Clinical trial NCT06361641: Functional and Phenotypic Characterization of Monocytes in Myeloproliferative Syndromes
Official title: Functional and Phenotypic Characterization of Monocytes in Myeloproliferative Syndromes-PHEMOP
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: NA
Conditions: Myeloproliferative Neoplasm
Polycythemia Vera
Essential Thrombocythemia
Primary Myelofibrosis
Lead sponsor: University Hospital, Angers
Sponsor class: OTHER_GOV
First posted: 2024-04-12
Enrollment: 70
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: DIAGNOSTIC

Brief summary: Prospective study for functional and phenotypic characterization of monocytes in philadelphia-negative myeloproliferative neoplasms

Detailed description: Philadelphia-negative myeloproliferative neoplasms (MPN) are clonal disorders of the hematopoietic stem cell characterized by an excessive production of mature myeloid cells. MPNs are characterized by the presence of somatic gain-of-function mutations present in more than 80% of cases and affecting JAK2, CALR or MPL genes. These mutations lead to a constitutive activation of the JAK-STAT signaling pathway at the origin of cell proliferation.

MPN include polycythemia vera (PV), essential thrombocythemia (ET), prefibrotic primary myelofibrosis (pre-PMF), and primary myelofibrosis (PMF). Despite the classification of MPNs into distinct subtypes based on clinical and pathological features, the precise mechanisms underlying the phenotypic diversity within these disorders remain poorly understood. One aspect that has received limited attention is the role of monocytes and macrophages, key components of the innate immune system, in MPN pathogenesis.

Monocytes, circulating precursors of tissue-resident macrophages, play essential roles in inflammation, immune surveillance, and tissue repair. Upon recruitment to tissues, monocytes differentiate into macrophages with diverse phenotypes and functions influenced by local microenvironmental cues. Macrophages, in turn, exhibit a spectrum of activation states ranging from pro-inflammatory (M1) to anti-inflammatory or pro-repair (M2), with implications for various physiological and pathological processes. Recent studies have implicated monocytes and macrophages in the pathogenesis of MPNs. Circulating monocytes in MPN patients display altered functional characteristics, including dysregulated cytokine production and enhanced fibrotic potential. Additionally, monocytosis, an elevated monocyte count, has been identified as an adverse prognostic factor in MPNs, particularly in PMF.

Based on these observations, investigator propose that monocytes and macrophages contribute to the phenotypic expression of MPNs and that distinct phenotypic and functional signatures of these cells may be associated with different MPN subtypes. By leveraging available techniques for genetic and functional analysis, study team aims to elucidate the role of monocytes and macrophages in MPN pathogenesis and identify potential biomarkers associated with disease phenotype and prognosis. Through comprehensive characterization of these immune cell populations, investigator seek to gain insights into the underlying mechanisms driving the heterogeneity of MPNs and identify novel therapeutic targets for precision medicine approaches.

Eligibility criteria: Inclusion Criteria:

* Diagnosis of PV, ET, pre-myelofibrosis or primary myelofibrosis according to WHO 2022 criteria (including BOM for ET, premyelofibrosis and primary myelofibrosis)
* Patient who has not received treatment specific to hemopathy at the time of sampling
* Obtaining the signature of consent to participate in the study
* Patient having consented to be included in the "Malignant Hemopathy" collection of Angers University Hospital and in FIMBANK database

Exclusion Criteria:

* Person not affiliated to a social security scheme or beneficiary of such a scheme
* Patient with another hemopathy or another active cancer at the time of diagnosis
* Minor patient at diagnosis (\< 18 years old)
* Patient not capable or without agreement from the guardian or legal representative

Primary outcomes:
measure: WHO 2016 criteria for polycythemia vera, prefibrotic myelofibrosis, essential thrombocytosis and overt myelofibrosis diagnosis
timeFrame: Day 0
Secondary outcomes:
measure: Identify correlation between the monocytic signature and driver mutations (mutation in JAK2, CALR or MPL gene).
timeFrame: 24 months
measure: Identify correlation between the monocytic signature and the grade of fibrosis
timeFrame: 24 months
measure: prognostic value of the monocytic signature using a principal component analysis Response criteria according to Barosi et al., Leukemia, vol. 29,1 (2015): 20-6
timeFrame: 12, 24 months
measure: Prognostic value of the monocyte signature for disease worsening according to Sureau et al., Blood Cancer Journal, vol. 12,4, 56. 8 Apr. 2022
timeFrame: 24 months
measure: leukemia-free survival
timeFrame: 24 months
measure: myelofibrosis-free survival
timeFrame: 24 months
measure: Monocytes parameters for hematological progression
timeFrame: 24 months
Other outcomes:
Locations:
city: Angers
country: France
facility: GOUBAND Agathe
state: Maine et Loire
city: Cholet
country: France
facility: BESCOND Charles
state: Maine et Loire
city: Saumur
country: France
facility: TRUCHAN-GRACZYK Malgorzata
state: Maine et Loire
Study officials:
affiliation: University Hospital
name: Agathe GOUBAND, PharmD
role: PRINCIPAL_INVESTIGATOR
References: