Results
A total of 13 cases of MPNs associated with MG were identified. Twelve of them were males and only one female. The median age was 49 years (Inter-Quartile Range = 35.5 – 64.5). The first case was reported in 1961 and the latest one in 2020. Nine patients had moderate to massive splenomegaly, while physical examination findings were not mentioned in the other 4. The most common type of MPN associated with MG was CML (10 out of 13 patients). 2 patients had PV, and 1 had PMF. There were no cases of ET associated with MG. In most of the patients (8 out of 13), MG symptoms appeared after a diagnosis of MPN was made. Two patients had MG preceding the MPN, and three had them simultaneously. In patients diagnosed first with MG, the MPN was diagnosed after an average of 8 years, whereas in patients diagnosed with MPN initially, the onset of MG was after a few months. 77% (10/13) of the patients had either anti-AChR or anti-MuSK antibodies positive. All patients with simultaneous presentation of both MPN and MG had either positive anti-AChR or anti-MuSK antibodies. Most patients were treated with steroids and cholinergic agents for MG. Five of them underwent Thymectomy, out of which only four had radiologically or pathologically proven thymoma. All patients had satisfactory remission of MG symptoms. Among eight patients in whom MG occurred after treatment initiation for MPN, 6 had CML, and one each had PV and IMF. Two of them were treated with tyrosine kinase inhibitors (TKI) and two with busulfan; one each Hydroxyurea, interferon-alpha 2a, and autologous stem cell transplantation (ASCT). The case of PMF was untreated. The earliest reports were of 2 CML patients who developed MG after several years of treatment with busulfan. A summary of all cases of MPNs associated with MG is presented in Table 1 [14-25].