Classical Myelo-Proliferative Neoplasms emergence and development based on real life incidence and mathematical modeling

Mathematical modeling offers the opportunity to test hypothesis concerning Myeloproliferative emergence and development. We tested different mathematical models based on a training cohort (n=264 patients) (Registre de la c\^ote d'Or) to determine the emergence and evolution times before JAK2V617F classical Myeloproliferative disorders (respectively Polycythemia Vera and Essential Thrombocytemia) are diagnosed. We dissected the time before diagnosis as two main periods: the time from embryonic development for the JAK2V617F mutation to occur, not disappear and enter in proliferation, and a second time corresponding to the expansion of the clonal population until diagnosis. We demonstrate using progressively complexified models that the rate of active mutation occurrence is not constant and doesn't just rely on individual variability, but rather increases with age and takes a median time of 63.1+/-13 years. A contrario, the expansion time can be considered as constant: 8.8 years once the mutation has emerged. Results were validated in an external cohort (national FIMBANK Cohort, n=1248 patients). Analyzing JAK2V617F Essential Thrombocytema versus Polycythemia Vera, we noticed that the first period of time (rate of active homozygous mutation occurrence) for PV takes approximatively 1.5 years more than for ET to develop when the expansion time was quasi-similar. In conclusion, our multi-step approach and the ultimate time-dependent model of MPN emergence and development demonstrates that the emergence of a JAK2V617F mutation should be linked to an aging mechanism, and indicates a 8-9 years period of time to develop a full MPN.