Why Choose Montefiore Einstein for Classical Myeloproliferative Neoplasms Care?
The Montefiore Einstein Myeloproliferative Neoplasms Program is an internationally recognized leader, specializing in the diagnosis and management of the full spectrum of Philadelphia-negative, also known as BCR-ABL1-negative, classical myeloproliferative neoplasms (MPNs), including polycythemia vera, essential thrombocytopenia, myelofibrosis, chronic myeloid leukemia, chronic neutrophilic leukemia and chronic eosinophilic leukemia. At the forefront of academic research, education and clinical care, our multidisciplinary team of world-renowned hematologists, pathologists, geneticists, cardiologists, oncologists, obstetricians, gynecologists, surgeons and other specialists provide comprehensive and coordinated care tailored to the unique needs of each patient at locations in the Bronx, and the broader New York metropolitan area, including Westchester County and Hudson Valley.
Using a research-driven and personalized approach to diagnosing and managing MPNs, our team of doctors uses the most advanced diagnostics and treatments, from the latest in morphologic and molecular testing to modern targeted therapies such as Janus kinase (JAK) inhibitors, newly emerging therapeutics and stem cell transplantation when appropriate. Through our clinical trials, we are also able to provide patients with access to novel treatments not yet available to the general public. We are ranked in the top 1% of all hospitals in the nation for cancer care, according to U.S. News & World Report, and are an international referral site for the most complex cases.
We work as a unified team with our Montefiore Einstein Comprehensive Cancer Center, among the elite 1% of National Cancer Institute (NCI)-designated comprehensive cancer centers in the U.S. Dedicated to enhancing the patient care experience and improving outcomes, we provide a full range of services from prevention, diagnosis and treatment to social and support services, genetic counseling and education. As all subtypes of MPNs are associated with an increased risk for thromboembolic and bleeding events, patients are also regularly monitored for these potentially life-threatening complications.
We work closely with our Hemophilia Treatment Center—one of the nation’s premier destinations for clotting and bleeding disorders—and with our Thrombosis Prevention and Treatment Program—one of the largest programs of its kind in the nation. We are committed to providing the highest-quality patient-centered and compassionate care, reducing or eliminating excessive blood cell production, preventing MPN-related complications, relieving symptoms and improving the quality of life for each patient and each patient's family.
Your Myeloproliferative Neoplasms Program Team
Swati Goel, MD
Our multidisciplinary team of world-renowned hematologists specializes in the prevention, diagnosis and management of the full spectrum of classical MPNs, delivering comprehensive and personalized care. We are committed to optimizing outcomes, reducing or eliminating excessive blood cell production, preventing MPN-related complications, relieving symptoms and improving the quality of life for all patients and their families.
Advanced Diagnostics & Treatments for Classical Myeloproliferative Neoplasms
We offer access to the most advanced diagnostics and treatments for the prevention, early detection and management of all types of MPNs in adults and children.
We offer advanced hematopathologic testing with the latest hematologic, morphologic, genetic and genomic testing, including next-generation genomic sequencing to accurately detect mutations of genes such as JAK2, MPL and calreticulin, among others, to help inform the optimal management and prognosis of MPNs and facilitate precision care plans. We use the latest bone marrow aspiration and biopsy techniques and incorporate digital morphology and artificial-intelligence-driven assessments to enhance the accuracy and efficiency of identifying pathologic bone marrow and blood cells. We also use the latest human leukocyte antigen (HLA) typing techniques to ensure the best possible outcomes for patients who are candidates for allogeneic stem cell transplantation.
We rely on advanced imaging technologies, including venous duplex ultrasonography for the evaluation of deep venous thrombosis, as well as ventilation/perfusion scans and pulmonary angiography for the evaluation of pulmonary emboli. We provide supportive care measures such as transfusion support, and we regularly monitor patients to prevent, potential risks such as thromboembolic or bleeding events, acute leukemia transformation and cardiovascular complications and also detect them early and treat them.
Depending on the diagnosis, prognostic scoring and risk assessment, and the presence of associated symptoms, we offer a full range of personalized and targeted treatments that are individualized for each patient and based on the biology of each patient's MPN. These range from conventional treatments to the most advanced and newly emerging therapies to combined treatments. Some of the treatments we provide are:
- Low-dose aspirin
These treatments are designed to reduce the number or size of cancer cells and improve the effectiveness of further treatment or relieve symptoms.
- Tyrosine kinase inhibitors/JAK inhibitors:
- Ruxolitinib
- Pacritinib
- Fedratinib
- Chemotherapy:
- Hydroxyurea
- Busulfan
- Immunotherapies/Immunomodulators:
- Interferon alpha
- Anagrelide
- Therapeutic phlebotomy
- Innovative treatments to reduce itching in polycythemia vera
- Plateletpheresis, the removal of platelets from the blood for essential thrombocythemia
- Allogeneic hematopoietic stem cell transplantation
Leaders in Stem Cell Transplantation
As pioneers in bone marrow transplantation and cellular therapies, our Stem Cell and Cellular Therapy Program is accredited by the Foundation for the Accreditation of Cellular Therapy, providing a full array of transplant options, such as autologous, matched-related, matched-unrelated and haploidentical or half-matched transplants. Our stem cell transplant team specializes in allogeneic stem cell transplantation, which is currently the only potential curative therapy for MPN, particularly myelofibrosis.
We are one of the few hospitals in the U.S. to have an Organ Procurement and Transplantation Network member transplant histocompatibility laboratory. Our in-house American Society for Histocompatibility and Immunogenetics-accredited immunology lab offers state-of-the-art histocompatibility, immunology and immunogenetics testing, including the latest HLA typing, antibody and cross-match testing techniques. We also offer innovative desensitization programs for patients with high antibody levels and incompatible blood types. To ensure successful hematopoietic stem cell transplantation, we optimize graft survival with advanced immunosuppressive therapies and novel immune tolerance protocols.
At the Forefront of Managing Clotting Disorders
We use the latest available anticoagulation, antithrombotic and hemostatic reversal therapies and monitoring technologies for the prevention, diagnosis and management of the full range of clotting and bleeding events associated with MPNs.
Research & Clinical Trials for Classical Myeloproliferative Neoplasms
We are leading collaborative research and spearheading numerous studies and clinical trials, translating novel scientific discoveries into new diagnostics and treatments to help improve clinical outcomes and change lives. Through our clinical trials, we are able to provide patients with access to treatments not yet available to the general public.
Our researchers have made substantial contributions to the field. Some of our research focus is on investigating the outcomes of novel treatments for MPNs and related complications, developing new therapies for MPNs, studying genetic differences and socioeconomic determinants of myelofibrosis outcomes and exploring the translational application of immune modulation in stem cell transplantation.
We are exploring the treatment outcomes of antithrombotics in MPNs and recently published our findings. The results did not demonstrate a significant difference in recurrent thromboembolic or bleeding events in patients with MPN-associated thrombosis anticoagulated with direct oral anticoagulants (DOACs) and vitamin K antagonists. We also recently participated in an observational, multicenter international study—part of a European LeukemiaNet project—aimed at estimating the incidence and risk factors for thrombotic and bleeding complications in MPN patients with atrial fibrillation and venous thromboembolism who are treated with a DOAC in real-world clinical practice.
Our researchers were also the first to discover that stem cells engage in trogocytosis, which plays a role in regulating immune responses and other cellular systems. Researchers found that impairing the stem cell factor receptor (c-Kit) would prevent trogocytosis and lead to more hematopoietic stem cells being mobilized and made available for transplantation. This groundbreaking finding may boost the effectiveness and expand the use of stem cell transplants. Our researchers also demonstrated that signals from the sympathetic nervous system regulate hematopoietic stem cell egress from the bone marrow and that adrenergic nerves regulate their circadian release.
We also published real-world outcomes of ruxolitinib treatment for polycythemia vera and found that crizotinib has preclinical efficacy in Philadelphia chromosome-negative MPNs, suggesting that crizotinib should be investigated for the treatment of MPN patients. We recently published the final results of a phase 2 study of add-on parsaclisib, a PI3Kδ inhibitor, for patients with myelofibrosis and suboptimal response to ruxolitinib and found that parsaclisib reduced spleen volume and improved symptom scores when added to ruxolitinib for patients with myelofibrosis.
Our clinical research team ensures that patients have access to a robust offering of clinical trials through which they can access novel treatments not yet available to the general public. Some of the novel investigational immune-based and targeted therapies available are bromodomain and extraterminal motif (BET) inhibitors, targeted antibody-based therapy, CAR T-cell therapy and immune checkpoint inhibitors.
