ASCO 2026 | The optimal frequency and timing of NGS testing in MPNs

Yes, that’s a great question. I think as a field, we question this a lot. How often should we be doing next-generation sequencing for our patients? And next-generation sequencing is always performed at diagnosis and a lot of times at disease progression. So if someone has been responding to treatment and they either stop responding or the treatment is not working anymore, or if they were not transfusion-dependent and suddenly they start needing transfusions or their disease is progressing from the chronic phase of the disease of MPN to more of a blast phase or accelerated phase disease or from MDS to AML. So disease progression is when we perform the next-generation sequencing again. However, we’ve learned from precursor conditions like clonal hematopoiesis of indeterminate potential, where in some cases we might even be performing an NGS every year or every two years and applying that knowledge from precursor conditions. Although this still needs to be vetted further, my recommendation would be to do an NGS more often, whether yearly or every two years or even every three to five years, but to perform it in between as well, because unless we do an NGS, we won’t know how the clonal dynamics of the disease are changing over time. And given our study and multiple other studies that have shown that if there’s acquisition of new mutations, not just TP53, but other mutations like IDH1 and IDH2 can impact prognosis and can mean that the disease is being more aggressive and has potential for progression and can help guide decisions on treatment as well as allogeneic stem cell transplant.

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