case_images: PMC11063320_01
case_images: Changes in the indicated haematological (A) and constitutional (B) symptoms over the indicated timeframe since the beginning of methotrexate treatment.
case_images: fmed-11-1285772-g001.jpg
case_images: PMC11063320_01_fmed-11-1285772-g001.jpg
case_images: fig1
case_images: At the beginning of treatment (month 0) the patient had haemoglobin (Hb) of 118 g/L, a white blood cell count (WBC) of 19.6 x 109/L, PLT at 522 x 109/L and splenomegaly of 19.1 cm length by ultrasound (Figure 1A). In addition, the patient recorded an MPN10 score of 25-scoring 7/10 for night sweats, pruritis and fatigue and 4/10 activity inactivity (Figure 1B). Over the course of the next 15 months, haematological values progressively improved with WBC reducing to 10.1 x 109/, PLT to 377 x 109/L whilst haemoglobin remained largely unchanged (Figure 1A):suggesting that MTX is not causing general myelosuppression. Spleen length reduced from 19.1 to 14.8 cm (Figure 1A):a change in length of 22% which equates to an approximate 47% reduction in overall spleen volume (assuming spleen diameter has decreased proportionally). MPN10 scores markedly reduced over the same timeframe with all reported constitutional symptoms consistently improving (Figure 1B). Molecularly, the mutant MPL variant allele fraction decreased marginally from 0.784 at diagnosis to 0.762 after 20 months of MTX.