Dr. Bose on Treating Progression in Patients With Myelofibrosis

Prithviraj Bose, MD, associate professor, Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, discusses treatment for patients with progressive myelofibrosis.

The revised International Working Group-Myeloproliferative Neoplasms Research and Treatment criteria released in 2013 provide insight on splenic progression and leukemic transformation, says Bose.

However, patients can progress in many ways. This makes treating patients with other symptoms of progression challenging. Patients who progress may have spleen growth, worsening symptoms, increased anemia or thrombocytopenia, elevated white blood cell counts, and go into accelerated blast phase, says Bose. These symptoms may present individually or in combination.

Though ruxolitinib (Jakafi) is the frontline standard of care for patients with myelofibrosis, many patients require an alternative therapy upon progression, says Bose. Notably, in August 2019, the FDA approved fedratinib (Inrebic) for the treatment of patients with intermediate-2 or high-risk primary or secondary (post-polycythemia vera or post-essential thrombocythemia) myelofibrosis. This may provide an option for patients who progress on ruxolitinib.