-up. In IRCCS Ca' Granda Foundation - Policlinico compared them with 11 cirrhotic patients addition, we were also able to measure SS Maggiore Hospital and 8 healthy volunteers (HVs). Accordingly, before and after treatment with ruxolitinib in University of Milan they concluded that FibroScan and spleen 3 patients, and the results showed that the im- Milan, Italy SWE have little ability to distinguish between provements in constitutional symptoms and patients with MF and cirrhosis, but they can spleen size were paralleled by a reduction in The authors declare no conflict of differentiate HVs from both patient groups. Fur- SS. Therefore, we suggested that this tech- interest. thermore, they also reported that FibroScan nique can also be used with the primary aim and SWE may serve as tools to evaluate the of facilitating the assessment of the responses response to specific MF therapy, such as anti- of PMF patients to innovative treatments with JAK2 treatment. JAK1/2 inhibitors (such as ruxolitinib), al- REFERENCES We would like to highlight the fact that though this needs to be confirmed by further 1. Webb M, Shibolet O, Halpern Z, et al. our center had already conducted 2 published studies involving larger numbers of patients. Assessment of Liver and Spleen Stiffness investigations on this topic. The first one fo- in Patients With Myelofibrosis Using Alessandra Iurlo, MD, PhD cused on the diagnostic accuracy of LS and FibroScan and Shear Wave Elastography. Oncohematology Division and SS in the prediction of liver fibrosis and por- Ultrasound Q. 2015;31(3):166–9. Oncohematology Unit of the Elderly tal hypertension in patients with chronic viral 2. Fraquelli M, Giunta M, Pozzi R, et al. IRCCS Ca' Granda Foundation - Policlinico disease. In this study, 132 chronic viral dis- Feasibility and reproducibility of Maggiore Hospital spleen transient elastography and its ease patients were compared with a control pop- University of Milan role in combination with liver transient ulation of 64 HVs and 48 patients with BCR- Milan, Italy elastography for predicting the severity of aiurlo@policlinico.mi.it ABL1 myeloproliferative neoplasms but no 2 chronic viral hepatitis. J Viral Hepat. 2014; significant hepatic comorbidity. In that study, Daniele Cattaneo, MD 21(2):90–8. we had not only gained insight into the use Oncohematology Division 3. Iurlo A, Cattaneo D, Giunta M, et al. Transient of spleen-transient elastography (S-TE) in he- IRCCS Ca' Granda Foundation - Policlinico elastography spleen stiffness measurements matological patients, but our attention was also Maggiore Hospital in primary myelofibrosis patients: a pilot drawn to the finding of a correlation between University of Milan study in a single centre. Br J Haematol. 2015; SS and bone marrow fibrosis (P < 0.01), which Milan, Italy 170(6):890–2. Ultrasound Quarterly � Volume 32, Number 3, September 2016 www.ultrasound-quarterly.com 317 Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.

Journal

Ultrasound Quarterly – Wolters Kluwer Health

Published: Jun 22, 2016

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