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Primary Myelofibrosis (PMF) is a myeloproliferative disorder associated with  JAK2 V617F, Calreticulin ( CALR ) indels, and  MPL W515L/K mutations activating the tyrosine kinase JAK2 and its downstream signaling pathway. The nature of signaling abnormalities in primary cells from PMF patients is poorly understood, since most of the work has been performed in cell lines or animal models. By flow cytometry we measured constitutive and cytokine induced phosphorylation of STAT5, STAT3, and ERK1/2 in circulating CD34 +  cells from 57 patients with PMF (20 with prefibrotic-PMF) and 13 healthy controls (CTRLs). Levels of constitutive and TPO induced p-STAT5, and IL6 induced p-STAT3 were higher in patients than in CTRLs. Constitutive p-STAT5 values were lower in  CALR  than homozygous  JAK2 V617F mutated CD34 +  cells from PMF patients. Moreover, constitutive p-STAT5 and IL6 induced p-STAT3 values correlated directly with circulating CD34 +  cell number/L, and inversely with the frequency of circulating CD34 +  cells expressing CXCR4. Constitutive p-STAT5 values of CD34 +  cells were also inversely correlated with hemoglobin levels. When the patients were divided according with presence/absence of  JAK2 V617F mutation, all the correlations described characterized the  JAK2 V617F+ patients with prefibrotic-PMF (P-PMF). In conclusion, increased constitutive p-STAT5 and IL6 induced p-STAT3 values in circulating CD34 +  cells characterize patients with PMF. Constitutive p-STAT5 and IL6 induced p-STAT3 values correlate with circulating CD34 +  cell number/L, the frequency of circulating CD34 +  cells expressing CXCR4 and hemoglobin levels within the prefibrotic  JAK2 V617F +  patient population. Our data point toward a complex activation of STAT5-dependent pathways in the stem/progenitor cell compartment, that characterize the phenotypic diversity of PMF.

Constitutive STAT5 phosphorylation in CD34+ cells of patients with primary myelofibrosis: Correlation with driver mutation status and disease severity